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HomeMy WebLinkAbout24369-z "NX NO. s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No24369 ZDate ............ .....,/.y.............................. Permission is hereby granted to: �!{�11..✓�......1.r.,......(.�!`..r�-r.�G�..I`1'/........,ri,./..�r.....��G'.,Q/1�,,�n/,.ff ro .../. Srf./ ........../.�''✓' ..... .F.� �A:..?:..F.l . .—,..........fT-^ ..... .,1..17.`T'`,7.......... C.. ..........r /. .........��' ........ 1�-, �....`.�.. r ................................................................................................................................................................ ......................................... ...................... ................................ ... ,............... at premises located at l ...........//............ .. ... ............ County Tax Map No. 1000 Section .... ..... Block ............Y..... Lot No. pursuant to application dated ...(rW� ................. 19. and approved by the Building Inspector. Fee $... .� ..................... ... ...... ....:.:..:1............................. uil ng Inspector Rev. 6/30/80 tlla.lL_Ilwl' " 'Gl1Ul1 RL`Cllit'{' o61'ti: ------•----Uut 11Ih:IiI fi_ ».. ------ -------- -- ---- ------ .------- 4 `n nlnllai r-nnnr. a y . PL111111 �ti(. ' f� in;;ul.nrinn PER it Y . , !;'I Avt null Tim r;nrn( rrnnt. _ All I•PIUII (;(1t ltii[lt'! t ----'-- --^�----»-- I,' ti•� � • D \ V• f" n v • r� `9 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNIDATION IST [ ] ROUGH PLBG. [ ] 6UNDATION 2ND [ ] INSULATION VJ/FRAMING [ ] FINAL [ ] FIREIPLACE & CHIMNEY REMARKS: DATE INSPECTOR 7GS-1802 BUILDING DEPT. INSPECTION ( ] FOUNDATION IST [ ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL ( ] FIREPLACE & CHIMNEY REMARKS: - . DATE �✓ /� INSPECTOR BOARD OF HEALTII FORM NO. 1 3 SETS OF PLANS A,... . . . . . . . . . . . TOWN OF SOUTHOLD SURVEY . . . r� AUG 131997 BUILDING DEPARTMENT CHECK . • -r4 . . . . . . . . . . . E b TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . . BLDG.DEPT. SOUTHOLD, N.Y. 11971 �.:T0WN0fS0UTHOLD TEL: 765-1802 NOTIFY: ��yy CALL :".7.�6./�. . . . Examined...... ' �L...., 19. .? •, ey _7_, MAIL TO: . . . . . . . . . . . . . . . . . . . . . Approved..... p L ..... 19.�!yPermit No. 4 �!./.G. .................................. Disapproved a/c .................................. ........................:......... ................................................... .. / .�-u . (Buil ng ns tor) APPLICATION PO BUILDING PERMIT nn 'Date. . 1. . .tt. . . . , INSTRUCTIONS 111 a. This application mast be completely filled in by typewriter or in ink and submitted to the Building Inspector e 3 sets of plans, accurate plot plan to scale. Fee according to schedule. ' b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining promises or public streets or areas, and giving a detailed description of layout of property must be drawn an the diagram which is part of this application. c. The work covered by this~application my not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS 11MM- MAL>C to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Inas, Ordinances or Regulations, for tine construction of buildings, additions or alterations, or for renewal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and i building for necessary inspections. ((Signature of applicant, or name, if a corporation) (Mailing address of applicant State wlother applicant is owner, ':lessee, agent, architect, engineer, general contractor, electrician, pludner or builth �mr> ,ras?DA/......1............ .. y.�.. �........................................... Nam of owner of promises ..t �4`n►�: �.4. '� L1�:�S lGl�rna.nn. .......... ........ ......... ......................... (as on the tax roll or latest deed) If applicant is a corporation, signature of thnly authorized officer. ......................................................... (Name and title of corporate offices) Builders License No. Plumbers License No. ......................... Electricians License No. ..................... Other Trade's License No. .................... I. Incation of land on which proposed work will be done.............................................................. 1 `X310..........�1'lic�.L.. 3MA,......... C�� ttko�lae .............. House Number Street Hanle-t-} County Tax Map No. 1000 Section.., 6%........ Block ...S ...... Lot ....qQo.. .... Subdivision ...................................... Filed Map No. ............... Loot ............... (Nano) 2. State existing use and occupancy of premises and intended use awl occupancy of proposed construction: a. Existing use and occupancy .............................................. b. Intended use and occupancy .... Q_, ............................... I. Vaihne of wotk (dteck w1iich applicable): New I4iildirig .......... AoWition .......... Alteration ..�... .. Itr:lchir ............ Rmil:,val .. ........... DenxiliLion ... ......... Other Woik ... ��-� (Description) 4 . list iurttegi (iisL :?0'.!.-W.. .......... fee .............................................. (lo lie paid on filing this application) 5. If tAAclling, txriier of dwelling urtitccssy . �. ......... Unirer of ilwel INig units ext each floor .. .!. .... ... .... !r If t age, tauter of cars .... ..Nher . ......................... G, if business, comercial or mixed occvparxy, specify nature six] extent of each type ��oyyf use....�I .......pp...... /. Diux:nsitins of existing stn Cones, if any: Froth. . .. !4-:�•.�tP .... Rear ......a��.:.I., Depth ......4.q :.4..,. It<ipliC ......................... Wtniter of Stories .......„-............ Dintensioos of Bare structure with alterations or :xklil.ions: Front .... '1?F:4., l2as�..�'."�F�`C'. Depth .................... lleigitt .. ...........,,..... Mrdier of Stories ............... it. Diltensions dfi entire new ccxrstrucLion: Front ... ............. !tear ............... Depth .............. Ilei(;1rt ......................... Ntniter of Stories ..................... 9. Size of lot.: Front ..........1...�.j........ Rear ....................+.. Depth .................... 10. Ikile of Purchase ... .-2�-a.�--. Rmle of Fonrer Owner ..•.-e'.1.. �'���1�" �� ��.77. U�4UllJ�.��.!":�.... . H. Zone or use district in uihich premises are situatell _r .............. ... 12. Does proposed construction violate any zoning law, ordinance or regulatioxt: ...:...,(x.[?............. 13. Will lot lie regrailed .......Ki;�........ Will excess fill be rcmrved from premises: YES 6) 14. Hanes of. (Mier of premises 14.111�IfrK�.S-.•./�1. ! f111lxklress .� AO.Ict.1.t �7aG�Il, /// Tigre of Architect: .�€?Yrjt_:.;i��.'skv ............ fvkiress .... .. h LLt-"" �9.,. fltone W. Nine of Csxitractor .t4? MI..Ve.�.�Y.+-!.S"f.._. Mires sMom W. 7T.3�� 15. Is this properLy within 3(X1 feet of a tidal wetlanl? * YES ...... .... a) .K..... *IF YES, S(XJIIrXD 3OIiN 911161Ix.S MINIT MAY 1% MX( JIRF.D. PLOT IMAGRAM lrx:ale clearly aril distinctly all buildings, ulielher existing or proposed, atxl inlicate all set-back dimensions frau property lines. Give street aril block rxnlier or description according to deed, and sltva street r><ares arxl intlicate t:ltellier interior or comer lot. SI'A'lli (X' NW Y(M' SS MINH (IF ....................... .......................................................... teiry; duly sworn, dcln:.es anti says that be is Ilse applicant (Hale of imlividtutl, signing ConLrnC0 nlxrve htaa!o1, lkis the ....... ............................................................................................ (Ccmtractor, agent, corporate officer, etc.) of said oxnier or owners, ging] is duly mithorimA to perforin or ]unve lwrforrn-ol the said work six] to nttrke arxl file Ibis application; that: all stalerents containta] in this applicatim gire !.otic to the lest of his knowledge mill Ixilief; mxl Ilial (.he work will lie performed in the uri ner set: forth in the app] kation f ixi therewith. SPiworn to before lle this (Sigiunlure of Apgili(anL) DON AhLPALIER "Pdlk8AQo dN wl Yo OaIB L °r,.."'M 4 t k 1' Y�'`, , * _ r«. �Y. .. ,j:F. :. .x.14 .,F..... '! �. .q_ .vy tpj 1e, E n, •• y l- 1 i, u t- "l ,f , � A i'+ i •145.-i,n- , i t� .ru "x. a , . ' .. .. f , i { 77 1 71 �r#�;,���'• SF k _ F'KAwr WFS'Tu�WLU VA'1len! vf' # e) 5 � 1 i I UNDERWFITT ERS CERTIFICATE - 1 r REQUIRED - _ L OCCUPANCY OR USE IS UNLAWFUL z j WITHOUT CERTIFICATE _ � r � = OF OCCUPANCY - � i 7Si r R h{ �if r< - f SZ 'CRL1' NOIMY m L 0 � ' .. TOYS rQ11��" owiw w row. - ae +MN UM C t A n N Au�oo� Mwu r» ' - THE MO N I MEXIM OR TM N.M. 1 _ STATE CONS IUC M MNOY' 10 CODES: NOT BEIMN/N1R fON DESIGN OR CONSTRUCTION,6tllQlli Lu C; it. ._ �. 1 I J1N ' __- ------- T1 I let __T1Ir[ PfC.[C'- "0.lot ,la J JaSY � ZW� l rw rir�. � t�a� � r+aKccw : • u�K ki < , I z I *II " :SzXIBuAu9� aluM : . 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