HomeMy WebLinkAbout23230-z FORM NO.3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD,N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMI UNTIL FULL
COMPLETION OF THE WORK AUT R ED) /�/J/!� /�/��/
Date................ .. . . ......,........•............ 19. 1�`�..
NR 23230 Z
Permission Is hereby gra e to:
. ....... .. .. �/ ....f9�r
to .... ... .. ....... r.�i. . .1.4. •r.....
Of-
............................................................................................. ........................... ...........
..........................
at premises located at..... .Q... ........ .........................4........................
...:................ ...
Q ............... ......................
County Tax Map No. 1000 Section .... .. .....<........ Block ........... ......... Lot No. ...
pursuant to application dated .................. .././................ 19....1.{G--, and approved by the
Building Inspector.
Fee $.... .
..... ...... .....�? ... .... ..............
Building Inspe r
Rev. 6/30/80
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WILLIAM H. PRICE, JR.
Attorney-at-Law
P.O. Box 2065
Greenport, New York 11944
Telephone Number: (516)477-1016
Fax Number: (516)477-0130
May 31, 1996
Southold Town Building Department
Southold Town Hall
Main Road
Southold,NewYork 11971
RE: 2074 BOURBON LANE, SOUTHOLD, NEW YORK
BUILDING PERMIT #232302
Gentlemen:
Please be advised that the project concerning the subject building permit has been cancelled.
Please refund my building permit fee of$75.00.
If you have any questions, please do not hesitate to contact me.
Very truly yours,
William H. Price, Jr.
WHP/lmt
828 Front Street,Greenport,New York, 11944
It IlA liD OF III:A I. I'll . . . .
'i `l i; rI ; n PLA N,'I . . . . . . .
FORM NO. 1 SURVEY
TOWN OFSOUTHOLD CHECK - - - - - - - - -
BUILDING DEPARTMENT SEPTIC FORM . . . . . . . . . . . . . :
TOWN HALL NOTIFY _
;OUTHOLD, N.Y. 11971 CALL,
p
TEL.: 765-1802 MAIL TO :
Examined . . . . . . . . ., I9
Approved . . . . . .c/. . . .�- . .> 19! ermit No. . . . . . . . .
Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . .r. . . . . . . . . . . . . . . . . . . . . . .
" — (Building Inspector)
JAN 4 11996 AP�' CATION FOR BUILDING PERMIT
._ Date . . . . . . . . . . . . . . . . . .. 19 . .
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with
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 premises or public stree
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app]
cation.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such perm
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 Occupant
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to ti
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances ,
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe(
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and 1
admit authorized inspectors on premises and in building for necessary inspections. (�
Qcu�,�XQr-S �hC.
(Signature of applicant, or name, if a corporation)
aQxl /l)i. . . . .5 w(t,,1, �v
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde
�ero�e.i Car
Name of owner of premises . . �, �kcf WL H. . 1;-t C e . r . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(as on the tax roll or latest deed)
If applicant is a corporation, signa ure of duly authorized officer.
�. . . . . . . . . . .�: - . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Name and title of corporate officer)
ALL CONTRACTOR' S MUST BE SUFFOLK COUNTY LICENSED
Builder's License No. . . .f. .ca5 3. . .K . . . . . . . . .
�I
Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . .
Electrician's License No. . . . . . . . . . . . . . . . . . . . . . .
i
I Other Trade's License No. . . . . . . . . . . . . . . . . . . . . .
i1. Location of land on which proposed work will be done. . . 2 : . . . . . S ur {S
. . . . . . . . . .
i
House Number Street Hamlet
County Tax Map No, 1000 Section . . . . . .` . . . . . . . . . Block 3. . . . . . . . . . . . . Lot . . . . !.
Subdivision . . . . . . . . . . . . . . . . . Filed Map No. . . :. . . . . . . . . . . Lot . . . .. . . . . . . . . . . .
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy . . . . .C?� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Intended use and occupancy . . . . . .� k . . . :(L) --. l. .. ..`" Ce
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . . . . . Alteration . . . . . . . . . .
Repair . . . . . . . . . . . . . . Removal . . . . . , . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . . .
(Description)
Estimated Cost . . . . . . . . . . . . . . . . . . . . . . . . . . Fee
(to be paid on filing this application)
If dwelling, number of dwelling units . . . . . . I . . . . . . . . Number of dwelling units on each floor . . . .r. . . . . . . . . . . .
If garage, number of cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If business, commercial or mixed occupancy, specify nature and extent of each type of use . . . ... . . . . . . . . . . . . . . . .
Dimensions of existing structures, if any: Front . . . . .%._3 . . . . . . Rear .�;_.3. . . . . . . . . . Depth .3S:?. . . . . . . . . . .
Height . Z ... . . . . . . . Number ofStories . . . . .Z. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dimensions of same structure with alterations or additions: Front . . .s.}. . . . . . . . . . . Rear . . . . . . . . . . . . . .
Depth . . . . . . . ?. . . . . . . . . . . . Height . . . . . `. . . . . . . . . . . . . . . . Number of Stories . . . .2�. . . . . . . . . . . . . . . . .
Dimensions of entire new construction: Front .,3.k .'. . . . . . . . . . Rear . .3b. . . . . . . . . . . Depth . Il . . . . . . . . . . . .
Height . . . . . . !?. . . . . . . Number ofStories . . . . . . 1. . . . * , * . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Size of lot: Front . . . . .1.00. . . . . . . . . . . . . . Rear . . . . :Z:��. . . . . . . . . . . . . Depth . `?.Q9.
Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Former Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Zone or use district in which premises are situated . 944r �14. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Does proposed construction violate any zoning law, ordinance or regulation: . . (KO. . . . . . . . . . . . . . . . . . . . . . . . . . .
Will lot be regraded . . . . .1Yi? . . . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes 0
Name of Owner of premises w,16n-I . Pr4 . . . . . . . Address . . eq-, S.� �DJU� ' :sy ?
. . Phone No. 7.Fz b
Name of Architect ���! !: �W w . . . . . . . . . Address t3 . .-}�I. . .�«yy t. Phone No.q.7?
Name of Contractor 1>s . .FSw+IAs ?. . . . . . . . . . . . Address &X' (111, , ,� tt�(, , Phone No.7kS;ZC.7?
Is this property located within 300 feet
yy__of a tidal wetland? *Yes . . . . . No ,C.<
*If yes, Southold Town Trustees Permitmay
be required.ed.
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
perty lines. Give street and block number or description according to deed, and show street names and indicate whether
-rior or corner lot.
..See
ATI OF NEW YORK,
itiNT1'yt�Fp. . . . . . '. . . . . . . . . ... S.S
!� . . . . . . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
we named.
isthe . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Contract,,,,) agent, corporate officer, etc.)
said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
plication; that all statements contained in this application are true to the best of his knowledge and belief;and that the
irk will be performed in the manner set forth in the application filed therewith.
orn to before me this
. . . . . . . A7C, . . . . . . . .day of . . .(/ X�uc���. . . . . .. 199.0
Mary Public, . . . . . . . . . . . . . . . . . . . . . County
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LWDAJ.COOPER / . . . . . . .
Notary Public,State of Now Yofk (Signature of applicant)
No.4822563,Suffolk County
Term Expires December
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IUO+dY BUILOUNG OF Al' „ ','„, t,t Ir
766 190 4 AM TO 4 I4 FOR THE i^ •• x 7 _ rFln<., I��I' '(/ \
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ALI, La1 GiRLI( YION SHALL MEET
THF PFOUIREMEN1S OF THE N.Y. J
STP.'E CONSTRUCTION & ENERGY -r
COOFS. 610T RESPONSIBLE FOR
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PLUMBING
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ALL PLUMBING WA E /` (,(i/7�i/yq �-- —� -
&WATER LINES NE RI / i.uS e- I-t ���� testi ^N CohtFri nY.CG4=vCt yr Aa Pur, ern
TESTING BEFOfi COV INC W�YrFk.aN VAN'TU'I�, eC. NIFYh,r1c;� 0
PLU BER CF_RTIFICATI N
ON L pD CONTENT BEFORE
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SO DER USED IN WAT
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for water distributin SU LY SYSTEM CANNOT II �'-o" I Iwlo e0.f,hiG rx
system; piping shall e o r;r' - - - - - -- - r-Grovlly n1V. )
of types K or L onl EXC ED 2110 of I% LEAD cr - Y ' ' ,r ,�
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N O T E S
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+I g 1 Contractor(s) shall furnish and Install all material and equipmenl } ;fv rr Phu 1rf h t -r-I raC' "'ri , I
� shown, listed or described on the drawings, subject to qualifications
- ___ -ir- T 4 � conditions or exceptions as noted Contractor shall l irnizh all labor, t� i
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scaffnlCln_I and tools necessary to complete the work IO
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I -- - -- I 1. All work shall conform to all applicable Federal Spate. and lural rI,N-1h<li 1"n! <R hPH'�.rJJ=01x-
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5 construction and shall report any discrepancies to the Architect before
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W-h Ivl.hllk iiaI�N�v+l ,v, Fy*c.,p.v�a 1 existing ork and/or the installation of new work
/ patching required
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til All newworkl>hall th itch and eat flush to erisiinq work aw a rLAf �
�i It c o$aly as possible unless otherwise noted
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wee ZoraG Ys111;x +. d All materials shall be installed in strict confonnanc:. w:tl,
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I '' Z r Provide all labor, materials equipment and services and 3O date. scale.
perform all operations required for complete mstallati,n of work .3, h,3p, q I�ai'_VLp h
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`0 8 Drawings are not to be soiled
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certificate flcate of occupancy and inspection ur
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