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HomeMy WebLinkAbout22939-z FORM NO.3 TOWN OF SOUMOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD,N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ................ 19... /.. ..........................., ........ [VP 22939 Z Permission Is hereby gra .... . �. ,..... :...�� ................ 4,, '.4 to .... .......... ...... ..........., /.. ........./��� ..... � r..... �✓......✓ '............��� ........ ........ .F................................ .............................................................................................................................................................. ................................................... ................................................. !....... ...-� h.. ..�d�:. ....:..... .� s ..... at premises located at............... 0.. 5.l r(... ..../..'.L. // .... ...: .::.....:.......................................... ........................................................ :4� ........, .... ' ........................... County Tax Map No. 1000 Sectlon ...../V��........ Block....... ....... Lot No. .....�f............... pursuant to application dated ...... . . .. ..../..7................... 19../�. and approved by the Building Inspector, crro Fee$.:�.....::"'.'.... Bu' Ing Inspector Rev. 6/30/80 N. BOARD OF HEALTH �JN p ,�ll 111 [; i 3 SETS OF PLANS . . . . . . . FORM NO. 1•�:'s, � SURVEY . . . . . . . . . . to 7 TOWN OF SOUTHOLD CHECK - • - - • . . . . . _ BUILDING DEPARTMENT SEPTIC FORM , , , , , , , , , , , , , ; TOWN HALL NOTIFY -�: . lJ;3 ' SOUTHOLD, N.Y. 11971p TC7v:YitS 's( uo't�}F)if7 �' TEL.: 765-1802 CALL -?(5: ./ t . • p/ MAIL T0 : Examined . . . . . 1 0, , , , , 19 .� Approved . . . . . /�0. 1 . ., 19Q" PermitNo. . : Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I (Buil to)pe or) APPLICATION 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 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 premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- 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 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 HEREBY MADE 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 Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, Ordinanssces, b ding code, housing ode, and regulations, and to admit authorized inspectors on premises and in building for neceary i _e' ctions �f?� . . . . . . . . . . . . . . . . . (Signature of a�v cant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, genera contractor lectrician, plumber or builder. 01, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .• ,( Y Name.of owner"gp'fenlises A LTJ . . . . P���.'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " t '.3= �.;.,,,t• =. (as on the tax roll or latest deed) If appliaanY is a corpoi m'h6h, si$+lralture of duly authorized officer. 'ty`t)V--o&5grP6rate officer) rl'Lt(COIrACI�; t ^`F1CIS1r�ESUFFOLK COUNTY LICENSED /. . . . . . . . . . . . . . . Plumbers'Yic�n� . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which propold work will be done. . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . I .$.$.5. .©. . . . . . . . . . . . . . . . . . . . . . . . .eT.. . . . . . . . . . . . . . . . . . . . . ! rb c . . . . . . . . . . . .. House Number Street Hamlet qy County Tax Map No. 1000 Section . . . . . . . t&1:: . . . . . . Block . . . b?. . . . . . . . . . . . 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 . . �?� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I b. Intended use and occupancy . . . o�. . . . . . . . . . . . . . . . . . . . . . . . . „ . . . . . . . . . . . . . . . . . . . . . . . . . . . . I 3. Nature of work (check which applicable): New Building . . . . ... . . . . Addition . . . . . . . . . Alteration . . . . . . , Repair . . . . . . . . . . . . . Removal . . . . . , . . . . . . . . Demolition . . . . . . . . . . . . er t or FaIC�.. . . !,�d (+DescripSion) 4. Estimated Cost . . •/�kl.i� : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . t�€ .'. . . . . . . . . . . . . . . . . Fee . ` 'to be paid on filing this application) 5. If dwelling, number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units on each floor. . . . . . . . .. . . . . . . . If garage, number of cars . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . . . ... . . . . . . . . . . . . . 7. Dimensions of existing structures, if any: Front . . . . . . : . : . . . . . . Rear . . . . . . . . . . . , , . Depth , . . . , . . . . . . . . . . Height . . . . . . . . . . . ., , , , , , , . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . , , . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . .l. . Height . . . . . . . . . . . . . , . . . . . , , . Number of Stories . S. Dimensions of entire new constr6ction: Front . . . . . . . . . . . . . Rear . . . . . . . . Depth Height Number of Stories . 9. Size of lot: Front . . . . . . . . . . .I. . . . . . . . . . .. Rear . . . . . . . . . . . . . . . . . . . . . . .Depth . . . . . . . . . . . . . . .... . . . . . . 0. Date of Purchase. . . . . . . . . . . .L. . . . . . . . . . . . . . . . . . Name of Former Owner . . . . . . . . . . , . . . . . . . . . . . . , . . . . . 11. Zone or use district in which premises are situated12. Does proposed . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded , , , te any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . . . . . . . . P • • • • • • • • • • . . . . . . . Will excess fill be removed from premises: Yes No 14. Name of Owner ofemi es. . .construction violate• . , . Address . . . . . . . . . . . . . . . . Phone No. . Name of Architect . . . . . . . . . . . . , . , , , , , • , • • , ,Address . . . . . . . . . . . . . . . . . . . Phone No. . r . . . . . . . . . . . . . . . . . Propertylocated w• t h • n " ' Address . . . . : . . . . . . Phone No. . . . . . . . . . . . . . . . 15. Is thise of Contraclor . • • • • " • • ithin 300 feet of a tidal wetland? *Yes . . . . . No " *If yes, Southold Town Trustees Permit may� be required. PLOT DIAGRAM Locate clearly and distinctly all (buildings, whether existing or proposed, and,indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lo�� lAAA N� 400 s I I ; f PPgf�VEDpS% 10�a-93y lr 0.0 pt 1 Opp' p6 p��M Oft uTM� l 141(.4) CE DAAFEE e1111,D1N0 qPM cCil?1CKkD�' t^Lr1C V �� "ot1�Z g ps E Of18: 106000O �• F�����tao. Mum" L 10N VU AWOf CON \ABMB ON * oliNTY OF . . . k. . o. . . . . . . QNB N CO . NATE OF F. .. .4031. S II,IS gTA a N a �� . a • ' • • • • • • • • ' • ' "• �� • . . . . being duly sworn, depose1 and says that he,is the applicant (Name of individual signing contract) ibove named. le is the . . . . . . . . . . . . . . . . . . . . . . 1. .'. (Contracto , agent, corporate officer, etc.) )f said owner or owners, and is duly, �uthorize perform or have performed the said work and to make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief;and that the ,,ork will be performed in the manner set forth in the application filed therewith. -worn to before me this . . . . . . . . . . . . . .dayof. �Tsv.l. . . . . . . .. 191.5 ;ota Public, . . . . . Count AW E112A8 ANN`dEVILLE G . . NotaryPubll StatepfN'-w York /(Signature of applicant) No.52-8125 50,Suffolk Coir Term Expires OctobeF 31,18__._ / N o 5' CL -� ` tP � P e\\ n FRANK MURPM' A P GARDEN CENTER R.p LOQ ' / 5• o �, OLD MAIN ROAD j' �< z o ,+K ti T 1, srw 1'+ o w c SURVEY OF y PROPERTY th AT MATTITUCK TOWN OF SOUTHOLD k SUFFOLK COUNTY, N. Y. 1000 - 122 - 07- al m� Scale: I"= 40' April 3, 1995 288.26" Zp' I X71 5 y�gBf g 84'42'10" W. V OLD MAIN ROAD :1FN ETZ it ME� VEY IS A VI OF SECTION 7209ANY AL TERA TINTHE TE'ADD1NEW YORK TION STATO TSTE EDOCA7701V LAWTrON ��,y EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTFIC4 'T/0.NS C�,�`l. N.Y.S. LIC. NO. 4961 B � HEREON ARE VALID FOR TWS MAP AND COPES THEREOF DAL F +' SMD MAP OR COPES BEAR THE WRESSED SEAL OF THE SURVEYOR C (Gyy EYORS, P.C. AREA = 3.00 Acres WHOSE s DNA r7 RE APPEARS HEREON Y5/$t 20 j ADDITIONALLY TO COW WITH SAID LAW THE TERM ALTERED BY' MUST BE USED BY ANY ANO ALL SURVEYORS UTAL2NS A COPY MAIN ROAD AN ASS ELEVATIONS ARE REFERENCED 70 OF ANOTHER SIDIVEYORIS MAP. TOW SUCH AS WSPECTED'ANO P � AN ASSUMED DATUM. WOUSHT'TO-DAT£'ARE NOT W COMPLIANCE WTIN THE LAW„ SOUTHOLD, N.Y. 11971 90 -168