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HomeMy WebLinkAbout20429-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERMIT (I'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK ^UTHORIZED) 20429 Z Permission is hereby grantgd to: . //__ / ,,~ ',~ · ~...~..,x'..~.,,.~.....~..zx~ ......... ~, ~..m,... ,o~o,.~ o, ....~.~....m~.~.....~../.... .................................................. ................................................. ......................................................................... County Tax Map No. 1000 Section ..... ./..~.~... ....... Block ......... Z ......... Lot No ......... ~.]. .... pursuant to application dated ...... ~ ...................................... , 19...~....~., and approved by the Building Inspector. Rev. 6/30/80 rOU~DATION (1st) '~OUN D A TI 0~'.! ( 2nd ) ~,OUGH FRAME & -PLUMBING £NSULATION FERN. Ye STATE ENERGY CODE FI;;AL THE NEW YORK BOARD OF FIRE UNDERWRITERS ~-~;f'; ~, I ~.~.~¢)~] BUREAU OF ELECTRICITY ~-- 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT o~y the electrical equipment ~ ~scrlbed below and int~uced by the applicant ~med on the a~ve application number in the prem~es of FIXTURE OUTLETS '? DRYERS FIXTURES RANGES OVENS EXHAUST FANS FLUORESCENT OTHEfi SYSTEMS NO. OF FEET E OTHER APPARATUS= HOTOR~6-I~ }{,P,~"t,O Il,P, S E R C NO, OF HI-lEG AWG. O~ HFLEG GENERAl, MANAGER This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. TNIS COPY OF CERTIFICATE MUST HOT BE ALTERED IN ANY MAHI~IERo I I 9. Size of lot: Front ...15.(2. :~.~. ........ Rear../.~-l~ ~.~.~. ......... Depth 10. Date of Purcha~ ' ..... ................. : .~::: ·: :'. .... :'.~: Name of Former OwneF -~'~.. i . 1 1. Zone or use district in which premises are situated ..................................................... 1 2. Does proposed construction violate any zoning law, ordinance or regulation: ~ ............................. 13. Will lot be reoraded ~/r~ o · -t v.~. ;. .......>- -....! ...... Will excess fill be re, moved from premises: .Yes I4. ,N, ame of Owner ofpremi,ses ~C,c~dCb..(~0t'][. · Address 13~ ~.~ot~tLfl.~ , Phone No ~..~- marne of Architect A/J/¢ Addre g~'g~'~).~ ..... - .............. "'' Nam ~ ~ ' [ '?'~' .................... ss ... t.. ~.. -t ......... Phone mo .......... e ox contractor AZ./t? .................. Address Phone N~ ' ..... 15. Is this property wa. thin 300 feet of a 'ti~'al wetlah'd'?'' '~('e's'.'.'.'.'.'.'.'.' }o. 1~'..."j.'.' ............. · If yes, Southdld 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 descriptio~ according to deed, and show street names and indicate whether interior or comer lot. lGo oo2.,oo /0% oo ;TATE OF NESV YORK, ?OUNTY OF ................. S.S - .................................................. being duly Sworn, deposes and says that he is the applicant (Name of individual signing contract) bore named. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 BOARD OF HEALTH ......... 3 SETS OF PLANS .......... SURV£Y ................... ClIECK .................... SEPTIC FORH .............. ~ ,~,~,....~ TEL.: 765-1803 Exami,hed ~/4 ........ 19.~..2.--- Approved ................ 1_... Permit No. ~ Disapproved a/c ..................................... (Buildiffg Ins~,dtor) NOTIFY; CALL ................... MAIL TO: APPLICATION FOR BUILDING PERMIT D te .... .... ,I9 INSTRUCTIONS a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 ;e*~s 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 ~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- za'tion. c. The work covered by this application may not be cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit Chail 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 ~hall 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. Fhe applicant agrees to comply with all applicable laws, ordinances, bt(~ code, housin~code, and regulations, ~nd to ~dmit afith6nzefl Lnspectom on premises and in building for necessary iU~'ti,0ns. V // (Signature of applicant, or name, if a corporation) · 7.7..7.. O.c r,..~... ~.~....../3..d..~x. ,: .~,. ~../.,././.~.79. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. N~ of owner of premises .f~..~.'-: .~-?r.~l..~...~...~..O. 6' .t.I .................. ................................ (as on the t,ax roll or latest deed) ~. If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No.. ~./~. .................. Plumber's License No..~J/~ .................. ~[hElectrician's License No../~/~ ................ Other Trade's License No ...................... ©CClJPAB6? I. Location of land on which proposed work will be done ....................... ' x .... ldz~p ' ~-k Xh-tl ...................... ,~.../:..o~/< ................. House Number Street Hamlet q~ [ ~'~/~ ~County Tax Map No. 1000 Section ./0. 2! . .1~".. ...... Block .~[!...~. ......... Lot .~.c~ .~i~ .... Subdivision .............. Filed Map No ............... Lot ............... (Name) -~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancyoo ! .,-, / ~ / ........... ": '" ' '''}' ''/~ TM 'J' ' ........... /..q,z~.~.~.~..o.~.e~.. i,.. ('.'. ~..Zt::/.'.'... b. Intended use and occupancy ..................':. ].. ~. ~." . ..... 3. Nature of work (check which applicable): New Building .... Addition .......... Alteration .......... ......... ~ ................. Other Work ............... Repair ..... Rem val , Demolition _~ ....... (Qescription) 4. Estimated Cost · .5 ..... Fee '. .... I t (to be paid on filing this application) 5. !! dwelling, number of dwelling ~n_its....A/././~ ........ Number of dwelling units on each floor..~.//fl .......... · n garage, number of cars '...~//--}' ............................................... ,/ ................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . A/.g ............ 7. Dimensions of existing stmcture~,if an,,' Front .. n .... ~ .... t~ · ~. F ., .............. txcar .............. LIep[n ............... · ,e~gm ......... Number of Stories Dimensions of same structure wilh alterations or additions: Front ................. Rear .................. ~Depth ..... .~ .............. i - Height .......... ., ........... Numbernf Stories ................... 8. tAmensions ot2entire new construction: Front.. a~,.~..~.~.~.... Rear. ~ ~ ~C'g.~'T. .... Depth . oO./~/. 9. Size of lot: Front ...}.~.~..~.~. ........ Rear./~/~. ~.6.~..~. ......... Depth c~..4'~..~. ......... 10. Date of Purchase ........... 4 ................. Name of Former Owner .................... 1 1. Zone or use district in which premises are situated ...................................................... 12. Does proposed construction violate any zoning law ordinance or regulation Y[]O ....... ~ ............. 13. Will lot be regraded · · ~.O ':.-' ~i ...... ~' '.-" :t ...... Wall' excess fill be re. moved from premises: .Yes 14. Name of Owner of pr,mi,scs ~C~e,~..(~o/~t'll. Address l'.St ~..u/~q../~.., . Phone No ~.].~ ~.'~/.~.g.~. Name of Contractor AJ~.,,/~. ~ ..... Aclcl.,-~,~ ~hA..,.. 15. Is this property w{th~n 300 feet of a tidal wetland* *y .... If yes, Southold T~wn 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 nprfiber or descriptiofl according to deed, and show street names and indicate whether interior or comer lot. NOT?i NOTIFY 765-1802 9 FOLLOWING 1. TWO REQI FOR POUf ~CRETE 2,_RO[JGH qG & PLU~ ALL N SHALL THE REQU~ OF THE COD~?S. N, ~PONSIBLE AT PM FOR THE IIRED BJNG ~itlS'r MEET ERGY FOR IUCTION ERRORS ;TATE OF NEW YORK, ~'0 UNTY OF ................. S.S (Name of individual signing contract) bev, named. ~ oooZ.oo Io7. oo .? being duly sworn, deposes and says that he is the applicant le is the ' ! (Contractor, agent, corporate officer, etc.) .f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements contain6d in this application are true to the best of his knowledge and belief; and that the ,'ork will be performed in the manner sdt forth in the application filed therewith. ,worn to before me this ........... ........ day 19. . .,. ........... ~ 0 e m New York (Signature of applicant) No. 4ffii2246, Suffolk County Term Expires June 12,