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HomeMy WebLinkAbout20756-zTOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO-No. 20756Z Date / Permission is hereby granted to: .... ...t.:.~:..~.....z.o.~z. ....................................... ...~..~..~.~. ....... ....~..:./..: ......... ~./~ ........ ,o....~.o.~c~.~ ....... ~. ....... ~.~.::.......,L.~.-L.....~.... ......... ~ ........ ....,~..~..b..?~. ....... ,~, ........... ot prem,,s,oc ted ot....~..~ .................... ~ ...................... ~ ................. : .................................. .................................................... Z~.~Z~£.~. ...... ~/.'..., .......................................................... ................................................ ~..~.~.....~.~.,~.~ ........................................................ CounV/ Tax Map No. iOOO Section ...../....~..~'.. .......... Block .....,Q..~. ......... Lot No ......~ ............ pursuant to application dated ................... ~./..~...J.. ........................ , 19..~:~...Z~.., and approved by the Building Inspector. Rev. 6130180 G/~FFNE'f ROBERT d. ~ DOROTHY ANN ENOF.'RLE At' MATTITUCK 7OWN OF sOUTHOLD SUFF'OLK cOUNTY, N.Y. SCALE: I"= 40' JAN. 9, 1970 JAH. 19~ 1970 JAN 22, 1970 APR. 7~ 1970 · T©WN=OF SOUTHOLD ~ GUARANTI~EL) ro THE TITLE GUARANTEF CO ROBERT J. G DOROTHY ANN ENDERLE , .,,,,~.,,j~ ,,,..1. LAND SURVEYOR N. Y.S. LIC. NO, e87~.15 RIVERHEAD_LN_z_Y. Examined .... ~.~.~.'~ Approved ...... ¢.~: ' Disapproved a/c ........ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 ·.., 15) .~..2~ ·., 19.~.~TPennit No.~..~...o~.~... BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORH ................ NOTIFY CALL ..................... MAlL TO:~.~.~5~ ;Og~ . APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building I/~spector, 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 tltis appli- cation. c. The work covered by tkis 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 agy purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Depar~ment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk Coun{y, New York, and other applicable Laws, Ordinances or R~ulations, for the construction of buildings, a.d. ditions or alterations or'for/'emoval or demolition, as herein described. Th~ app icant agrees to comply with all applical~le laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary in,~pe~tions. (Signature of applicant, or name, if a corporanon) ' ?0 /Cox./ozv T. ....... ................................ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner ofpremises .... ~'~¢~..~....~...~.. ,2~).~./.~../'~../9... (as on the tax roll or latest deed) If applicant is a corporation, si~no2ture of duly authorized officer. ..... ..... ........ (Name and title of corporate officer) Builder's Ucense No .... ./0., .?.7.'?.. d.lr. ...... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work ~vill be done ............... ' //'-/CS co tc Ilouse Num her St reet, Hamlet County Tax Map No. 1000 Section ...... ./'.~..~. ...... Block .... .~OO... Lot. ~. Subdivision ..................................... Eiled Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Exist_agi use and occupancy ................... ~- ...... "*'. ~f(~?:~*~;%~[~.q.~:,at,~ ............... a. b. Intended use and occupancy ........ ~¢... C- .........~. .... / ~,~*~'1, } 'h ;,, .~'[ W~t,} ~ 3. Nature of work (check whict applicable): New Building .....' ..... Addition .......... Alteration,. ...... Repair .............. R6moval ............. Demo it on ....... Other Work~-. . ./~e.~.q .~ ..... 4. Estimate'd Cost ,. ~- ,,"C (Description) .......... i ......................... Fee ......... ' (t b id fill g thi appli atio ) 5 lfd~ elli Iii! it o e pa on n s c n b fd Ntmb fd ' 11' ' h fl · v ng, num ero we ngun s ............... ~ ero we mgunitsoneac oor .......... If gara=e, number of cars ~ .... 6 zfb i' ...................... cif d t of h typ f 7' us ness. commercia orm e occupancy, spe y nature an exten eac e o use ............. Di f ti t~ if Fr · mensionso exis ngstmc res, any: ont.., ............ Rear ............... Depth .............. Height ............ Nhmber of Stories . .. D~mens,ons of same structure! w~th alteratmns or add,Uonsl Front Depth ' Height ................. Rear ........... .................. i ........... Number of Stories ..... 8 Dimensions of entire new construction: Front ............... Height Number of Stories ............... Rear ............... Depth ...... 9 Sizeoflot: Front ' i ................. ~ ...................................... · · ........: ........ Rear 10 Date of Purchase Depth Name of Former Owner ' I I. Zone or use district In which premmes are situated ! 2. Does proposed construction violate any zoning law, ord hence or regulation: ... ' 13. Will 10t be regraded ...... , ........................ 'i ..................... Will,excess fill be removed from premises: Yes Nc 14. Name of Owner of premises . I ................... Address ................... Phone No ......... Name of Architect ........ ( Address Phone No. Name of Contractor ....... ! ........... . ........ Addres~ ...... ~ ....... Phone No. .,. ........ :.. 15.Is this property lo aced within~00 feet of a tidal wetland.* *YES .... NO .... ~If yes, Southold Tovn Trustees Permit may be required. .... PLOT DIAGRAM Locate clearly and distinctly ~1 buildings, whether existing or proposed, and. indicate all set-back dimensions frorr property lines. Give street and bloc number or deschption according to deed, and show street names and indicate whethe: interior or corner lot. APPROVED AS NOTED . NOTIFY BUILDIN~ 765-1802 9 AM ~ 4 PM FOR THE FOR POURED CONCRETE 2. ROUGH . FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRucTION MUST 6E COMPLETE FOR C O ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N Y, STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR D}~SIGN OR CONSTRUCTION ERRORS STATE OF NEW YORK. COUNTY OF .... 3'u .t'.~. L ~(~ .... .......... r/., .' ./.o.&... ' (Name of individual sign!ag con t~a'c'~i ......... being duly sworn, deposes and says that he is the applican} above named. lie is the ~ ' ' i (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul9 authorized to perform or have performed the said work and to m~e and file tliis PPbeaUon, that ail statements contained ~n this application are true to the best of his knmvledge and belief; and that the Work will be performed in the m~ner[ set forth in the application filed therewitli. Sworn to before me this , ' ........ ;-d~ of ~ ....... ., 19 Nota~ Public, nty .~L~ ~l~d in Guff~k ~ _~ (Signature of applic~t)