HomeMy WebLinkAbout19974-zFOUNDATION ( ls t)
FOUNDATION
2.
(2nd)
ROUGH FRAME &
.FLUMBING
INSULATION FERN.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
LVOIL~ NO, ~
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)
19974 Z
Permission is hereby granted to: ~
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~....~ ....... ~.....~~~,~ .......................................................
~"~=1 '~ ' :':.Ecr"~"77"'~"~T ........ L ', ' ' \.._."'"'~' ~ ........
a~'premises located at ....~.:~..~..........~ ~..~...~ ................ ~...~-.~..~ ..................
Coun~ Tax ~ap ~io, ldO0 S..on ...... ..~.E~ ...... mock ....~..~. ......... Lot No.....~:..!..~ .........
pursuant to application dated ......... d..~l~L.....l...~ ..............., ]9..cJ..j.., and approved by the
/
Building Inspector.
Rev. 6/30/80
,j',' JUN I 9 1991 TOWN OF $OUTHOLD
BUILDING DEPARTMENT '
~ ' TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765'1802
Approved ..'~ Aam'~. ~ ~.., 19 .~!. Permit No. [ .C~ .~ .~..~..~.
Disapproved a/c .... . ..........................
................................
* (Building Inspector)
, APPLICATION FOR BUILDING PERMIT
BOARD OF HEALTH ......
SURVEY .... ?-'$<~ · - -~- · ·
::
C,IECK ..... ~.. X~.5.7... -
S~T~C Fo~, -~ .........
MAIL TO:
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 tiffs 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
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, ordinances, building code, housing code, and regulations, and to
admit auth°rized inspect°rs °n premises and in building f°r necesi~ .W.~~.. ~..~A .,fi~......~ ........... :...
- (Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engiiieer, general contractor, electrician, plumber or builder.
.............. ....
Name of owner of premises..-~...~.. !~.~.~ .~.b.~.~. ....... .~.'~..'~ ........................................
(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...c~.l.~. ~ .............
Electrician's License No....~0.0. '
Other Trade's License No ......................
1. Location of lando~_~_~.2°n which proposed~..~ ~L]~ .~..w;l~w-il'Lb¢ done .................................................. .o..~..~ .~. (~. l.~. (~...C,~...
............................. ~'~/~'~ri~t ..........................
House Number Hamlet
Coun, Ta MapNo.,000Sect,on .2.2. B,ock Lo,
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 occupancy .....................................................................
b. Intended use and occupancy ................... I .... l.~./.(~. './ ....... {id -./[~_~j~/{.P
3. Nature of work (check which applicable): New Building ....... Addition .......... Alteration ...........
Repair .............. Remoyal .............. Demolition .............. Other Work ...............
/ (Description)
4. Estimated Cost. , Fee .....................
(to be paid on filing this application)
l
5. If dwelling, number of dwelling uinits .............. Number of dwelling units on each floor ................
If garage number of cars ' '2'
6. If business, commercial or mixedioccupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing structuresi if any: Front ......... . ...... Rear .............. Depth ...............
Height ............... NumBer of Stories ........................................................
Dimensions of same structure with alterations or additions: Front ................. Rear ..................
Depth ..................... i. Height ...................... Nurober of Stories .....................
8. Dimensions of entire new construction: Front ..... (.a.t{'J ......Rear .. (~. .......... Depth . .~,~'7.-2~ .......
Height ...g.~. ........ Num6er of Stories.........'7---- ....... , .......................................
9. Size of lot: Front . . t,~-.S"' . . .i Rear [~--~-~....'. Depth .~-. ..................
Date of Purchase Name of Former Owner
11. Zone or use district in which preroises are situated .....................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: .... ., .................
13. Will lot be regraded ............................. Will excess fill be removed from premises:~ Yes No
14. Name of Owner of premises ..... ! ................ Address ................... Phone No .................
Name of Architect .......................... Address ................... Phone No ................
Name of Contractor ........................... Address ................... Phone No ................
15. Is this property within 300 feet of a tidal wetland? *Yes ........ No .........
*If yes, Southold TOwn Trustees Permit may be required,
PLOT DIAG P-.AM
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 descriptioh according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF NEW YORK,
COUNTY OF ................. S4S
.............................. ' ................. being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the ....................... :'. ................
' (Contractor, agent , corporate officer, etc . )
of said owner or. owners, and is duly lauthorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
..................... day of. ............. ID
'
........... County,
Notary Public ........ i ' ~ ~/~
HELEN K. DE VOE ~ *
NOTARY PUBLIC, State of New Ymk .... ~ .......................................
fie. 4707878, SuffollL CounP¢., ,-, (Signature of applicant)
Term Expires M~rch ~0,19~
8iNGLE FAMILY DWELUNG ONLY
EXPIRES ~0 Y~RS"FROM ~TE OF APPROVAL APE ~
HEAl I'H
SU~
JEFFREY ~ATZ ~ ~A~Y ELLEN GATZ
~UFFO~K COUNTY D~ARI~[N1 OF N~tl~ ~ LOT NO. I~, "HONEYSUCKLE HILL$"
~T ~ATTITUC~ D~T[: APR. ~,1~1
~O~ APPROVA~ OF CONS?~CTION ON~ ~N ~ 8OUT HOLD $C~L[~ I"~O'
NEW Y .K ST&T[ [~C&TION ~AW
--,-~.o,~ ~x~ k~ s,.~, xx ,VGG I~ YOUNG YOUNG
,.~G ~2~-00~ ~ RIVER~AO, NEW YORK
NOTE: ~ = STAKE ALDEN W.YOUNG, PROFESSIONAL ENGINEER
SUBDIVISION MAP FILEDIN THE OFFICE OFTHECLERKOF
SUFFOLK COUNTY ON OCT. ~6) 1981 AS FJLE NO. 7019. AND LANO SURVEYOR N Y.S. UCENSE NO 1~845
HOWARO W. YOUNG~ LAND SURVEYOR
t~ L~ ~ ~L(Wi, K~IC TANK(ITII C[~l(~) WN ~[~ N.Y,S, LICENSE N0.45893