HomeMy WebLinkAbout19307-z rossx xo. s
TOWN OP SOUTHOLD
Rl)ILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
{ COMPLETION OF THE WORK AUTHORIZED)
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Permission is hereby granter
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` at premises located at t3.fT.n Q!-~'1A,..
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County Tox Map No. 1000 Sectio ..~.~c.~........... Blcek ~ Lot No..~:.a
pursuant to application dated ..h,:!~~....~ 19.~/..U.., and approved by the
k Building Inspector. 1
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4 Fee 3r~~r
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Building Inspector
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Rev, 6/30/80
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D ~ BOARD OF HEALTH
r 3 SGTS OF PLANS .
f ~ FORM NO. 1 SURVEY
Yr ~ _ TOWN OF SOUTHOLD CAECK • •
/~W BUILDING DEPARTMENT SEPTIC r•oRrt
' TOWN HALL
I3LAG.t7EP7. SOUTHOLD,N.Y.11971 NOTIFY
TOWNgFSOUTNC39_p TEL.:7G5-1802 CALL
M!o~...7.., 19 4.Q MAIL T0 : .
Gxamincd '
Approved h„°Q' ...L 1989. Pennrt No. ?..Z-`
DisaPProveda/c
. O,.c c.9, w....~•,~, ou-.tom-:--
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date 19 -
INSTRUCTIONS
a. Tlris application must be completely filled in by typewriter or in irzk 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, ordinances, building code, housing code, and regulations, and to
" admit authorized inspectors on premises and in building for necessary inspections.
, , ,~,gc%JoNy~p w~nllwaiL?~.nJr„ G.o.~i°, ,
(Signature oi' applicant, or name, if a corporatron)
........h.'°.'~.....°.aN.'.°. moo„ o !.rvr~.! 1.. .
(Mailing address of applicant) •
State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises C .?-!7,x€.5.,. '9,`!/.i2,,1?i~! :4°'• v ti ~ .
, „~,;•;G;.,;~-~ ,(~s on the tai roll or latest deed)
If applicant is a corporation,~sign3~'tur'd'of~lli"("y~~uth`~`ri'z o~li~cer.
/ ~6 's"tC~~S"t';39 ~8i1y'a,',9~~f~.3J ?61'~;P
(Name and title~of'cb'~3~e 1Stf3oer~~'1 ~ftl~°a _
Builder's License No. , /.-r. ,T ...~.h!. l.... .
Plumber's License No . .
Electrician's License No . .
Otfter Trade's License No . .
1. Location of land on which proposed work will be done. °...l-~'.9 •Y, , , , , , •C'}~•!;~..v
house Number Street, ~ Hamlet
County Tax i11ap No. 1000 Section ~•7• • • • • • • • • Block Lot .
Subdivision Filed flap No. Lot - .
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
e
a. Existing use and occupancy P!.G t~. K F•'~•%~`.C~" . .
a;2v t • ,rsY,~ '
b. Intended use and occupancy
_.r.pw{q" Rte" f y. f
Addition ........r~~ f ;»~Al~~~ iS,
• • . • • ' , , R applicable): New Building •'j • • • • ' •
3. Nature of work (check whic
Re air ~movat Demolition (t 1V '`~"+T•
p ~ ; ~~f5~ ~ ^ °1 t• . .
(c,~scription)
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4. Estimated Cost ........5, :'k?: . . Fee _ .
(to be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor .
Ifgaragc,numbcrofcars ..1
6. If business, commercial or mjxed occupancy, specify nature and extent of each type of use .
Dimensions of existing structures, if any: Front . Rear , , Depth .
Height ...............N,umbcrofStorics...............,,......................................
Dimensions of same structure with alterations or additions: Front Rear , .
Depth . 1 Iicight , .....................Number of Stories , .
8, Dimensions of entire new construction: Front Rear ,Depth .
Hciglrt . . . .........Number of Stories , .
9. Size of lot: Front Rear . Depth .
10. Date of Purchase . ..Name of Fottner Owner ,
I ] • Zone or use district in which premises are situated . . . .
p p ~ violate any zoning Saw, ordinance or regulation :
12. Does ro ose~d consptruction v, Will excess 611 be removed from premises: ,Yes Nc
13. Will lot be re raded . ,
14, Name of Owner of remises Address , , ............Phone i~1o.. , , .
Name of Architect . . . ....Address , ..............Phone No.............. .
Name of Contractor .'i. , . , . ....Address ..Phone No.. a.. .
IS.Is this property located with in~00 feet of a tidal wetland? *Y);5....NO....
*If yes, Southold ,Town Trustees BLOT DIAGRAM a required.
Locate clearly and distinctly all buildings, whether existing of proposed, and, indicate all set-back dimensions frorr
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or comer lot.
I'.
a~~ as aor~o
qA~: B.1? ft ? 9 3 0 7
FEE .4~.-~='_.t3Y ,
NOTIFY RI,JtL01NG t~[ ('4nYtN1F?NT ~tiY
?851802 9 RM i'f7 r! "V +'Cl~i I"s~F .
FOI.LOWINGtPlS+'t~~^±~;~.~~
1. FOUNDArlpi~t tiVd~1 *+Ef~ifltitD
i FOR POURED CONC,fFST%
2. ROUGH -FRAMING t;, PLUMHfNG
~ 3. ?NSUlAT1QN
_ I FINAL CONSTRUCTION MUST
@E COMPLETE FOR C.O
ALL CON8TRUCTYON' , &HAt.t MEET
YHff REtNJtR~IE
Ny„'~n>3~_'~•"OF THE N.Y.
ATIE CpN8TR11CGt~N i ENERGY
y Okt.~ Nt~l'~ ,.ABN4'0N8~.6 fOR
pp CtOM{~{TIRflC31Q~ERRORS
at,
STATE OF NEw YORK, ~ S.S
COUNTY OF .
. j being duly sworn, deposes and says that he is the applicant
(Name of individual signiing contract)
above named.
i
(icistlte
(Contractor, agent, corporate officer, etcJ
of said owner or owners, and is duly authorized to perform or {rave performed the said work and to make and file this
application; [hat all statements contained in this application arc true to the best of his knowledge and belief; and that the
work wilt be perforned in the manned set forth in the application filed therewith.
Sworn to before me this ~
, . ~ . .~.daygo~f~l...4// -,4~........, 19 ~G
Notary Public, ..../.~":'.`7~""••':•'•'; ~'~:5~!•~.... County
BEM IG OL YOE I . ~~::~.C. :~c_.
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~~k~ (Signature fapplicant;
Tetm Expkes t,Mreh 30,1
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