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HomeMy WebLinkAbout19163-z 70H1[ NO. f TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES U IL FULL COMPLETION OF THE WORK AUTHORIZED) N a i 91 6 3 Z Date 19.Z:o Permission is hereby routed ~L~.1.~.~...~.~.e,~.....~..- .63.f.1.~ to acr~Gi.. .'~'~r1~.....~~.. ......~e~.lx.d........... ~ . of premius located at ..1Q . ~~~R~,G~..................................................................... . County Tax Map No. 1000 ction Block Lot No........7............ pursuant to application da ........fv~,~^.Z 1Stl..!~.., and approved by the Building Inspector. Fee i~ , 1 i D 1(jl,Y r . . . ilding Inspector Rev. 6/30/80 c1~LD I;. S'.°~=.U;i ~`Jni I~ Ci1MM F:NT° -o 1 1. ~ ~ H FOUtJDATION (1st) c FOUNDATIOII (2nd} - ` 2 . P,OUGH FRAME & ~ .PLUMBING ~C ~ H \ 3. ~ m H I1ISULATI011 PER N. Y. STATE ENERGY ~Q~ CODE ~ } " 1 M r 4. FZ;JAL I ~ J ' ~ _ o ADDITIOPIAL COMMENTS: x ~ x ' H O ~ i_ A r\ H ~ ' ',4-.' b • m , H ~ J BOARD OF HEALTH 1 SETS O~iPL.\;SS FORr~iNO. t SURVEY .~.r TDWN DF SOUTFIOLD CIIECFt • • • • • • . BUILDING DEPARTMENT SEPTIC FORPI . TOWN HALL $OUTHOLD. N.Y. 11971 NOT I PY ; / TEL.: 7G5.1II02 CALL ~lO.~f.. , , , , , 19.4 PlAIL TO....... Examined . Approved 197:~Pcttssit No..~ln~c$,G.~ . Disapproved ale ~ ~ ~ ~ ~ U ~ . tilding Inspector) • TOti~1`~`t~'-~~`~ ~ APPL{CATION FOR BUILDING PERN1'IT J Date Ut:h.~__s2.'2...., 15~~. ' ~ INSTRUCTIONS f_5 a. This application must be completely lined in by typewriter or in ink and submitted to the Duildin; 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 adjoinin; premises or public streets or areas, and diving a detailed description of layout of property must be drawn on the dia3ram 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 Penttit to the appiitaaL 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 hIADE to the Building Department for the issuance of a Building Permitpursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Yotk, and other applicable Laws, prdinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herin described. The applicant agrees to comply with all applicalle laws, ordinances, building code, housing code, and reouLltions, and to admit authorized inspectors on premises and in building for necessary inspections. • • ~(Signatur iQa~pplicant, or name, if a/c>orpora;wn) • • - 6~7 /7d_c'7l?ZS. ! : L ~"~/~~~i~/?~!`.c7,'c~!V~., jf,~'•S 2 . (Mailing address of applicant) • State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~r . Name oC owner of premises f I: a:G~. L-/!'~.c(~U~1 ~ , . (as on the tas roll or latest deed) " ICapplicant is a corporation, signature of duly authorized otFcer. • (Name and title of ceorp{orate officer) • Builder's Liecnse No. s~.~`.'[ .f . Plumbei s Liecnsc No . . Electrician's License No . ' Otlser Trade's License No . . . Location of land on which proposed work will be done; - IJouse Number • • • ~ ~ ~ ~ Street. Hatnlct • • ~ • • ~ ~ ~ ~ • County Tas Map No. 1000 Section ~ ~ • • ~ • • • • ~ Block • , . • • . ~ , , , , , , , Lot 1" Subdivision Filed Alap No. Lot ..(Natncj . Stasc csisting use and occupancy of premises and intended use and occupancy of proposed construction ` - a. Existin; use and occupancy p' a ~~r' c~cc v~• . ~ , a~.~.. ~ ...1l.`d+.N l G t /t xr.. ~?'1........... off' rZ e tf ,l t b. Intended ~ KO ~ w~ `w•rF.°a,stlJ,,a" an}t use and oeeu ane l.~t?? ~ e=as~-,t+„~~~y4.~. .r:;~! . 3. Na[ure of work (cheek a•hrch applicable): New OurldinS • • • • AddiUen • • • • • • ~Uteraupn . Repair RFmoyal Demoyition ............Swi~nin; pool............ Tennis Court•... ~,~.J... Accessory•6uilding.. V .....Fence .......Other Work.. ~4. Estimated Cost o??'~f Fce • (to be paid on filing this applica[ion) 5. ICdwclling, number of dwclling~nits • Afumbcc of dwelling units on each floor • If garage, number of cars . 6. If business. commercial or mixed~,occupancy, specify nature pnd extent of each type of use . 7. Dimensions of ¢ex'isting srtvctures, if any: Front . Rear Depth . Height a'_:':: P; : •N°u nr ~ 4r•.a C S torics . . t ~ . jL. . Dirncnsiobs o`f sa astructurc`lvi~h gglterations or additip~ts: Front I6:......... Rear . . Depth : T~Icight ~~D... . Number of Stotics . S. Dimensions oflantir f;natyrc~tnstn{ction: Front Rear J~ Depth ...:z~......... . Height " °Numt}cr of Stories . 9. Size of lot: Front . ~>5... ~I b' ~ • • • • Rca'r , ,Qcgth • 10. Date of Purchase . l~,eF(L : ; l / ~Y, , , , , , , • , rIamF of Forttcr Owner /'rZTFIF%3..~Y~ . . 1 I. Zone or use district in which pretytises arc situated P s /.rf ~~.'7~L~~........... • • • • • • • • • • • • • • • • • • t Does proposed construction violate any zoning law, ordinance or regulation: • • • . • • • • • • • • - • - - • • l3. \Vill lot be regraded . !UQ r~/ • \Vill excess C11 be rem(wc fro emises• Yes . • Na . . 1•t•. Name of Owner of prcmises~•¢C~•~iyPT.~ f41.•.... Address ~3l.~~lnfi .~'(~,{:~!m~P.ne NqQS'/~:7~•~':3oor( • Name of Architect ...............Address ..Phone Nom Nb/ s"76~I • _ _ _ Name of Contractor . ~ .Address . .Phone No. IS.Is Chis properCy-locaged within •100 feet of a•tidal•wetland? ^YNS.lr.NO.... *If pes, Southold Town'~,Trustees Permit may be required. PLOT DSAGRAII Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate ali set-back dimensions frrxrn property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. , F--°•~ ss, _ ece ss~~ 1~id • ' X 8, r pW~~/ Xy~ $"'c x~e r ~ ~o`ro AD r {n ~ it /_3or<. . ~r u `'ti, Pte,$ I s,~ I ~ fir' ' ~ ~ Wont v ° ~ ~~~~tiead STATE OF `E1V YORt:, S•S Wjar COUNTY OF ~ o ~'od~~. • being duty sworn, deposes and says that he is the applicant • (name oCindividual nit ~ contract) above named. ' licisthc (Contractor, agent, corporate officer, ctc.j • aC said owner or owners, and is duly~~i;wtltorizcd to perform or have performed the said work and to make and Cde this application; that all statements contaiiicd in Utis application arc true to the best of his knowledge and belief; and that the work will be pcrl'orntcd in the manner Set forth in the application Gh:d therewith. •tl, »vom to baforc me this j ~ ; .............°.~.~~.r. ..day of . / 19 dotary Public, ~t'•"•': • • • County ~ ~y F~KDE ~ ....C•~ No:~ G (Signature of applicanU - ~ t1~ M tt~'~~°m ~ x~vixwa g ~~Z .ate ~ ~ ~ ~'~~:,ir. ~ afi~~~df ~,V ~j.~.°., - . . ~ , . - . , s.e ~ O ~ ~ ~ 2 ~ OC ; U d S~ C'(~ ..gym ly us'T it ,N eM SP Q~F~VO- ~ ~ _ - - e _ i s F„ u - ~ _ ~ ~ SJ ~ ~ C.1 ~ 1 ~ L~ - ~ _ ~ Vt L f ~ .N ' x ~ i ~ ~ +"J ~ V ~ ni t yam" A ~ .....~L. ~ : Q! -I } E ; r! arm ~ ~ ~ ~ ~ k~ r r _ ~ ~ i . ~ 'ti - ~ t e I ~ ' ~ ~ _ ~ ~ .r ~ ~ a r ~ ~ ~ ~ ~ ~l - . ~ ~ ~ : ~ i~1 ~ i~ { j~i i~ r . ~ ~~F ~ - ~O ~ ~ ~ ~ i a~ ;t ~ k n. 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