HomeMy WebLinkAbout18880-z sosee xo. e
TOWN OF SOUTNOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PR ISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZ )
i
N o 18 8 8 0 2 Date a-!:.SA..!.5................, 19.2.
Permission is hereby pmnteTTd
to:
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ro ~t-r..t.~ .....4r~1...... C>~.... ~ n.' . -p
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of premises located ot ...i'.~.5....~~!:4r'.......~ ..............~.~.~.:~<~.C.?~:!~!~~..,.............
f:...........................................................................................................................
County Tax Map yo. 1000 Section .....I...~~.~....n.... Block ........Q..J....... Lot No......I d'..~.........
pursuant to opp~ication dated ....~'.~Gl'~l,.lkf...•..~••+3••••••-••••••, 19.g.i,?., and approved by the
Building Instpector.
Fee S...a,~:..~...
/ O ~tl.ti
Building Inspector
Rev. 6/30/80
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" SUFF. CO. HEALTH DEPT• APPROVAL H. 8. NO.
OWNCR:
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~ I~ ~ / ~ t0 TIIIS SURVEY IS A VIOUtIUN Of
A{'0 N ' ~ ~ DFCTION 7409 Oi MF NEW YORK STAR
t„~•x •~..a, ~ EDUCATION UW.
Rp ~Q ~ L' j
~ ~ C091EF OE THIS SURVEY MAP NOT !FARING
-J \ _ i11f IAWO SUItVFYOA'S INKED SEAL OR
' E~' ~ ' Q v tMBO55ED 5[At SIIAII NOT 8E CON510fRlD.
Lt TTp ' • 10 BE A VALID TIHIF CORY.
, L~{]~„ L E~.~ •n GVANAMFES INDICAIFO NR[ON FHAII AIIN
~R~1' J ~ r•'~ _Y' ~ON 1 ONIY t0 THE VG:SUN IUN V/IIUM ill{ SIIRO
Vm, ~ ID YNfI`ANED. AND ON NID D:IIAL/ f0 1Nl
• •'J• ~ 1 ~ ~y,, ! (HN COM9ANY, GOVLRl:MLNYAL HONKY F
~1 I s •
' ~ ON) ~ ~ ` • ~ LENDING INDiIIUNON IIRTED I4.RLC/N, ANP
- ~ IO LIEF ASSIGNRS OF illt LWORM tNSIL
TITL4 CI[RTIP. , tUfHNF. 4LARAHTFFS AQF NOf IRANNIi;AV
•M, 1 Y i epY f;b't y y , , j ~ ~ { ' 1 ~ TO ADOEt10NM If{SII(VgONS OR SU14F4M~
a z,a~tGr"~,;,¢r§lh~~tYi'u~~~P,~~°dr°~~#,~,~~'%r+,o'~`jitd~~`I~+ y,ow.aEeF,,
N1r--~~~ ors ~ r:~ 8~;':~~ ~ ~ 8T#
~JA/ • "Mr~i%' Gf= t?[~tsl.-7lv0'.~D ~.-~7Vt~: ~ ~ saAL
, ~ ~ ; ~xaW,r~t/td ~C~hi k'$R ~[97~3, ~ .
a ~ ,
' RODERICK VAN TUYI- P. o. ' - •
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/ `w.U7 ~f+'/QG~•.~f~+. ~ l 1 4f~1: F 1 y{ ~ • " ~
wp wM `~'~-~'~~"~~M'~ ' LIO. LAND SURYEVORB-OREEMPORT. N• Y.
:.v "v1~ Co.7'a~1 lvfah OctaigrY.xfiT~fr; pi tN:IUr.~ESPCt !3'7~F3fFael: "1,: ~lr, 9, !O •
TEST HOLE BUPF. CO. DEPT• OF HEALTH SERVICES STATEM[NT OF INTENT
O• ~ ~ ,,..t'
rT`''~E"~'~••~ FOR APPROVnL OF CONSTRUCTION ~ANLY ~ ~ '
' ~ ~ THE WATER'SUPPLY AND SEWAGE
I ,
' DATE: DISPOSAL 8Y8TEM8 FOR TH18 REST.
:lprt rl . ~ ~ . ; ~ DENCE WILL CONPORM TO THE
' ,r ~ ,
' , H. 8. REF. NO.: ~ ' . • STANDARDS OF 8UFFOLK CC-, DEPT,
r(J' ~ OF HEALTH. SERVICEf. ~ •
APPROVED:
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1T ~ APPLICANT
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rr~ C~ ~~v~l_r`~~ ~~p BOARD OF HEALTH • . • • , . • . • ' '
lut Is 3 SETS OF PL.1NS
FORM NO.1 SURVEY
r .3~ TOWN OF SOUTHOLD CHECK .
~S_f` BUILDING DEPARTMENT SEPTIC FORP1 .
BI.Cti.
1SEPF. m~ TOWN HALL
TOW~F 50UTHC~E C7
• $OUTHOLD, N.Y. 11971 NOTIFY
TEL.; 7G5.1B02 CALL ..r.
n MAIL T 0 : u~G~a-yc-~-a'"""M° A .
Examined l.i., 19 9.~ ,(/~s-u4/~'r`~,.`'Pi-..... .
APprovud S., 19 4'R Permit No..~ 2~ ~ ~ V .
DisaPProveda/c
.~.,F.c~d:~!....
(Building Inspector)
APPLICATION FOR BUILDING PERPr11T
Date . 15 .
INSTRUCTIONS
a. Tlus application must be completely filled in by typewriter or jn ink and submitted to the Building Inspector, with
sets of plans, accurate plot plan to scale. Fee according to schedule.
t b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets
or azeas, 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 Buildin; Department for the issuance of a Building Permit pursuant to the
Building Zone Ordjnance 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 ail applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
(Si atur or a lica , or name, if a corporatron)
(Marling address of applicant)
State whether a plicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
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•.::,:,.~.:..:.:.eW. lA.~i,~fr.'::_' ' 'tat`#et.9 \
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Name o{~,~vner f renYPses ~ ~ " f ~ ~ dk
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TOt 9 s~ 3P~i~tA~ r . 5 r (as on the (~~:7R11 Pr latPs`} deetl~
9617 Ape ~,1°i t+ f,r ~ r r .fa3~g
r. e' €
If applicant isa corp~6dR?bzis,:SLgnat~u+re'oPduly authorized officer... s t
iS"tfld41#?9A C1W1` - k13+#"ih,CY4h!ti)~
•ti .i~S S'iT3Y~"~~~.{~i+~~.~~lAi`t, O~tlf~~Ti l.~}S ~Ck C~~..
~rt1i~ ~d~ltlPe`~2if'cor~fi5'P,dfe`?ofBcer)
Bu~~~Ads fi"sct~Nlb. ~ :~y'u~;-n e:'!. t .
Plu~r~~,`d}'s1LPe~t`sses`fV%o!~~`' "'+~~:1->............
~ , '~,i~~ltt~e Nb: ~;t !'rn'~:
Ele~`c~~ ~
a~~ 1~_1 f 'a;~.;~t'
ls(~ll~f3+'.~ r„s:r;,~a~, €io yx° ~ .y-
Otlt~cr ra e s icense 8 . .
1. Loca~}t-io~n~of~land on which propo~s'e1/d w-o{r-k will be done~RD
Y.::... / ........T„t `2.E?..1 w bpF~ Ji .~.Y':~ "--:y e .
House Number Street, HamletV ~O. t
County Tax ~fap No. 1000 Section Block 1............ Lot ,r , ,
Subdivision . piled Alap No. Lot .
. ' ~(Namej .
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existin;uscand occupancy
/ ~ ~ '
b. Intended use and ~ ~,OV;~ - C ~ 1.. D .
occupancy r
p • moplicable): New Building Addition .....Alteration ' .
3. Nature of work (check which ap 3[dOpRh ~ $d
Re air Rp 'val Dcmolit: ; U
Tennis Court Accessory Building.... ...Fence ..Other Work............
4. Estimated Cost l ~c?c9, : Fee
(to be paid on filing this application)
5. If dwelling, number oC dwclting Units Number oC dwclting units on each Cloor
If garage,numbcrofcars
6. If business, commercial or mixed occupancy, specify nature and extent of each type oC use .
7. Dimensions of existing structures, if any: Front . , . Rear . C• c7.......... Depth Z~ . .
Hei=ltt ....9.~ Number of Stories .
Dimensions oC same structure with alterations or additions: Front Rear . .
Depth Ilcigl[t ......................Number of Stories .
g. Dimensions of entire new constn[ction: Front Rear Depth .
Height Number of Stories r5'" .
9. Size of lot: Front ~.~7~?
. Rear ~'O a Dept . C..... ,
10. Date of Purchase (.~l7 4 Name of FormeF-Ow~er ~ rY.......... , ,
1 1. Zone or use district in which premises are situated ......}:~,-r.•s~.~.Qe . .
IZ• Does proposed construction violate any zoning law, ordinance or regulation: • • • • • • • • • • • • • •
13. \Vill lot be regraded .:......f/.`s.~`...... ..Will excess fill be removed from premises: .Yes • No':'
Ira. Name of Owner of premises ..:~4$:~~+...~~^.~wJ~~ Address . ~-g~c~ ~ ....Phone No.:Z 3.~f..~~.`{ ZI . . .
Name of Architect .........Address ...................Phone No................ .
Name of Contractor ...Address ..Phone No....., .
IS.Is this property located within 100 feet of a tidal wetland? *YLrS....NO....
*If yes, Southold Town Trustees PLOT DIAGRAM a required. ~
Locate clearly and distinctly al) buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block', number or description according to deed, and show street names and indicate whether
interior or corner lat.
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APP p A8 NOTE9
DATE: 6.P.N~~ ~$o
FEE: ~~.'--~---$Y: V
OCCUPANCY ON NOTIFY BUtLOWO DEPARTMENT AT
US~ IS uNl,pW'~UL 786•t802 8 AM TO 4 PM foR THH '
.1 CER~IFICAiE ~ ; FOLLOWING INSPECTIONS:
w'TUOU ;.i 1, FOUNDATION TWO REQUIRED
p~ gGCUPANCY FOR PDURED CONCRiiITE
? 1 2. ROUGH FRAMIN<i fi PLIIMlINO
• 3, INSULATION
4. FINAL - CONSTRUCTION MUST
SE COMPLETE FOR C.O.
STATI; OF NE1V YORE, ALL CONSTRUCTION SHALL MEET
COUNT OF - S.S THE REQUIREMENTS OF THE N.Y.
(n m f indi idual si ~ g y STATE CONSTRUC~OI~EEN~ Epp
~ bcin dul swdiA asd~7nd~S g licant
~ fining contract) DESIGN OR CONST
about na ed, n
FFcistlte
(Contractor, agent, corporate officer, etc.)
of said owner or otvncrs, and is duly authorized to perform or have performed the said work and to make and Gle this
application; that all statements contained in this application arc true to the best of his knowledge and belief; and that the
work will be performed in [he manger set forth in tltc application Glcd therewith.
Swom to before me this
............/.3. .......~d/ay Ofd....... ~'1......, 19 9a
Notary Public, ..N'~ltt
:..Yl:..,W.~' : • • • • • • • County
NELENKBEVOE • • •$ignature•ofapplicant;
~I~Y4707878 Sul~lolk ~~~Y~
Tatm Expires March 30,18.~11