HomeMy WebLinkAbout18578-z soaas xo. s
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
CQMPLETION OF THE WORK AUTHORIZED)
N O 18 J 7 8 Z Date .....5~. ~°.f: r5..........!..~ 19.~.a.
Permission is hereby gronted to: 1 n y~
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at premises located of 3.~?R.....,5............~0.:1:9.?!~....p~..9:::4~........J..R..c.e?.~:~
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County Tox Map No. 1000 Section .......~.4t.~...... Block Lot No...Q..`j
pursuant to application doted ....~;?..t'.~...~:~^44.....~..~ 19.$.~.,, and approved by the
Building Inspector.
Fee $..:1.a :'~.v.....
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Building Inspector
Rev. 6/30/80
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P,OUGH FRAME &
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IIJSULATIOf1 PER N. Y. • •
STATE ENERGY
CODE
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BOARD OFD HEALTH
3 SETS OF PLANS
' FORMNO.1 SURVEY ,
TOWN OF SOUTHOLD CHECK ?-.~:f:a. .
BUILDING DEPARTMENT SEPTIC FORM
• TOWN HALL NOTIFY
SOUTHOLD,N.Y.11971 CALL
TEL.: 7G5.1802
MAIL T0:
Examined ~ 9 19~~.
Approved ~ ~ 199. Permit No............
Disapproved a/c
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date ..C~~-?k-...L3......, 19S'.°l
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 ad}oining 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 co,/d~/e1,~using code, a d regulations, and to
admit authorized inspectors on premises and in building for necessary inspections[:/.' z
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(Signature of applicant, or name, if a c rporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
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Name of owner of premises .1 .~:G~!?.tGt4 . L.cr2Pit11Mh, ...A l4 ~.`191J .
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer. i
(Name and title of corporate officer)
ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED
Builder's License No. 3 • .
~ •
Plumber's License No . . .
Electrician's License No. .
Other Trade's License No. .
1. Location of land on wtric}r proposed work will be done . .
2,,®p S/}lI.T. M V~P3t4 ~ l.Vturts
House Number Street Hamlet
County Tax Map No. 1000 Section .....x'1.8. , Block Lot . , ~ .
Subdivision Filed Map No. Lot...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ...~.~r.ZCnC'...`?v:~.:.~IVUtM.ti!t .
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b. Intended use and occupancy . 5! Nbt i.ir, • ;~lxwr:.~!'•215t/.,I. 1e
...,d@t tMM11~,"
3. Nature of work (check which a plicable): New Building Addition Alteration .
P
Repair Removal , Demolition Other Work .
! (Description)
4. Estimated Cost ~.~;aaouz~ Fee
' I (to be paid on filing this application)
5, If dwelling, number of dwelling units J... , . , , , , , , Number of dwelling units on each floor .
If garage, number of cars ...1.•~L. G.Y~~'r~l~. • .
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions of existing structure§, if any: Front . Rear ~`7.'.... Depth , .~'`7.~.
Height ~.3,'.......... Number of Stories J .`/,2........... .
Dimensions of same structure with alterations or additions: Front Rear . ,4,b ,
Depth '.Hcight......3Z:; ,,,,,,,,,.NumberofStories..2..~:~,,,,,,,,,,
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8. Dimensions of entire new construction: Front ~i;.:....... Rear ....i Depth 2.~ .
Height , .'zP.'.... Num}ter of Stories ,Z, . .
9. Size of lot: Front . . l3 S.:.. Rear ..lq Via' Depth . Ate. I ~ ~ ~ ~ .
] 0. Date of Purchase , 9 ar. , , . , Name of Former Owner .
1 1. Zone or use district in which premises are situated , '.9p
. .
12. Does proposed construction violate any zoning law, ordinance or regulation: ,`iGS .
13, Will lot be regraded ..LJ.a '
. . . . . . . .Will excess fill be removed from premises: Yes
14. Name of Owner of, remises ryeRt~K. ~.1.o1W}~!u¢, QN~yau o A~aewc°
P ~ , 4 Address 1 Z .N6rz, Pr:4t~FNy; ..'hone No 561+ :48.4, :4LS6... .
Name of Architect . ,~6~.7(?+gt~ : (tksw~P~), , , , .Address P:a.&~?~7~.`1.4P-S esy-7C ..Phone No.~G: 3.L,; :~g:??~ , ,
Name of Contractor ..:~•.Rz:A' : . . . . . ...Address .Phone No.... .
15. Is this property located tt+ithin 300 feet of a tidal wetland? *Yes ,?~5... No
*If yes, Southold Town Trustees Permit ma be re uired.
PLOyT' DIAGRAM
Locate cleazly and distinctly all ,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 lot.
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STATE OF NEW YORli, S:S
~OliN'TY OF
G.~T~YRiI'7'I.~...TIkOW1C~Dy, , , , , , , , , , , , , , , , being duly sworn, deposes and says that he is the applicant
(Name of individual s~gmrjg contract)
~bovc named.
is is the a;2Gyl;l S'~''.[?C .
(Contractor, agent, corporate officer, etc.)
rf said owner or owners, and is duly! authorized to perform or have performed the said work and to make and file this
pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
cork will be performed in the manner pct forth in the application filed therewith. '
worn to before me this r
1.3..... .day or .I!I!.. . 19 .4 ~
votary Public . County
Wow"`-~' .I
(Signs re of applicant)
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