Loading...
HomeMy WebLinkAbout18596-z rows xo. a TOWN OP 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) ~gJ~~ N ~ Z Date .....li?./...~~.~.:v 19.~~ Permission is hereby granted to: / ' a /©c?.~......~.~.. ..~??l..e ta ....~............................~~D. G~ ~ of remises located at .....:......./':e~!I .......................................................................~.,,/..r................................................................................... . County Tox Map No. 1000 Section ..........T./......... Block Lot No.........~`..J...... pursuant to application dated ..s....a?~~!..y......................., 19.i and approved by the Building Inspector. m~ p ~ Fee $...~..J~...,4C~ .........f.... uildi I r ~ Rev. 6/30/80 F - rn ~ ~a . ~ ~ ~ . ' 4~ . 11 ~ f ~ .n~ ~ , } ~Ir, ~ ~ ~ .a~ , ~ ; v~ n" ~ , . ~j s; ( I ~ - ~ ~a i° t a ! ~ ~ r Iw,'~ m ~ i ~ ~ ~ ~ ~i~ n ~c~ ~ { . ~¢¢yy-~. D N A~ V~'~ 7' z _ . N s?~p.~~~,11i F ~ ~jnllLSfJhi aq`~~ ,n~~aot I FYOR • ~ _ ~J I 'i ~ and fem. i i .0.. I ~ N ~ ~ ~ C I ~ y I ~ ~ I m r (1~~ n5 It Z irS ~.i t7 ~ - ~ tJ ~ ~ ~ ~1ry7 ~n> fir{- ~ ~ c•1 7Q ~ ~ ~ iL I P..~ q~ ~ ~ m ~ ~ ~ yr ~ rn K'' { : a~ ~ ~fl r ~ ;n E~ p~ z rn ~ ~ ~ . as i ~ ~ ~ mm c~da~~ Yid r,-~ ' ~ ~ r1s.; c~ . BOARD OF HEALTH 3 SETS OF PLANS ~FORMN0.1 SURVEY TOWV OF SOUTHOLD CHECK • • • • BUIL"D.INGDEPARTMENT SEPTIC FORCt TOWN HALL SOUTHOLD,N.Y.11971 NOTIFY •.~.77../~~~•• ' TEL.:7G5~1802 CALL 1 T0: Examined ~ 5 19Up./.ry, Approved ..~~~?.:S/ 19Q~~, Permit No.`~~~~~ D ~ ly Disapproved a/c ~iT ~ ~ D APPROY~ AS NOTED• • ~`Vr~` ~ BLDG. DEPT. NOTIFY 8 I DI G OEPA ENT AT (Buil ng Inspector) ' 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: APPLICATION FOR BUILDING PERMIT 1. FOUNDATION - TWO pEQU1RED Date . ~c: , . d ~ , , , , „ 19 ~ 9 FOR POURED CONCRETE 2. ROUGH -FRAMING & PLUMBING INSTRUCTIONS 3. INSULATION a4. F :AL CQ NSTRU 'fb10N MU~T ~~~i~E~ F~ a comp etely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets Q(~ fl~t ~~LrLo ~ Fee according to schedule. 1~ 1 two t and of buildings on premises, relationship to adjoining premises or public streets or a~1'dl'~n~ g ' e~ dy'~r n of layout of property must be drawn on the diagram which is part of this appli- catir~ S R C ~Rtion may not be commenced before issuance of Building Permit. pan approval o thrs application, the Building Inspector will issued a Building Permit to the applicant. Such permit sh eb~',~~gg~ spection throughout the work. !'J~~ [I[~3~if„;t ~t ed in whole or in part for any purpose whatever until a Certificate of Occupancy shall h Lt_ +~i't ! C~~ iP g ri pector. K AP14LE©,4~I~114BJ1HER'~G•~4~~~Et@ the Building Department for the issuance of a Building Permit pursuant to the Building ~0~Rft9~dl:~8li~E>1F~'B'own of Southold, Suffolk County, New York, aztd other applicable Laws, Ordinances or RegtilaPioRQtt6HtltEFb@R21111Cnc~toflLbtAtl~I~l~ings, additions or alterations, or for removal, or demolition, as herein described. The ap~tliN~&t1L~FflBNto comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit a'4ttF.l$t~ed ittsrSSiOfd~~84{CpTrlQ~gg;l~d in building for necessary ' , ti - BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. (Signature of applicant, or name, if a corporation) STATE CONSTRUCTION 8~ ENERGY /oo a ~ ' G,~ ~r CODES. NOT RESPONSIBLE FOR • • • • • • • • ~.......-pp n . f)ESIGN OR CONSTRUCTION ERRORS (hiailin~ address of a licant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. r~w,rr~,Z \amP of owner of remises `''A~~ d- ~i~~E""~ ~ C'~.•9iZ z-~'~ f ' - P (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ' ALL CONTRACTOR'S MUST IIE SI~PFOLK COUNTY LICENSED Builder's License No. ..4~.~:+~.Q~G/L, • , , • • , , • , • Plumber's License No . . Electrician's License No . Outer Trade's License No . . 1, Location of land on which proposed work will be done . . House Number Strcct • • • ~ ~ • • • • • Hamlet County Tax tvlap No. 1000 Section ....d yl , , , , • • • „ Block ~ „ • , , , , , , , Lot , , ~3.. _ , • . , . Subdivision . , V~~iZL•/ ti ~?/hr'+~~/'Z ..5.. Filed \1ap No. Lot . /~02 (Name) State existing Ilse and occupancy of premises and intended use attd occupancy of proposed construction• a. Existing use and occupancy , • ,~D~r ~,r~;' b. Intended use and occupancy ~}?"?F , , • ...,r~t',~ye~q„~,~t,,;l>~+_ 3. Nature of work (check which applicable): I~`e~v Building , , Addition Altetatio - Repair Removal , Demolition . , .Other 1ti'ork ..~~t~4c~". ~ ~ 4. Estimated Cost .....~h~,ml'? (Description) Fee • g ~ (to be paid on filing this application) 5, If dwelling, number of dwellin units , , , , Number of dwelling units on each floor If garage,numbcrofcan 6. If business, commercial or mixed occupancy, specify na3ure,,and extent of each t pc of use 7. Dimensions of,existing structures, iF any: Front . S ~ ~ ~ ~ ~ ' Hci^ht ' .,,.Rear Depth , .~.~r....... Number of Stories , . Dirtt!ensions of same structure wish alterations or additions: Front Rear . Deq~}i ~~tt~e ~ c !..Height . Number of St . 8. D' e,Rb~on pnstruction: Front ',~'~~~'#•<;,•„..~i:~ Hei ht Rear Depth Thu n cr f Stories . ~ y ;+tt - 9. Siz of lot: Frbn~ ~ , . ~ Rear 9a Depth , /J~2- d /6 R,.9... . "0'~~~ r . Name of Former Owntg r 1. Zone or use district in ~ehich premises are situated ......l'!:...f,'~,V';Or.~n~#+~ ; y • ' 2, Does proposed construction violate any zoning law, ordinance or regulation: , , , , ; , , ; , , , , , , , , , , 3. Rill lot be regraded ; , , , , , ; ill excess fill be rembi~~'$~ibn ~iremises: es No 4. Name of Owner of premises .~'~az~:*~~~;=; ~;.cH~:zr~l~ddress Cto~.a,!'?'?::" :r~~.ri.°'rPlr6ntCilv'o.`.:~~~~~7J Name of Architect ! ...............Address . r"., ~t'~`'; ~Iione~I~o. Name of Contractor . .Address . ra• lil}otie No. P P Y 'B i.. ri', ,iy; S. Is this ro ert located within 300 feet of a tidal wetland? *Yes ...~=.,•No ,~..t *If yes, Southold Town Trustees Permit may be reqyu~ired. PLOT DIAG1tAM °r=i ifr.:, It F: _ , , Locate clearly and distinctly all puddings, whether existing or proposed, and:~ir5`dS~ilte~&tll~Sct=b"ack.dim`ensions from" roperty lines. Cive street and block number or description according to deed, and sNi3ty sir'e`ilYllSiilesi~nd`in'dicate Whether" ~tterior or corner lot. I ,~`.,i3~ ~ • /(OdY' 7~ ~ ('d Nf.6~11~''G?i ~'.h' ~'a~'".r/f2 c.1G' ~~-'~f~ . ~ " :'ATF. OF NER' 1'QR~~L c_ S.$ . ~C~1TY OF . ~'e ~ " ~~g~ , being duly sworn, deposes and sa s that he is the applicant (tiamc oCindividual signing contract) ovc named. ~isthc ....................~e'/~r°'/Z.................. ! (Contractor, agent, corporate officer, etc.) ~ ~ ~ said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this atication: that all statements contained in this application are true to the best of his knowledge and belief; and that the rrk will be performed in the manner sit forth in the application filed therewith. orn to before tnc this I tar}' Public, County l~/~ - CHPI l? HALI.t)CK P $~91 1Y./i , (Signature of applicant)