HomeMy WebLinkAbout18480-z M/8M NO.
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MU5T BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N 8 4 8 0 Z Date .....9~ ~ 19...1..
Permission is here y gr me to:
.............~d~
~ /3a ~o
to ..G~~°C~.......
ct premises located at .....~c.~.~..~:.<2......wAPFr.'...~~y?~1.....~..~.~.~. w
.................................................~y~...~ ...J~~~:SC!!~!7...............................................................
County Tox Map No. 1000 Section .......~,1........ Block ~,i~....... Lot No......~..~---.....
.
pursuant to application dated ~7.:,~f 19.~~~.., and approved by the
Building Inspector.
04
Fee S..•r°).~
B ding J for
Rev. 6/30/80
_ _ _ _
I~ BOARD OF HEALTH
U ~ ~ ~ 0 ~ "FORM NO. 1 3 SETS OF CLANS
SURVEY..........
AUG 29 TOWN OF SOUTHOLD CHECK • - - •13 q 9-~
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL NOTIFY
Bl0(; nT $OUTHOLD, N.Y. 11971
TOWrvOF~.'~!`TFIOLp TEL.: 765.1802 CALL - - • •
p MAIL T0: P 0 5 ~ IICrS
Examined .pq~~`~ 19i/.~ ,~j ~ Py-c,o~*~~
Approved ..5:/:~........, 19~Permit No./~~~!!.~
Disapproveda(c
.
r
(Bui mg Inspector)
APPLICATION FOR BUILDING PERMIT ~
2
Date 9........, l~
~ INSTRUCTIONS
' a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, wi
r 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 str
or azeas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this a~
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 peg
shall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in pazt for any purpose whatever until a Certificate of Occupy
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
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descril
The applicant agrees to comply with all applicable laws, ordinances, build' e, housing code, and reg do s, an~
admit authorized inspectors ap„az~ryiies.,~~~ilding for necessary ins lion l9Cy
~.......~q.~..1.VM !iitt~~R NNi~U~ ~3.a;? .
(Si ure of applicant, or name, if a corporation)
x Trl~tN~A:~~Ct Eri~'I!i].11t;.i v,:r~ O ,~6X ~ //i
~ns? tzt~a s >x~, a ,
(Mailing addre of applicant)
ayr,~rv~. .1N",, ,
i, • ,
State whether appli~'~ " 3ri~'=~lessee' ~1'~`~r~f' yyrc~iitect, engineer, general contractor, electrician, plumber or buih
Name of owner of pr~~iYiS$s~~ ~L . r . .
7-l~r ~ ~ 34` ~ U ~ (as on the tax or latest deed)
If icant is corporalriotkt~gn~tute ofdiriy atithontied officer.
! ~Jj ter - 3
(Name an Htl~~'f ~orlibYafe fi`cer)"
ALL CONTRACTOR'S MUST B SU~ OLK COUNTY LICENSED
Builder's License No...~,.,--(~~..-~.~....... .
Plumber's License No . .
Electr'scian's License No . .
Other Trade's License No . .
1. Location of land on which pro ed work will e ne. .
!3 aao .sT .
House Number 2 Street / Hamlet
County Tax Map No. 1000 Section Block T.......... Lot
Subdivision Filed Map No. Lot.............
(Name)
2. State existing use and occupancy of premises and intended use a d occupancy of proposed construction:
a. Existing use and occupancy , r .
b. Intended use and occupancy
3. Nature of work (check which appIicable): New Building Addition tali
Repair Removal Demolition Other 1Voi
(Descripiio,
6
4. Estimated Cost ~ll Fee .
` (to be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor .
If garage. number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions of existing structures, if any: Front ...............Rear Depth .
Height ...............NumberofStories.....................................................
Dimensions of same structure with alterations or additions: Front Rear .
Depth ......................Height ......................Number of Stories .
8. Dimensions of entire new construction: Front Rear Depth , .
Height ...............NumberofStories......................................................_
9. Size of lot: Front Rear Depth .
10. Date of Purchase .............................Name of Former Owner
11. Zone or use district in which premises are situated .
12. Does proposed construction violate any zoning law, ordinance or regulation : .
13. Will lot be regraded Wi11 excess fill be removed fzom premises: Yes i
14. Name of Owner of premises ....................Address ...................Phone No............. .
Name of Architect ...........................Address ...................Phone No............. .
Name of Contractor ..........................Address ....:..............Phone No............. .
15. Is this groperty located within 30~ feet of a tigidal wetland? *Yes No
*If yes, Southold Town Trustees PermitPLO~ DIAGitAM ed.
Locate cleazly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions frog
property lines. Give street and block number or description according to deed, and show street names and indicate wheth~
interior of corner lot.
~a~~~~j~
DATE: ~t !3 i.RN..Lii..irSL.~
NOTi B~ n DEM 7
Tti13-ice 4 AM TO 4 PM IaOR THE
FOLLOWING IN EC'f1ONS:
f. FOUNDATION 1VNOREl1EMRED
FOR POURED CONCRETE
2. ROUGH • FRAMING 8 PLUMBtiVti
3. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLE. _ FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE RE4UIREMENTS OF THE N.Y.
STATE CONSTRUCTION ~ ENERGY
CODES. NOT RESPONSItit~ FOR
DESIGN OR CONSTRUCTION ERRORS
STATE OF NEW YORE,
CODNTY OF S.S
. being duly sworn, deposes and says that he is the applican
(Name of individual signing contract)
above named.
lie is the
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file thi
application; that all statements contained in this application are true to the best of his knowledge and belief; and that th
~vozk will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
~.~.........day of 19t~~
:..~l ~ U Gam:..... .
Notary Public, County
tIEtEN K D'E ~E~ ~ ~ .
60
a,~( (Signature of applicant
7Ma Expira Mitch 30.1
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SURVEY FOR
IRENE McKAS7Y
NOV. 15 , 1985
AT EAST MARION DATE Nov. zl, Isfia
TOWN OF SOUTHOLO $cALE~ 1"=ao'
SUFFOLK COUNTY, NEW YORK N0. 64 - 1162
R UlYU MgtiZ ED ALTERiT10N DR ADDITION TD MY GUARANTEED T0~ '
SURVEY 6 / VWLinON OF SECTION TZO{ OF THE
NEW YORR STATC EDUCATION LlY UNION SAVING
R COPIEf OF Mif SUIfVET N07 SURWG THE LANG TPS AB$TR ECIftt~.
SURVEYORS IMKEO SEAL OR ENSOSfED SEAL SHALL TPS L 7Y3
NOT K CONf IOEREO TO K A VALID TRUE COIT
R GUARANTEES WDtUTED HEREON SIYLC RUN ONLY TO % ~pP h', y \
HE4LTH DEPARTMENT-0476 FOR APPROlf1L TO CONSTRUCT THE PERSON FOR YNOM THE SURVEY t5 PRENRED Ertl r
AND DN MIS iENALf ro ME nTLE CON PANT, GOVERw- ) ~ G 1
w NEAREST YRfpl tlIN_NI.I RSOURCE OF PATER. PRINtTC _?VSUC NENTAL AGEN:Y AND LENDING INSTITUTION LIST[0 Q Z
R SUFF CO. iA%NIP DItT 1000 SECTION DSI St.OCAC nlA LOT D12 HEREON, iND TO ME LSSIGN ELS OF ME LENDING G
R MEK ARE NO DYELLINif YRNIN 100 FEET OF 7Mf PROP[RTY INSn TWIpI GuARANTEEf ARE NOT 7RANSFERA SIC ~ / 1.
OTHER THAN THOSE tNOYN HEREON. TO ADOInONAL INS TITUTIONS OR SUSSE DUEMT
OYNCRS ~
R THE VATCR SUPPL7 AIC SEPIA{E DIT~OSAL SYS TEJI FOR THti RES IDEHR / '
RDI STA MCES 5110YN HCREOM FROM ?ROPERTT UNCS ~ X/'
PILL CONFORM N 7ME STANDARDS OF THE SUFFOLK COUNTY pCPARTNENT . mow- yy .1J ~
OF NGLTN SCRVICEf. i0 Ei if TWf SiRUCNRE3 IRE FDR • SPEL7FfC I ~ (,L 'D. 45$9~j
ARPLICANT, PUR IOSE JNO IRE NOT 70 {E US CO TO Ef TAS LIfN ,
PROPERTY LINES OR FOR THE CRECTION 0 FENCCf ~ OL
ADM[1t ~ ~DI"" ~
TCL ~ - YQUNG & YOUNG~'`~' ~RHEADNNEW YORKE
f~NONUNCNT FOUND .7 ~ STAKE
{WLOIN{ t3 W A DILA?IDATED CONDITION AL DEN W.YOUNG, PROFESSIONAL ENGINE £R
~Rt<_o rrl LINES. ~~,n+s.F. ~ cN0 LiND SURVEYOR H YS UCENS£ NO 12645 `