HomeMy WebLinkAbout18518-z POEM N0. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
50UTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST 8E KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
u 185.8
N_ Z Date ..7~ 19
Permission is hereby grant to:
T~~...~~.-
to .."•••^~br•.~.~....... ......4':+~......~........~7~t?~e2!!..:7~Cr........G1!ita~.
at premises located at ....r,~........`.!'yf..~-tz....
...............~.ld~~~.....
County Tox Map No. 1000 Section ..........~7..... Block .........7r..:..... Lot No........T...3t.~...
pursuant to application dated 19........, and approved by the
Building Inspector.
da
Fee S...t
.J`..~
...=~~Bui~ Inspector.
Rev. 6/30/80
BOAKD OF HEALTH
3 SETS OF/¢LANS
~FORMN0.1 SURVEY
TOWN OFSOUTHOLD CHECK
BUILDING DEPARTMENT SEPTIC FORM
TOWN HALL NOTIFY
.°,OUTHOLD, N.Y. 11971 CALL
TEL.: 765-1802
~~jj ~j MAIL T0:
Examined ~o.........., 19 f~ . ,J L.
G p p~ t4`/ _ _
APProved /~~,Q 19 CI.(Permit No. ~ } ~ ~ ~ ~ ~ ~ ~y
Disapproved a/c B~"" ~~P ~ 2
~ L,,....._..,...~
.
DATE ~ o ~ ~ a~ N ~ Taws
o
~~z:ryr
aUTHQLt)_
NOTIFW~~~OEPM _ AT 6 ui] g Inspec or)
786-180'1 9 AM TO 4 PM FOR THE
FOLLOWINGINSPECTICNS; APPtiCAT10 FOR BUILDING PERMIT
1. FOUNDATION - TVMO REQUIRED Date ~ 19g
FOR POURED CONCRETE
2. ROUGH • FRAMING 3 PLUM9ING INSTRUCTIONS
3. tNSULAt10N
. C N~STR~U
T~ION MU^~T
$${Q~t be comp etely filled in by typewriter or in ink and submitted to the Building Inspector, witi
sets t ~o ~ Fee according to schedule.
I 1"~at~o t and of buildings on premises, relationship to adjoining premises or publicstre
or a Ean~~~~'
e~ d~~ipn of layout of property must be drawn on the diagram which is part of this apl
cati S. N RESP NSIBC~ FOR
t ~~r~~A$~~jyigpppj~tion may not be commenced before issuance of $uilding Permit.
-U"pon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such peer
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 Occupan
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, Ordinances
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describ:
The applicant agrees to comply with all applicable laws, ordinances, building code, housin ode, and regulations, and
admit authorized inspectors on premises and in building for neces m e ons. ~
~
~ (Signre of ap' p ~ nt, or n~a corporation)
f (o Tw i s-r~ N G J,A . LJJ,a n/T A 6 u N ~ ~ ~ ;
(Mailing address of applicant)
State whether applicant is owner, Iessee, agent, architect, engineer, general contractor, electrician, plumber or buiid;
~ 1~ .....................................,.l................................
Name of owner of premises ~CN,t/OCoS5...4 JGa~,N~;../~iG-7-~-U(,.!.`
(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 HS BE UFFO K COUNTY LICENS F/'L
Builder's License iv'o. .~-fit;c!-.~p,.. UU
Plumber's License No . Y ~ T FiCATE
Electrician's License No . f1F CUPA i
Outer Trade's License No . V '
1. Location of land on which proposed work wilt be done .
House Number Street Hamlet
County Tax htap No. 1000 Section "
~ ~ Block ~ a, 0 U Lot
Subdivision Filed i11ap No. Lot .
(Name)
State existing use and occupancy of premises and intend(e?d use and occupancy of proposed construction:
a. Existing use and occupancy c~ h ~ s,~.~z !-t c.:Qa_.2 :~'.~s. ua:~c.,~~
~?:?S~.+C i
b. Intended use and occupancy `
3. Nature of work (check which applicable): New Building Addition Alteration .
Repair Removal Demolition Other 55'ork ..F~. ~i~~ . .
(Description)
4. Estimated Cost
..~7~ Fee....................................
• (to be paid on filing this application) '
S. 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 oC each type of use .
7. Dimensions of existing structures, if any: Front Rear Depth .
Height ...............Number of Stones......................................................
Dimensions of same structure with alterations or additions: Front Rear .
Depth Hcigidt Number of 5to ~''&&SS~~ y~ F.~-.. L.,S .
Rear :~"~`!i'~ fh' .
8. Dimensions of entire new construction: Front .
Height Number of Stories .........................,..,.~..~..a.....,.#! !4.~° ~T.*.
9. Size of lot: Front ...2•.c2 b` Rear 9.s Depth ?~:~.;~-..lo g.`...:a:;I.
10. Date of Purchase - _
....................Name of Former Owner, T~~wt;:'A9:
<'3..ii:S: t
11. Zone or use district in which premises are situated . 84~.i'srll. l~.hi.1.`.'.
12. Does proposed construction violate any zoning ]aw, ordinance or regulation: ~c? . .
13. 55'i11 lot be regraded 9 .will excess fill be removes ft~tr[ premises "Yes r
14. Name of Owner of,premises ~ !u`. ~~4d...... Address~i~.kk M .~rrk:~.l+a, , ~zlv.~ P}ioiie'?`~o: ~.~:3'.:.3~:~Y.
Name of Architect ........Address `7] Phane No.... . .
Name of Contractor .I~l~e C k?.0..~+ ~~,NC , ,4'0: Address~a:2~, /4'>'.: Naas! .,,Phone No. 7-?.7...3.7./x. ~
15. is this property located within 300 feet of a tidal wetland? *Yes No ~
*If yes, Southold Town Trustees Permit may be reggu~zred.
PLOfi DIAG]tAM _ ; _
Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate s71 set-back dimensions fro
property lines. Give street and block number or description according to deed, and show street names and indicate wheth:
interior or comer lot.
L2 CmY,~ ~ ,~j/~ ' taxi ~i C~"~'° G~~"`~l '
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O N >-y F az o~ T s r a~ c I N~ s.
NoN~ ~,`fZ°ss 3gci~
:r
>TATE OF NE ' ~ OR f S:S
~.1~~ 1 ~ • • ~ . • • • being duly sworn, deposes and says that he is the applica~
(Name~of individual signing co act)
'Dove named.
feisihe .............................(~.~Y~~.......................'........................
(Contractor, agent, corporate officer, etc.)
f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file tl
oplication: that all statements contained in this application are true to the best of leis knowledge and belief; and that t]
ork will be performed in the manner set forth in the application Fled therewith.
worn to before me this
...........r. ~~~~...day of`.~.... 19~J ,
o[ar}• Public, ? County
CLAIRE L QI.E1N
No1wy p~b11o, 8ws of tiawYaek • • • • .
No. X879608 (Signature of applicar
OlusliHed M Suffolk CouMY
Commission Expires December 8, 19.....
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