Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
19004-Z
FORM NO. f TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN WALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N219004 Z Date .. .... .. .......................................... 19X. Permission is hereby gran d � � ...... ... .. /330.�...`. i......... 2®............. to ..... /.. ......... ............... . . .. . .. .... ... ... ... .. .. ... ........ .. .......... .�....., :...�. ................................................. .......................................................... atpremises located at .....fc ... . . l�.t . ...... . ,.......................................................... .................................................. . .... .. 4 � ......................................................................... ................................................................................................................................................................. County Tax Map No. 1000 Section ...1 l .......... Block .....//........... Lot No. ... .,. .. ....... pursuant to application dated .........�N�...................................... 19 �., and approved by the Building Inspector. Fee $.. . ...............� .. .. ..... ,2�,�........ ��ildin nspec or Rev. 6/30/80 BOARD OF HEALTH . . . . . . . 3 SETS 0 PLANS . . . . FORt/l NO. 1 SURVEY � � • _� _ � _� ' - TOWN OF SOUTHOLD CHECKyy�_ _ BUILDING DEPARTMENT SEPTIC FOR:I - • • • • • • • • • • - TOWN HALL SOUTIiOLD. N.Y. 11971 NOTIFY , q n TEL.: 765-11302 CALL ',�,�? ..3 Examined . 19 MAIL TO : . . • . . . Approved . . . . .,7 . . . . . . .. 19ir Pcrmit No./22P O . . . . . . . . . . . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - -� =,i ► bl MAY — 11990 . . . . (Bi. ding•Inspector) APPLICAT N FOR BUILDINGPERMIT TVN 01: v171-i-D Date . . h/h J�RS'/_..-..._, INSTRUCTIONS a. This application must be completely filled in b y 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 buildin-s on premises, relationship to adjoining or areas, and giving a detailed description of layout of property must be drawn on the diagram which h Papulic street cation. rc oft his appliS C. The work covered by this application may not be commenced before issuance of Building Permit. !hd. Upon approval of this application, the Building Inspector will issued a Building Permit to the applic2nt. Such permit all 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 Ce shall have been granted by the Building Inspector. rtificate of Occupancy 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 Re_ulatians, for the construction of buildings, additions or alterations, or for removal or demolition, e' The applicant agrees to comply with all applicable laws, ordinances, building es 'bed admit authorized inspectors on premises and in building for necessary inspections.de, housin., code, o s . ' .�A7'i?'T�ci�• V,����r�'I?zz�- .� � _ ,fie (Signature of applicant, or name ifCz(cor or (Mailing address of applicant) l/ State whether.•;;apphcarit;,.is,owrier;" "ssee,'%agent; architect, engineer, general contractor, electrician, plumber or builder. '. '.':t' 1 A•�; . . y . . . . . .y. .y:.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...... . . . . . . . . . . Name of owner ofprem i'ses © {} ; ,`',�•'� UP, . . � (as on the tax roll or latest deed) If aIn s o;; �r. � si n u of duly authorized officer. (NarM."4nd titie°of rpQratd ;oGf ccr;)�^ BuiIdcr's''Liter' rAc ,�" •+mq Plum ber's +: 3•'aa.�ia'�"si•','s' Lcccnsc No. Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . , , . 1• Location of land on which proposed work will be done; house Number • • . . . • . . . . . . . . . . . . . . . . . . . . Street. Hamlet • . . . ' • ' ' . County Tax ,flap No. 1000 Section . . . .U. . . . . :. . . : : Block . . . . . . Lot . . ., !" Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . .;i'. . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. Lot . State existing use and occupancy of premises and intended use and occupant _ f� y of proposed construction_ a. Existing • J�� Z�e �^ use and occupancy . . . . . . F �` .�. . .�. .. . . . . . . . ... b. Intended use d .. . . .�. 1 Q ,� . . . •A.,,'i an Occupancy ... . . . .. .:�1: . . .. I10! 3. Nature of work (check which applicable): New Building • . . . . . . . . . Addition . . . • . • . . . .uteration . . . . . . . . . . . Repair , • Removal . . . . . . . . . . .. . . Demolition .Swi:anin; pool. . . . . . . . Tennis Court Accessory Building. . . . . . . . . . Fence . . . . . . .Other�tTork.��.� �• 4. Estimated Cost . . . . . : .�.r�,<'. . . . . . . . . . . . . . . . . . . Fee . . . . ... . . . . . . . . . . . . . . . . . . .. . . . . . .. . . . . �• (to be paid on filing this application) S. If dwelling, number of dwelling units . . . . . . , . , . .� Number of dwelling units on each If barage, 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 . . . . . . . . . . . . . . . Number of Stories . . . .. . . .'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . .... . . . . . . :. . . . . Depth . . . . . . . . . . . . . . . . . . . . . . Fleight . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . ... . . . . . . . . . . . . . S. Dimensions of entire new construction: Front . . . . . . . . . . . . . .... . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth ... . . . . . Hei-•Ilt . . . Number of Stories . . : . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . .... . . . . . . . . . . . 9. Size of lot: Front . . . :. . . . . . . . . . . . . . . . . . Rcar . . . . . . . . . . . . . . . . . . . . . . Depth . . . . . . . .... . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Former Owner . . . . . . . . . . . . . . .... . . . . . . . . . . . . ii. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . 13. Docs proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . • • . . . • • •.. . . • . . . • • . . 13. Will lot be regraded . : . . . . . . . . . . . . . . . . . . . . . . . . . . Will excess fill Uc removed from premises: Yes . .. . No . . 14. Name of Owner of premises . . . . . . , , , , , , • ,", , , , Address . . . . . . . . . . . . . . . . . . . Phone No. ..... . . . . . . . . . . . Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No: ...... . . . . . . . . . . Name of Contractor . . . . . . . . . . . . . . . . . :. . . . . . . . Address . . . . . . . . . . . . . . . Phone No. ....; . . . . . :. . . . 15.Is this property located within 100 feet of a •tidal wetland? *YES- -- -NO. - - - *If yes , Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly 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. 4 AC 141PY 6. "f y(f A-ONr S 702 � ,r APR VED AS NOTED DAtE:� t5 B.P 8 906el FEE: BY: NOTIFY 13UILDING DEPARTMgXTAT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION ,,, - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - .CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHAH MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS - STATE OF NEW O r COUNTY— . . . . . . OUNT . 1 S.S • • • . . • • �- �s f� :� • . . . • . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual—si�nirlo contract) above named. Heis tile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Y.:S . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or llave performed the said work and to make and file 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 the manner set forth in the application tiled therewith. Sworn to beforemethis . . . . . . . . . . . . . S . . . . .day of. . . . . . . . 19� Notary Public, ,�,Q��Q, . . . . . . . County - •CLAIRE L,GLEW . Notary Public,State of New Yodt • • • . . . . . . . . . . . . . . . No.4879505 (Signature of applicant) Qualified in Suffolk County Cemtnlesbn Eaplru Deeembw 8,1 .�.• ' ( E n 02/21/9lJ0�2 FROM 6E$S1';4MEYER F550C. 02.21 1990 00:54 P. 1 4}: Vo t N,O/F . MA-rTITUCK :3 t iATION N LIBRARY ASSOCw `. M N IQ I f EUGENE GIANff ' 75• O.w � Hb,'�2 11 4 (- a 994' :rye 1 r di meq,�amo c 14 {�p1 goj ti r y 4 117' - (� i ripti s. d -..� uj To w N. 30 47� 00�� Y1► "','s -:. NIQIf KATHN LEEN MARY KEDALL - t '3 :f `•r -------- --------- ------------------ --------------- • s'4, it. f•w 02/21/90 08:53 003 FROM SESSY-#MEYER :.5500. 02. ?1 . 194Q 08:48 P, i K SPPROVE018Y*A*Rama, USA (516) 727-8311 v,p:jd���O 8M01 0*6AV TUCK MATTI y„ VILLAGE PIZZA 7'' N y1/ , 8910 6 ' �ltTlS� ,SCALE FACTOR: 1 .5 INCHES - 1 FOOT APPROVEOiBY*A*Rame. USA (516) 727-8911 U(CT7- 1� mAjfuH`j' I A DOT::�q p QQ ((-D) 6 � 1v jt;i� SCALE FACTOR: 1 .5 INCFES � 1 FOOT 0