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HomeMy WebLinkAbout18153-z PO$NI NO f TOWN OF 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) N ° 1 ~ ~ ~ Z Date .........:3/ 19>~/.. Permission is hereby granted to: to .L~~ ....~t.. ~ ~p~~~~..,~ :7y?..:~. ~ . at premises located at ...+~.1~~..~.a~.,.? .....~r~l~...?). ....~.~.......~6~'GG~,,~,,,~ ....................................................Q~d2!%G~`'9............................................................ County Tax Map No. 1000 Section .......97....... Block Lot No.......~ y:....... pursuant to application dated Z 19..~ and approved by the Building Inspector. Fee i ..L~1.,~..... . . uildin nspector Rev. 6/30/80 5 e~ B0.\RD OF HE.\LTH U , 3 SETS OF PL.\NS FORM NO.t SURVEY P 2 ~~g9 % TOWN OF SOUTHOLD CHECK . BUILDING DEPARTMENT SEPTIC FORM ~ TOWN HALL 61•UG. OF-~ ~ ~ EOUTHOLD, N.Y. 11971 NOTIFY TOWN OF S0, r`i! ' W • TEL.: 7651802 CALL v MAIL T0: Examinud .'9~,~, 19~ . APprovud ~.~jl..... , 19~ Permit No. ~~JJ~. DisaPProveda/c din~ector) APPLICATION FOR BUILDING PERMIT Date 15 INSTRUCTIONS ~ a. This application must be completely 511ed in by typewriter or in ink an_d s_ub_ m_itted 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 adjoining 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. I 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 Re;ulations, 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 code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary insp coons. ~ /J ~f~ tgnature of applicant, or name, if a corporation) • E.,.~,,,,, ~ /al S cue ~ 1193 f'~~-• (Mailing address of applicant) ~•~t~ b~1~1~S1,x3 F ii ~e~S State /wheihe~~pplicant•is~,o\vners lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. a~. .tit k: ~''"E ? ? ?li) y1: ~ ~ ~ ~ Q C. Name oC' os~tt'r°of prer~~as 2 s"..i; .~.r.~/./°.' ....l.":......Y. d . , (as on the tax roll or latest deed) _ If applican cbrp'tir ti'ph;3si " ~t~tre of duly authorized officer. iii • ~ •`/~'.~~~.~e , , , ~ • • • • , , , , • • • • • • . ,~Ntt'mie'a41~\~le;ofcorporate//officer) ~B~.ggi)jd,QQ'S~l~ic`a>7sd'No. Plumber's License No. C.. ~ ~ ~~:.:P . Electrician's License No. , Outer 7•radc's License No. , . 1. Location of land on which proposed work will be done . • , , , • , , , • , , • • , • HouseNumber ~ f$t,?Jr Street -4~G~ Ham County Tax Map No. 1000 Suction Block Lot . Subdivision !'d'............ F.ilud Piap No. •tv~~„ • „ • . Lot . i:'.~/S (N~m) State existing use and occupancy of premises and in[endud use and occupaynvcyy~of/propofse~d c~on~struction: a. Existing use and occupancy ....~p....`~• • :.I...:~:`:!"~ . b. Intended use andoecupancy ....~-+A•~~••• ••••••••e~'~:~'••....••••,•••„•••••,_,•,,... 0 ~ ~7 ~S3 I 3. IJature of work (check which Applicable): New [luilding ' Addition rUtc~a' trr Repair Removal • on . ~ . . • • • • • Demolition Other 1V8rk`.~ , , . , , , • 4. Estimated Cost ...........r ..~~SrpO'~' dv ~ (Dc cription) I Fee g. g units . 5. If dwcllin nurnbcr of dwcllin (to be paid on filing this application) • • Number of dwelling units on each poor , . If garage, nurnbcr of cars ~ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .~4g~, : , ; !des~:~~, 7. Dimensions of existing structures, if any: Front , , Height Number of Stories Rear Depth Dimensions o same structure with alterations or , dditions: Front , p~`l• 5' ~ • • ' • Depth II . Ilcight . Rear .a~: G 8• Dimensions of entire new construction: Front . , p,~,`~' ~ ~ • ' ' ' ' ' • • Number of torics , Height . Rear . ,c~,~(: Depth . S . I~[urhber of Stories . , 9. Size of tot: Front ...oZ~{ :5. Rear . ..a;{. ~ . ' . . ~ lt), Date of Purchase ~~,~p • • • • • • • • Depth .~Y , , , F'""`•••••••••••..nNamc ofFormcrOwner ./~f~. ./t~~f~ 1 1. Zone or use district in which c p 'cmises are situated . , 1?csy,y4R.~-• Cu" ' ' • _ • • • • • . . Does proposed construction vio o hate any zoning law, ordinance or regulation: ../,l/,(~, • • ~ ~ • • ' ' ' ' ' ' 13. Nill lot be regraded • - 14. Name of Owner of premises ~±E , • • Will excess fill be r moved from premises: Ycs (~o Name of Architect ftlrfiry-:e,.•; , • " • 'Address . (J;l~• ~;1?'rrayh !t!~Phone No. T'!~ y~;y~ t:/.4: Name of Contractor . • • Address . , ,/tom; ,Phone No..`? 3~-~ y p~,r, ' IS.Is this property Ioc"'ted within~••"Address.......:•,:,,,,•,,,PhoneNo...... I~ ~ 300 feet of a tidal wetland. *YES..,.NO.... *If yes, Southold Towq Trustees Permit may be required. I, PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from _ property Gnes. Give street and block ,number or description according to deed, and show street names and indicate whether interior or corner lot. 1 I --1---, ~ U . i I F} o^`. ~ra~s1-~ ~ ~ t ~AtES APPROVE~IA8NOTED N IFY BUILDIN© DEPARTMENT AT 786.1802 S AM T~ 4 PM FOR THE II f FOLLOWING INSPECTIONS: 1. FOUNDATION ~ 'CSC-?t-~° ~ ~ FOR POUREp CO~~~ EOUIREp 2. ROUGH - FRAMIIV~ ~ PLUMBING 3. INSULATION I 4l. FINAL - CONSTq~ICT1ON MUST 8E COMPLETE FOR ~,p, I ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION 8 ENERGY CO[)ES. NQT RESPONr]18L`~ FOR DESIGN OR CONSTRUCTIQ1y ERRORS STATE OF NE1V YORK, COUNTY F , , S -G•c~.`..... S q........ (Name of individual signin•i ~ • • ~ • ' ' ' ' ' bC1ng duly sworn, deposes and says that he is the applicant contract) about named. ~Ifc is tftc ........~.~rarL ' (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 this =PPlication; that all statements contained in this application are true to the best ofltis knowledge and belief; and that the work will be performed in the manner so,t forth in the application pled therewith. ~tvorn to before m••~e this 'I aSX.. ....day~~o//f..~' •d~ .7,),;. ...,19.~~ ,/rte btary Public, ~tJ~ C~i)'nt _ ~ C~~~` NELEN K DE YOE • • • • • • • . NOTARY PUOtIC, Slate of New Vork ' ' ' ' ' ' • • • . I No. 4107878,SottolkCounlY (Signature of a Leant) Term Ezpirea March 30,19._.;.%/ PP • i