Loading...
HomeMy WebLinkAbout18040-z roans xo. s 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 18 0 4 d Z Date 19.1.. Permission is hereby granted to: e . . . . . . . . . . . . . . . . . . . . . . . . . . . ..nn . . . . . . nn. . . . . . . . . . . . . . . . . i . . . . . . . . . . . v . . . . n . . . n. . . . . . . . . . . . . UU.. . . . . . . . . of premises located of ...T..c77,..~.....l~4~GS 4it....../.,~ ~.,...........~.P: irrtiT.~.9~ County Tox Map Na 1000 Section o~ Block ......5~°.j......... pLot No ....Q.~..... . pursuant to application dated 19...1.., and approved by the Building Inspector Fee $...:~`.5:.~... . Building Inspector Rev 6/30/80 ~G M ~i, N w ~t ~ ~ ~ c Gi s ? ~ a ~ ~ v a H Q ~ N . ~ . ~ l ~ i a r ' ° ~ ° o i ° ~ ' ~ s G , 2 m m i m £ a m f o 4 ~ . ; c ° , f ~ ,e ~ m ~ n ~ = m a / 4 iy ' n~ i ~ ~ ~ 1 -y, o ~ Z ~ 't ~ ~ (Z ~ E ZV I ~u3cst. y ~Y u`. - S.ZS°OS'"vQ'W. t00.1J -r ' . ~ q ~ ~ o I1 z0. ~ ~ o• ; ~ h 1 , C 11 f a ~ ' 1pµ - ~ `4 L• ° y ~ .a r , r ` ~1 ~ - BOARD OF HEALTH 3 SETS OF PLe]NS FORM N0.7 SURVEY TOWN OF SOUTHOLD CHECK . BUILDING DEPARTMENT SEPTIC FORPI ' TOWN HALL EOUTHOLD, N.Y. 11iJ71 NOTIFY TEL.: 7651802 CALL Examined ~ ~ -l 19.1. MAIL T0: Approved . ) ` , l9 0~. Pcrmtt No. $ ~ ~ . 1 Disapproved a/c 7 ~UF§OU1NOl0 (BuAdmg Inspector) APPLICATION FOR BUILDING PERMIT Date . ~ I5 INSTRUCTIONS a. Tliis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 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 stree or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this app capon. 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 perm shall be kept on the premises available for inspection throughout the work. e, No building shall be occupied or used in whole or m part for any purpose whatever until a Certificate of Occupane 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 ti Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Rcaulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descnbe~ The applicant agrees to comply with all apphcab7e laws, ordinances, budding code, housing code, and regulations, and admit authorized inspectois on premises and m building for necessary mspections_ (Signature of applicant, or name, if a corporation) .fie ~Dk~,~~:..~©x~Yv~.~S©~r~o1z (Mailing address oC applicant) State whether applicant is owner, Iessee, agent, architect, engineer, general contractor, electrician, plumber or builde. O .r~~.yl.~.~ti ...........................J.V~...........:................................ Name of owner of premises ..~4FrYtTer..'(`. ~OO~,vL. ! ~•~"y N ~ ~ . . (as on the ta~c roll, r la[esY deed) !C applicant is a corporation, signature of duly authorized offices _ .Y y (Name and title of corporate officer) . Builder's License No. ~ . Plumber's License No Electrician's License No Ot}ier Trade's License No . . 1. Location of land on which proposed work will be done . y~o.. C e~?~-~?.. ~R ~pu~~~l.~........................ . I{ouse Number Street Hamlet ~ County Tai tap No 1000 Section ro~;4"t-~ Block , Lo[ . ~ Subdivision .Filed Itiap No. ~O. ~.z...... Lot . (Name) State existing use and occupancy of premppises and intc~~nttd/ycd use and occupancy of proposed constriction: a. Extsttnguse and occupancy .......Y.n ~!..~I.,~l,~• . y.~ . . , b. Intended use and occupancy ~ M ~'tl'~ S .l t ~ . tbM9iwn'~ 3. Nature of work (check a•htch applicable). New Eluilding Addmon .Uterat~n Repair Removal Dcmolttton OthcrlVork,l'.~J.~.C:~- (D~scnptio 4. Esttmatcd Cost I ~~:~4 Fee . (to be patd on filing thu appltcauon) 5. If dtvelttng, number of dwetltng unt~ L , Number oC dwclltng unds on each floor . If garage, number of cars . 6. IC business. commercial or mixed occupancy, specify nahtre and extent of each type of use . 7. D ~y~y e.C2 structures, tf any Front Rear Depth . . H ~ . 'yl 1 Number of Stones .......l........... . Di sio f same structure with alterations or additions-. Front ....,J`. °t.... • • . Rear .+2~. 2 . , . , D . lietght Number of Stones . Dit~n nsi entire new cq'nstruchon. Front Rear Depth . He ~ Number of Stones . 9. Size oC ~ ~ ~ 4~.N+p~ta.~.~: Rear J. ~Q t R DG th ~ oO t . 10. Date""of'I'luichsse ..,tt'rf~'~.~..~~I.g~............NameofFonncrOwner tt'?!, fJ'.d./~.f•)-3~':~~~Pc~~~7,~~ 11. Zone or use district to whtcft premtses are situated . 12. Does proposed construction.v~tolate any zoning law, ordinance or regulation: . ~4 13. Hdl Iot be regraded .....Hill exc ss Gll be removed from premtses: Yes 14. Name of Owner of premtses ~'}'~~..l~?~1J~N~ ...Address . ~.~.4°~f~~~.... Phone No. 7t~.~o ~f Name of Architect ...........................Address Phone No....... Name of Contractor ..........................Address ...................Phone No....... . . iS.Zs this property located vithin 300 feet of a tidal wetland? *YES.., ii..,. *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buddmgs, whether existing or proposed, and indicate alt set-back dimensions fry property lines. Give street and block number or description according to deed, and show street names and indicate wheti interior or corner lot. { p~ as N(?r~o oarE• 1 B p ~~7E'~o'~~D--~ FEE gyY Ci.l.• NgnFV SU40{NG DEPARTMENT AT . 164 1862 `3 At\A TO n PM FOR 7HE Ft)Ltf7eY9VG tVSPECTtONS t FOUNRATION TWO REQUIRED FOR POURED CONCRETE 2 ROUGH • FRAMING & PLUMBING 3 tNSULATiON 4 FlMAL - CONSTRUCTION MUST 8E COMPLETE FOR C O ALL CONSTRUCTION SHALL MEET 7HE REQUIREMENTS OF THE N Y. STATE CONSTRUCTION A~ ENERGY CORES. NQT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF XEH YORK, COUNTY OFCC.~4 ,~~.4 , . S S ..1.~. l :1'~ being duly sworn, deposes and says that he is the applic: (Name of mdrvtdua! signing contract) above narncd. Iie is the ~~'(r,f/`/e~~ (Contractor, agent, corporate officer, etc.) oC said owner or owners, and is duly autftonzcd to perform or have performed the said wort. and to make and file t apphcauon, that all statements contained m this application arc true to rite best of lets l.nowledge and belief; and that •vori, will be performed in the manner set forth m the application filed thcrewrth. iwom to before me this ..........C.,;........ da~y~ oC..~ ............19`... r~('GA rotary Public, i.... i.. County j__ G ~ (Si,nature of appiica OnMli1~~'