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HomeMy WebLinkAbout18239-z r+osai xa s TOWN OF SOUTNOLD 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 ° ~ $ ~ ~ g ~ Date 19.~~ Permission is hereby a ed to: ~:.Y.~s .............~5 ...~~.,l.~,.......li~' ~i of premises located at ....~.T.~n...r.... ..0.~~~k^clrr..~.....'i....a:!~.-.4 ..d?-f...~......................................................................... County Tax Map No. 1000 Section .......7/~....... Block .........1...........~Leo~t No.......°~.~.`.3........ pursuant to application dated ......~~l..b 19..11...1 and approved by the Building Inspector, Fee uildi nspector Rev. 6/30/80 (o ~ ~ ~ ~OG6C A.~ L" NGL- ' , ~ .a 1A ~ ,q.7.: , ~F - _ ' t . ~ "`4 { / A ~ _ ~ ~r i ~y' ~ c ,Cv~ o ~ ~ fe 4~ ~ ~ ~ ,,r ~ n ~ . ~ ' ~ q ~ rae~~ ~ ~N °7~?~~ ~ ~ ~ ~ ~ C.1 . ~ wq ~ ,f ~.y~ i ~ ~ 4`+ ~ ~ / / ~ ~.at~ vt~~~ S, d,..Q7': °.i?Gt",N71"3 t.~Y r ,`*+f~l?~b!pl C"e`"~~"',t' 11 __JfA+, v v 'w:. .r:?'!{.~.~,u s~r2~4t.,~, Y~..:~+>+1 ?.1'. - - d ...t ~ i s B0.\RD OF HE.\LTH FORM N0.1 3 SETS OF PL.\NS SURVEY TOWN OFSOUTHOLD CtIECK BUILDING DEPARTMENT SEPTIC Foart TOWN HALL SOUTHOLD, N.Y. 11~J71 NOTIFY 7 - / G TEL,: 785.1802 CALL Z~.~-~l;?~r~ , Examined 19~ii MAIL TO : • .\Pproved 194. Permit No. ~U .2 :3 rw N~e~.., ~ (f ' Disapproved a/c ~J ~ I_~ . . . ,JUN (:.,61989 ................C BLDG. DEPT. • TOWN OF SOUTHOLD (Bu' mg Inspector) APPLICATION FOR BUILDING PERMIT y (~y y~j~ Date 115 1 W INSTRUCTIONS ~VI a. Tltis application must be completely filled in by 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 buildings on premises, relationship to adjoining premises or public streets ~r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appB- _ation. 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 Certiftcate 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 3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions ar alterations, or for removal or demolition, as herein described. Tile applicant agrees t55{~~pgyp IIyy applicable laws, ordinances, building code, housin, code, and regulations, and to admit authorized ins~~tlE~s>~tt~r~~e~~and in building for necessary inspecti s. ''alw~•..••••~p ~•-4--°--^ ~ ~t~°1 (Si;natur of applicant, or name, if a corporuon) • 7is 1xns~l~n. i}1~1141~.71136a ~:n {tahi ~ . f1~#fliiJ£) t~+~~ ~ ~°'}~t~'~x<~-1'~` ` (I`4ailing address of applicant) State whether applicat3ill~;25IJril:F~"tl°rs`s~ee~`'~a~~nG, architect, engineer, general contractor, electrician, lumber or builder, ~ .U' ~1 h <dY>3 #''.'s~ P • ,w ~'''i b p 1'Igt,~l~t dh:J~1~.a.1 Sit"t~Y Name of owner ofpremi~s%I`P'4Y'."t`"x`t~ ~ ~0~ 7'3~4~ .usaa~ Nit+t„sr)Ifii4 '.r~ : ~ ~ 1 Y ;HST ~"tNNt~iY4lU;~'3t~ •nlll- (as on the tax roll or latest deed) , fapplicanI is~~rat~'otlq~~{yt~T@tt~j2'lu)~Ait1'horized officer. (Name an title oyf corporate officer). f Builder's License No. , , , , , , , , , , • Plumber's License No . Electrician's License No . OtlterTradc'sLicenscNo, Location of land on which proposed tv rk will be done. Ilause Number Street • ~ • • ' ' ' • • • • • • • • , , ~~jj Hamlet County Tax \tap No. 1000 SeC[lOn ~.Q , Block , , • , • Lot , , • . • • • Subdivision Filed Atap No. Lot . ..(Natnc) State existing use and occupancy of premises d intended use and occupancy, of proposed construction: a. Existing use and occupancy ~N,.,u';~!r;~(~ b. Intended use a . 4...~ J . nd occupancy ~ , 3. A'aturc of work (check which applicable): New Repair , lluilding , , , , Addition . ~Uteration • R4moval Demolition Other 55'ork . •,r~=.W ~i~-: 4. EstimatcdCost.,~~~, (D,:scription) Fee . 5. If dwelling, number of dwelli ~ units ~ ~ C (to be paid on filing this application . • Number of dw ) If gara,c, numhcr of cars ~e, , , , ~ ~ • • ' ' ' ' ' clung units on each floor ti. If business, commercial or miffed occupancy, specify nature and extent of cacti type of use . • • ~ ~ ~ • • • • 7, Dimensions of existing structures, if any: Front . . • • • • • Height . N4mbcr oC Stones , ' • • Rear Depth . • • • • . Dimensions of same sttucturc'with alterations or additions• Front ~ , • • • • • • Depth . . Height . ...Rear . . . ' 8. Dimensions` of ~ntirc new construction: Fro ~ ~ • • • • ~ • ~ • ~ ' ' ' ' ' ' • • • • Number of Stories . ~ ~ • • • • • • ~ ~ • ~ ' ' Hcigltt Ny'mber of nt Rear Depth . ~ . 9. Size oC lot: Front ,7, Stories • . 10. Date of Purchase ' Rear /~v , De th ..c? . . • ~ P Q~'•~~'......... . 11. Zone or use district in which premises arc situated , . • 'Name of Former Owner , 12. Does proposed construction vr¢latc any zoning law ordinance or regulation: • ~ . 13. SVilllotberegraded • • ~ ~ ~ . 5Vi11 excess till be removed from premises: Ycs • Nc l4. Name of Owner of premises , ,I, , • • • ~ • ' ' ' ' ' ~ • Name of Architect ................Address Plronc No. . Name of Contractor .......Address ...................Phone No.............. . IS.Is this property located w •""'••'Address.. .PhoneNo.. *If yes, Southold Town TrusteesnPeOrmitemay bearequiredetland? *YES..-.NO-,,,~• PLOT DIAGRAh1 Locate clearly and distinctl}' alj buildings, whether existing or proposed, and. indicate all set-back dimersions fror;r property lines, Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. I AP dA=~j DATE: ~~~~~M.R N~ NE ~ 786-1802 9 AM TO 4 P FOR THE • FOt-LOWING INSPECTIONS: , I T. FOUNDATION TWO REQUIRED - FOR POURED CONCRETE ' 2. ROUf3H - FRAMIN© !r PWMSING 9. INSULATION 4. FINAL - CONSTRUCTION MUST SE COMPLETE FOR C.O. ' All CONSTRUCTION SMALL MEET THE REQUNIE4TENi`S OP THE N,V. STATE CONSTRIICTTION i II CODE. NCT RESPOI~fQII i DE31(iN OR CONSTRUCTION EMIIIp118 TATL• OF \E51' YORK, OUNTY OF . . S. ' ' ' ' ' ' ' ' • ' • • • • • • • • , being duly sworn, deposes and says that he is the applicant (lame of individual si;ning contract) rove named. :isthc . . • . • (Contractor, agent, corporate officer, ctc.)• ~ • ~ • • • ~ ~ • ~ • • • " " • • • • • • - said owner or owners, and is duly aptlrorizcd to perform or )rave performed the said work and to make and file this ~liration; that all statements contained in this application arc true to the best of his knowledge and belief; and that the rk will be performed in the manner set forth in the application Glcd thcrowith. om to before me this ~.~11// ,,,,day of..: 19 ark Public, , - , , , ,/~2~2~ pQ_ • , ' ..Z.~ County i HELEN K DE VDE • • • • • • " ~ ~ ; r!•`'~! , ,l~J NOTARY PU8L10, State M New York . • . . • • . No. 4707878,SuflolNCounty (Si,nature of a lrcant) Term Eopirea North 30,19~~ I ~ PP i ~