HomeMy WebLinkAbout18280-z rossi 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)
~ ~ ~1 ~ O ~ Z Date ...............7 19A
Permission is hereby granted to:
~.1r6.lti.....~.
to .s~,......~~.-~-~~t....C... ~.~.~..s~.~.~.....
of premises located at..4~.~.°..qS:.........~~....~ :................c!~:~zi~s--r,....................
. 1.5:..... J~`~'
County Tox Map No. 1000 Section ......I.~.3" Block ~.5........ Lot No...0.3............
pursuant to application dated ......~,A.`!:kR,..,....~.~ 19.~.q.., and approved by the
Buildin_g/(Inspector.
Fee $.c~r?...:/...
.
But ng Inspector
Rev. 6/30/80
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~ n 60.1RD OF HE.\LTH : , •
u FORM17N0.1 ~kC 3 SETS OF• PL.1YS •
,.n~ SURVEY
TOWN OF SOUTHOLD CHECK
~ [3UILDING DEPARTMENT SEPTIC mart
TObVN HALL '
8 DEPT SOUTHOLD, N.Y. 11971 NOTIFY
pffi q TEL.:765~1802 CALL
Examined 19 ! MAIL TO : • .
.\pprovcd ~•4~•{,I„~, . 19 .~gPcrmit Nod S aid .L•
Disapproved a/c
(Building Inspector)
APPLIC ION FOR/~ PERMIT
~c~ ~'12r'l l
j
Date . 15...
• INSTRUCTIONS
a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
:ets 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
ar areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-'
.cation.
' c. The work covered by this application may not be commenced before issuance of Building Permit. '
d. Upon approval of this application, the Bui]ding Inspector will issued a Building Permtt 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 Bui]ding 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 or alterations, or for removal or demolition, as herein described.
Tile 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 inspections.
. ~kk~?~P-w -.VS.. cc~2P
(Signature of applicant, or name, if a corporatton)
~.8o4S . M!~~ ~1. ~!Q.. c'.s~cW~?Ci.~C..1lq.3~
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Qame of owner of premises . ~-Fa-;k~, ~
.
/ (as on the tax roll or latest deed) • ' ' ' ' ' ' ' '
f applicant' co tzration, si n ture o authorized officer. ~~ts SIC~t~ (L.tr~,age„4."S ~ pL~I)
?d cR- StG~.1 T1~L~,a LZ~w~.l ~0.1R..tu..r(,,. (~-~,yS-i'+wt~to~
(N me and title of co ora~c officer StCwt,,,~ lS 5~••IA~.t..l'1•t. a ~faT' f~15 HIGH
Builder's Licansc No. A, vl-+D OI.C~ 5t(~~ ~..s1~s
P~l~fCLe~~'b (3y 2SOL1'1•~ru~,7 C3ua~at,o~ ~ APP~"ta~S
Plumber's License No . OW Nt~y 1~ Zq6 ~ Co,py op PUC3Lat yG}~(L,,
Electrician's License No. ` " '~~~~bi'. §°5
~~wti1~-n.~$S~A~P~PucA~tsul -
Othcr Trade's License No. a p•
Location of land on which propos • work will Uc one. .~fi " G2~ ~ ' ~
c)1LHOC~taEt,l..\;~VJ \'1~1F(LOV.SCO~• ~ ..,t,.., ,.}.,;}..iri:~~~ 7.~ta.'4. Ftt
House Number •«~V~..
Street. ~ b~~,S ~'t;{49`3'^St~'.'D•.3it'Ft.
® ',s.~tt3~e°tl,l" ~ ~7i5+'t'~Af1'i •~~P~kX~iFB
County Tax Map No. 1000 Section R~...... , . Block - ~`°•°tl""~I f" ..,3
Subdivisio[l t,.,, S;i1 '.94r1?",~tirSf: ~ .~d~NfC):f : f0 .
F.ilcd Ista t:E ~ #
r;~t1~Fi3 ffi t.<~S•s'.;;,,,(N~7~rc)" ~8i ,.s.F~,40~! &~4't~lp.~i'ffit:~t193.,31C3 Lot
State cxisti'HO~~~ ~~,p`~puttcy.gf,pre*rn;ys34s and intcndcd~l ~ ~ ~ ~tl~`c'o~struction:
a. Existing use and occupancy ..~~"?~'~`~1....~1..~r:~~t~Fa"ir~'rs?"'°S't Tt~>'A .ffii`;Fi,3::
b. Intendc ;~ttewtts:lii ir4$'tsY„~tst~~`~a~~~.A1..i.+ d~I
d use and occupancy
l I
, r•y ~ .
~ 3. Nature of work (check which applicable): New ~ .,~~_~~l'°f , ' I~
Repair ~ Uuilding i1~il~i'Rio'rt`°:::'..:'":'.~.. r~ltcl'~tion
i Removal k
• • • • • • • Demolition
4. Estimated Cost • • ~ t (Dacnption)
. Fee ,,.r°~ . .
5. IC duelling, number of dwclliny u its N./Q's, , (=10'~ " °1' `pna PPlication) • • •
If garage, number of cars NUmblr of dwelling units on each floor . . .
6. Ifbusincss,commcrcialormix do~ctcu anc
- 7, Dimensions of existing ~ P Y, sPccil'y nature and extent of each type of use .~~?u`1y ~?+:1~1r"~S•Gr,tA~
d structures, if any: Front .
Height . Number of Stories ' • Rear Depth .
i Dimensions of same structure with alterations or additions: Front ~ • • ~ •
Depth. . Height. Rear...,..............
8. Dimensions of entire new const~fuction: Front , • • ~ ' ' ' ' ' ' ' • • • • Number of Stories • • • • • ~ • ~ •
Height Nutnbcr of Stories Rear Depth • • • • . .
9. Size of lot: Front ~:4!?'1. ,L",1VCLpf,L•~ . .
10. Date of Purchase ~ Rear Depth • • . .
.
. ..................Name of Former Owner • • .
~ I I . Zone or use district in which pri;mises are situated , ' ' ' ' ' ' ' ' ' ' ' ' ' ' '
1 Does proposed construction vio'atc any zoning law, ordinance or regulation: , , .
l3. 1Villlatberegraded
I 14. Name of Owner of prcmises~,•~~1 ;~1 "YC~• • • ~ ~ ~ ~ ' ' ' ' • Will excess Fill be removed from prcmises• yc • N •
Name of Architect _ ' ' • • • • • • Addres~Au^1,~,rQ, ,CJ.~;Cakr~tg4~=Phone No.~(:~a•; fq~ ~q• •o
- Name of Contractor ' ' ' ' ' ' ' ' • • • • Address ...................Phony. No... •
IS.Is this propertq local'ted '••••.Address.. phoneNo.. •
within 300 feet of a tidal wetland? *YES....NO
*If yes, Southold Town Trustees Permit may be required,
- ~ PLOT DIAGRAIv1
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 decd, and show street names and indicate whether
]nterior or comer lot. I
~ ~ •
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IQU~3`O C12i N~SJ
T,\TE OF XE1V Y'ORI~, ~I ~ rt*t`r^tfrf; qr ?tn+FD
OUNTY OF . . S.S APPROVED AS NOTED t, ' ` -
..~~.~I S.p~ M (.-cF. ~_.~,~_.93Y: t'7 AT
(Name of individual s' t.. ugly swot•p deposes'and~S5y9-trh~t he i°'
tovenamed. .Cn' L 7, ,o,._ ,t ,~•vf i,~~~~~~plicant
_ NOTIFY UILDINO OEPgRTMENT qT
= is tltc . 766.19 AM TO 4 PM FOR THE '9 , ~ ~ ,1.~ NEOU~RED
fAL!-O G INSpEGTIOryg;. .
• ..SCE:;^S;sIb4~?Ey'.~JCiiETE
1. FO NOA06OIgtractppygggEO~~ratc officcp, ctc:)~t t t?aMtIJG FiLUAIIBItJO
said owner or owners, and is ul , t `watt
Plication; that all stateme,'nts c t ~~~~t or have performed'the S ' d' wog
~~Pt'reaEl~~ to tlic (icst4o!"1~i~~ t<v,,~"~T~R1CT1Jf~IOJAdtlSfilc Illis
'rk will be pcrfonncd in tlae marfic I L ~1 tar ~ '~A~. '~BRtlrag,uf; and that the
om to before me this " •
tNU1CtIONrMl18T thcrL•with'ALL CONSTRUCTION SHALL MEET
8E COMPhETg FOR C.Q. THE REQUIREMENTS OF THE ' N.V.
' • • • • • • • • • • • • • L .dav. ~N=TAl1CTI0N SHAhI• II~ ~ STATE CON8TRUCTION A ENERGY a
IREMENYS'01t' ~ • ip CODER. NOE RESPONSIBLE FOR
:ark Public, i STATE CONSTRU(;1'ION ~GV DESIGN ORCONBTRUCTIONERRORS
COQ@S.r •Nln"RESP'ON FOR
DE814N,OR CONSTRUCTION ERROR8 '
6 • (Signature otapplicant)
I
N I 0 ~ ~ MpANY
GO
w0
KENGNP ~ aiki~9 Lot \~'0 08 °nsn~ a
Asphalt P ot~ N ~ Z
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NOTE
EXISTING BIDG.NOT SHOWN HEREON SURVEY FOR
TO BE REMOVED LOf S ANN TE R P
Prepared in accordance with 4he minimum AT C UTCHO G U E
standards far title surveys as established by TOWN OF SOUTHOL D
the L.I.A. L. S. and approved and adopted
for such use by The New York State Land SUFFOLK C 0 U N T Y , N Y .
Mlle Association.
1000 - 102 - 05 - 03
~,~''~AND SCALE I" = 30'
~~~yo A.ICC9G~ JUNE 20,1986
NF
C>>O 2~ ~
t t
N~~. ,No g®6 Q~' N. Y. S. LIC. N0. 49668
OF
)PECON YORS 8~ ENGINEERS , P. C.
( 5161 765 - 5020
P. 0. BOX 909
MAIN ROAD ELEVATIONS ARE REFERENCED
SOUTHOLD N.Y. 11971 TO AN ASSUMED DATUM.
86 - 293
n..__ ~_t