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HomeMy WebLinkAbout17795-z FOEM NO. D TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CfHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N Q 017 7 9 5 Z Dote 19...1. ~w Permission is hereby granted to: /~3 ..7.~~r............ ..y....5~.~.f.. .i. .c.v. ~ ' . ~r~.. ~ ~ ~ ct premises located ot ..7..~.~.5.:...... ~~.~:..............,,x~~t~.°~...:~'............ County Tax Map No. 1000 Section ........~e..~-3....... Block .........t'~..r.~>...... Lot No......^/! pursuant to application dated .....~~/...;7 1., and approved by the Building Inspector. Fee $..o~.Z. /.Y,~' ~pn~.~-, ~ B ing Inspector Rev. 6/30/80 av R 7~ r m I' m h ~ ~r y Y°' POS iB d WIPE _ _ r,HPPE _ _ - - - T 1 o~ ~ ~ ~ ~ I I g ' ~ ~1 5 S 4 l I i y l 1 2 ~ I I I 1 I ' ~I ~ ~ i ~ 'HELU! m ~ ~ ~ ~ 1~1~~1~11~ _ ~ _ I LDpEFCO," 1 I~ xSO~ \ 13 I Eao 166E 12 ~ PIPE ,ay vEm~n,'_ - I N66°53'101. a i5 _ - Il _ ~ / V l c.P. ~ W GI' CP. . 9D' ~ I~ I - 24 q : CPH sece - " ~ ' l o SPRPPE $Nf ~ IB I~ 9 - r C.P I 5\ 2 111 ,"NI P. ~ ~ _ - ~1 a wew ~ m rtecc ' , 26.2' - ~ ~ ~y an°xG ~T 27 it - LsD `~flpe.vL ~1 pSPHP ~°°ERI f.T w 1 'fi ~ ~ t wan. °crr°sir ~ PP VEMEN7 28 ~3~.- 3 BD ~ 2s ~ 04:~ sronY 3 a 'y .d 23 \ ~ ~ 1 O ~flIME BVILDINfi 3<1 s1 o ~ Sz ~ SRS Ii SCJ ~ .I II1 ~i .71 11 ~ ~nK° _ ~~~~{~t}~ /III; 6 09 P' - ~1`W L /1 J Z J i_ m .LONG WPLI( ~ sEP re ~ '3' i 40° ~ ,~s y ~ ~s ~ 00' unLlrY 5-. ~ ~ ~ 87 - - OVEHMEPO ~ wiv, y cr~P ~ R $ .C-: _ i $ 74' 06' 00" W - -ONES ,sB 2 5 ~ s- 8180 I, unLttr" ~ ~.O' - OVEAMCPO n a n- MAIN ~,...~._...~.._A~.~-.„•_. BOARD OF HEALTH 2 3 SETS OF PLANS . ~ ~ r ~ : ~ . ~e.,.,,.~-,_._,~l~tta FORMNO.1 SIIRVEY~• . ,-t; ~rYt ~I1! 1' TOWN OF SOUTHOLD CHECK • • • . ~;ti~~~ BUILDING DEPARTMENT SEPTIC FORM TOWN HALL NOTIFY a„•' "s:'°•.°.°.:.°~°::,.~'" 3OUTHOLD, N.Y. 11971 ~x.D~.D~a~'r. 'ij0U~1N. F.•:+Otes3lt)' . u'°' , TEL.: 765-1802 CALL MAIL T0: , Examined , 1 , _ ~ Appioved . ~ 191 Permit No~s~..~.~, i~ . Disapproved a/c (Buxldmo.. Spector) _ .4 APPLICATION FOR BUILDING PERMIT , i , , . Date ~ ~:-r? 1.~:. j 19 ~`~.~~,•~Y~ INSTRUCTIONS ~ ~ , . - . ' . ~ , a. This application'must be oompletely 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,draw8 on, the diagram which is part of this app] cation,{ , ~ ~ , ~ . ,n, ~ , a . • ' c.:.~'he 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 in part for any purpose whatever until a Certificate of Occupant ~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Depaztment for the issuance of a Building Permit pursuant to tY. ' Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t p p emises'an3' in`)iulding for necessary inspections. admit authorized ins ectors on r V , , ~Oh n • ~~r~(1„fl•~• • ! V•V-:t ~G~ ~C•ZnC,- • • • , . (Signature of applicant, or Hamerr, if a~~cQQOrporation) • ~ . _ ~ , pit,.- ~ ~a, ~ (Mailing address o~ applicant) ~ 1'~ ~ j ic~' '+l'~. "n 1..k C.z=.: State whether appliCant.ls own~rl.aleffisee,ragent;;~r~hitect, engineer, general contractor, electrician, plumber or builder € trfls.~e~cwl.~ e-flE~f~~'.~,r~t~ :1-f'fA-c'~a . . a a' i i'ry'ttv'¢Q: #+l;.T~. t..3 ?'sh`ti Name of owner o'f415reltils~sD.'lt~ft~ ~(i~'~`~fl~'..J.~}lil•~~[~~(,(,l(~(;n~:...C~CfI}~F'i;~ ~;firi~I'~`/I1Q.~..1-]µtfe~a~;~ . . ' ~.r_ttt€;~ 8d031'1}G d~'~~4t*?§:4t1 4i~ (as on the tax roll or latest deed) r. c.l: ~ B+,I.._....,. If applicant is a core rati, on,~s• ignatu a of du•,1 authorized officer. 0~t,.',~; ~Si i~ (Name and tit e o corpora e o icer) ALL CONTRACTOR'S MU ~9~9 SU OLK COUNTY LICENSED Builder's License No... . . Plumber's License No. ~ ,ISnCA-~0 ~J ~ Electrician's License No. 1 ~./Alt~~l ` Other Trade's License No . . 1. Location of land on which proposed work will bendone . . ....,~,.7. R ~ ,S' .mCt~.r1.,..1C4~•-4~ .................c~du`~i•o.~.4~..•.............. House Number ~ Street Hamlet r, ' County Tax Map No. 1000 Section ....~0.3 Block ....©.3 Lot 02 ~ ; . Subdivision Filed Map No. ; Lot . (Name) 2. State existing use and occupancy of premises and intended us"eta~nd occupancy of propose"d construct"ion: a. Existing use and occupancy r~C.(1'~°.. J°.~. ~~-I~R-L1~..Of1 . L.4-~O.1ct,CQ.~-!..... . 'b. Intended use and occupancy ...'.c~,C1.f7L?-~ . ' ~ ~,I,i 1,. ~ r.(?il 3.. Nature of work (.heck which pplicable): New Building Addition Alteration . Repair , . , . Removal'.;: , , , , , , , Demolition~~"-',', ......Other Work . t ~ ~ ~ j `~Descrip2ion) 4.' 'Estimated~Cost , '':1. ~ , `'Fee` • • ~ it~r ~ ~ ~ r ' r~ ~s v , (to be paid on filing this application) 5. If dwelling; number'of dwelling pmts , , , , , , , , . , , , Number of dwelling units on each floor . , If garage, number of cars . . 6.. If business,-commercial or mixed occupancy, specify nature and extent of each type of use ..f.eS ~-Clf,~t,~h.fi-:.... . 7. Dimensions of existing structures, if any: -Front . . ~cy'~ ~ Rear ' '„~9 , ,Depth ..`.r'.(a :a7... . Height . Number of Stories . r . . Dimensions'of sea~e structure wi'.th alterations"or additions: Front • ~.y~.~.:", , . ,....Rear ...~9..:.. r.. . . Depth ?:~~.1. , ........Height Number of Stories ..'>J . . ~•~•8. Dimensions of entire new construction: Front . " Rear . ...Depth , , , , . Height . . . Number of Stories . ~ , , , , , , , 9. Size of 1oE:.Front ~~~r~~,~ Rear ....~yq•~~'........... Depth ~ .R~,rf.9: 10. Date of Purchase I~ Name of Former Owner . 11. Zone or'use district in which premises are situated . , ! . . . 12. Does proposed construction violate afi}~lioning'law, ordinance or regulation: O.Q . . : . 13., ,Will lot be regraded n A Will excyy~~s fit] be ramov~d rom premises: Yes 14. Name of Owner of premises ~P~~'. ~`~4.fC9.w~",,.... Address .10r4e.ol~JoL1-../~.~, ,Phone No . . Name of Architect , Address ..Phone No. . Name of Contractor V D}1.~ . ~tC ~ta/l1. 1~ ~Q~ .~./lGAddress JAG :~.arGG(TVQ Phone No.7,i~~ .~~.y.... . 15,, ;Is ,this, property located, ;~uith1n,300;,feet. of a tidal wetland?. *Yea~~.'.'.. c; No- ..X'J. *If yea,' Southold Town Truetees Permit ma be re uired., f PLOyT' DIAGRAM , Y1L f, :rS~i tr} *~-7 {ti.,7~1, ` t t ~ iP;^ la ~ ~1=~•Locate'cleazly'1arid Histinctly all (buildings, whether existing or proposed,iand,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 lI1teTI0I OI COrner lot: li. i'i''~ Ln1r '.i, ~ l,,., ...i, ~ ~ ~ ~,r,.,z~ :;i: rz~.r ?u2 ,~',~u,.:E' , Flats - ~ - ~ ~ • ;i it ,G"' iP ~ ,l Y.. ' ~1 '('fit-/) r r J I(. ~ ' ' ~J , . . y> J. ~ , r s a 9MOad~ NOIlOilalsNaa a(a'N~IS.3U . ` ~ r ~ I r~Od 31815NOdS3!! lON 'S3C7O9 AOt13N3 ^ NOIlOf7tIlSNOO 31t/,LS ,i 7i~ . ,,F ~ •A'N 3H1 SO S1N3W3NYflO3tl 3Hl 'i 133W l'IbHS NOtlOfllllSNOO llb' .O'S"dO3 313'1dWO0 38 ' , ~ : 1SITW NOIl~fIkIlSNOO - 'lb'Nld '4 NOIlV'IIISNI 'E „ , , „ - ' dN18Wf11d'>< ~JNIWVtlJ ' M'Jf148 .x , 9L9lYJNOa G7Nf1Od tlOd Oi~N1Ab$8OMt " ' NOI1VONflOd 't I~ ~SNOIJ.a3d$NI'ONIMOI'tOj . ~ ~ ~ , ~ ~ ~ 7M1 tlOd ~1 ~ Q4 WV r6 tOB~t'9Bl ~ • ' . ~ . ~ 1Y J I ,~iiD~ I~~11N~1 ~ ~ Sri ~ ~ . ~ 'a-~-`T r ~ ~ue!o . _r G +~unr~~+r' ; ati ~ : STATE OF NEW YORK, COliNTY OF ~.~A.'(folk........ 1~•S Name of in~idua~ni ~ ~ ~ ~ ' ' ' ' ' ' ' • • • being duly sworn, deposes and says that he is the applicant g ~ng contract) above named. He is the . ~.Or~RC4:~.r. ~ `.~1SJc~r . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that alI statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner{ set forth in the application filed therewith. Sworn to before ma this ~ i ~ ~qq ~ ' ~ ~ ~ . . . i ::...~d/ay of i, 19 ~I: Notary Public, hJ ~ UD,'~ ; County ~ NELEN K. 9EVOE (Signature of applicant) NOTARY PUBLIC, Stato of Mew Yark No. 4707A7A, SuftolN Countypq Term Expires Mntah 30,19---n-1