HomeMy WebLinkAbout18314-z 8osas xo. s
TOWN OP 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~ ~03~~ Z Date ........~.A......~..~ 19.1.
Permission is hereby granted to: J
......I~..... .
A
at premises located of ! 9 ~P.......1.N:!.tC.N-~K1..~.~.:~:~`..S':~....~?-t:la2..........~~
County Tax Map No. 1000 Section ....dO~:n`£?....... Block Lot No...0~
pursuant to application doted .......~..1!I~t.}...~..~ 19.~.~., and approved by the
Building Inspector. l
Fee 5..~,::?.,..
Bui ding Inspector
Rev. 6/30/80
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~ anly/ 1989
E30,16D OF NE,ILTH
FORM1i N0.1 3 SETS OF PL,1NS
SURVCY " " '
TOWN OF SOUTHOLD CFIECK , . ~ ~ ~ ~ ~ ~ ~ ~ "
BUILDING DEPARTMENT SEPTIC I'OR;1 • . • •
TO6VNHALL
• SOUTHOLD, N.Y. 11071 NOTIFY
TEL.:7G5~1302 CALL
E~amincd...~~,~~• 19,1 MAIL T0:~3.c.?r~,-~~~•
Approved f . ~ ,'ih•'I'p. /D~ep~
~~...I.., 19~.1.,Pcrmit No..~..~~, ~7,
Disapproved a/c
• • • • • • • • ~ 70WN
OF SOUTFIOID
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
• Date . 15..
INSTRUCTIONS
a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Bui]ding Inspector, with
:'its 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 strec
ar areas, and giving a detailed description of layout of property must be drawn an the diagram which is part of this app
':anon. ,
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 in part for any purpose whatever until a Certificate of Oceupanc
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY h1ADE to the Building Department for the issuance of a Building Fermi[ pursuant to th
3uilding Zone Ordinance of the Town of Southold, Suffolk County, Nety York, and other applicable Laws, Ordinances o
Re;ulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describec
,ite applicant agrees to comply with all applicable laws, ordinances, buiIdine code, housing code, and regulations, and t<
admit authorized inspectors on premises and in building for necessary inspections.
• (Signature of applicant, or name, if a corporation) ~ ~ •
(Dfailing address of app]icant) . • ~ ~ ~
Mate whether applicant is owner, lessee, agent, architect, engineer, general contractor, e]ectrician, p1umL•er or builder.
\ame of owner of premises ~ r ~ .G; /~~~G
,
(as on the tar roll or]atcs[deed)
} ~ f
:f applicant is a corporation, signature 6~'aiily, authorized officer.
• .
........Name ~ d ~ttc,Yr;t~+'3^,.,a:"
arl t,~itl~.~f'~or~i'o~te,.cji~~jfer,}y,
V VE ?1s9 6 j'1,3 . L
BuiWcr's i zPrc93.t~~'~a,,`-~'~.. s.
5?t't'a ;l ;'331;1:3{b'rtz. =`'S tgk •..:dr•~.z.t.
Plumber's Lice~s~yylgax§ijS.D313 t1C;') • • • . • . •
Electrician's Liccnsc No . .
OtltcrTradc's Liccnsc No .
Location of land on which p oposed~rk will be done.
flouseNumbcr Strcct. ~ ••••••~~"",~'2/~•••••••-•.......,
j Hantlct '
County Tas Afap No. 1000 Section ~ Block ~ •
Lot..
Subdivision File Ufa t
I No.
(N:unc) Lot..............,
State c~isting use and occupancy of premises and intendj°d use and occupancy of proposed construction:
a• Existmguscand occupancy ~ LIr,(/A//~~
i
b. Intended uze and occupancy . • , ,
t
3. Na[urc of work . , "
Repair (check w•n[i:h applicable): New Uuilding ,
Rcmov 1 .Addition . ,Utcrauon
Ty~ial/.a j.a.:i •o"~! Demolition '
Gvvo ~ •--{P„vc'~ mni • • Pthcr 11'ork x
4• Estimated Cost „~1 *~~/z+JrsB o 7`
r-~~...
5. If du~clling, number of dwelling units (to be paid on tiling this a
ifgara,c,numberofcars PPligtion)
, , , Number of dwelling units on cacti floor . .
6. If busrncss, commercial or mixed occu • • • ' • • • • • • • •
Dimensions of c. ' pancY, specify nature and uxtent of each t ~ • ' ~
etsUng structures, iC any: Front , YPc of use ~ • ~ ~ • "
Heieht .-,.:.i... ' ~ umbcrof ~ .Rear
Stories, Depth.'........
Dimensions oCsamc stnrctur~pvith altcratio • • • ~ • • • • ' • • • • • • . , . • • • . • • ~ • ' '
DcpJl~ , . Ilci~ ns or additions: Front • • .
' 8. DimcnstorrTc~ ' ~S ,1[t Rear
Ifc(_{[i; construction: Front , , , . • • • " • • • • Number of Stones ~ •
9. SiZ ~flrJ Nu'mbcr of S(orics , Rear De ,
~ t:"I'lorjt~ Pth
10. Date oaf I?tu.j:?~k"~Sc'.,'`, ~ ' , ....,~.:..j........... Rear ' ,
1 Zone or use district in which Depth • .
• ..NamcoCFormcrOwner
1=• Does Proposed construction `premises arc situated , • • • • • • , , , , , , •
13, 1Pi11 lot be [olatc any zoning law, ordinance or regulation: • • • ~ • • • • • • • • • ~ • • • • • •
recraded • • • • • • . .
14. Name of"Owner of premises • • • • • • • • ' ' ' ' ' ' ' • • • «'ill excess fill be removed from premises: • • •Yes • ~ • • ~
Name of Architect • • • • ' ' ' ' ' ' • • • • • • • .Address , ,
Name of"Contractor . • • • • . • ......Address P)[onc No............
IS*Is this property logated• .............Address.. ........Pftonr.No.........•
If writhin300 feet of a tidal vetlaaaone~No.
yes, Sou [hold Tocrn Trustees Permit may be requirod,
Locate clearly and distinctl •V PLOT DIACRADS ~
PrOPenY Gael, Give street and blocklnumber or description~acaordin^ to deed
g or proposed, and, indicate all set-back dimensions frog
interior or corner lot. o ,and show street names and '
/ rndicate whcthc
5~~ ~dJ-oak ~ ~e rs~ r~ o "1' S~Z/ ~C
APPR VEDAS NOTEp 9
DATE: 7 ~ B,P it ~~~--(b-'~~~1~_G._
• FEE: ~S. HY. 11L'--~ •
NOTIFY SlJ[LD[NG DEPl1RTMEN7 qT
765.1802 S AM i0 q PM FOR 7HE
FOL4.OWING iNSpECT10NS.
1. FOUNDATION TWO REOUIREb
FOR POURED CONCRETE
2. ROUGH - FRAMING B PLUMBING i
3. INSULATION
4. FINAL - CONSTRUCTION MUST #
BE COMPLETE FOR C,Q. a
ALL CONSTRUCTIOp SHALL MEET.
THE REQUIREMENTS OF THE N.Y.
>§TA7~ CO(y~p~~~ ~ ENERdY '
CODES. NOT :~gPON818LE FOR
~ TL• O F El.' YORK, DESIGN OR ~ETRUCf10N ERRORS
oU\T1' OF
S.S
• • • • •~~',.:nc of individual si~nim
'ovc named.
;contract) • • • ' " bang duly sworn, deposes and says that he is the a
PPlicant
:isthc .
• . (Contractor, agent, Corporate officer, etc.)
said owner or owners, and is duly aUthorizcd to perform or have performed the said work and tom . • . • "
'I'ratton; that all statements contained in this application arc true to the best oCltis knowled~•
rk wdl be pc; fomrcd in the manner sqt forth in the application filed thercwitlt. ~`O and file this
^m to bt(ore me [his d~ and belief; and that the
~i PU bli:. .JJ;..I,'~;
,,~.`"."'~~0000... ~l %
County
NELEN K. DE YOE ~ t!~ ~
NOTARY PU84IC, State of t~ew York .
No. 476787p, Suffolk County ' " " ' ' ' " " ' ' ' '
Term Expires kgarch 30,19 (S ign a turc o f a p p li can t )