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HomeMy WebLinkAbout17310-z ffOEM NO. 9 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDliNG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 017310 Z Permission is hereb, y anted to: · , ~ ~f.~,..... ~...~...~ ........................................... . ...~~~.~.......~.:::. ,o .~~......~~ ....... ~....~~...~ ............................ ....................................................... :~~z,.: ............................................................... ~o.~ ~x Mo~ ~o. ~o ~.o~ ..... Z~.Z ...... ~,~ ............. ~. ~ ~ ........ ~...~... pursuont to ~pplicotion dated ........ .~/ ..................................... , 19~ ond opprov~ by the Buildin~ Inspector. Rev. 6/30/80 BOARD OF HEALTH ...... 3 SETS OF PLANS ....... SURVEY FORM ' 'FORM NO. 1 TOWN OF SOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC TOWN HALL NOTIFY SOUTHOLD, N,Y. 11971 TEL,: 765-1802 CALL MAIL Examined.. l~./(. ~. ......... , · ....... - Approved ............ 19 f~. Permit No..'(..?.? ./.O... Disapproved a/c ..................................... ..................................... '/~ .... ;''.' '//~/'? BLDG DEPT ~..~..~. ~/, ~ ~.: ~t~t. ......... o~, ~:~*,~, ~;/:4 ~; ~8.1.~t IC~.~ ~bO8¢ ~ (~ilding Inspector) . ~A _ ~.. FOR BUILDING PERMIT ~: Ct~ ~: tO~ ¢'O INSTRUCTIONS a.~'~{~ion must be completely filled in by ~pew~ter or in ink and submitted to the Build~g Inspector, with 3 sets o~p~Fi~.~q~ee according to schedule. V. m~'~?~Al~and o~ build~s on premises, relationship to adjoining premiss or pubUc streets o~ ~t, ~A~0~I~ o~ layout of property must be drawn on the diag~m which is pa~ of this appli- ~h~][,~~. mu ~ ~ .. ~ ~b~'~:~l*~°n may not be commences before issuance of Bufla~g Permit. c. d? :~$n~r~'~t~z~ea;.the Building Inspector will issued a Bulldog Pemit to the app~c~t. Such pemit shall be kept on the premises available for inspection throughout the work. e. N6' build~ng shall~ gccup~ed or used In whole or m p~t for any purpose whatever until a Ce~ificate of Occup~cy shall have be*tlg~l~l~ding Inspector. ~PLICATION IS HEREBY MADE to the Building Dep~tment for the issuance of a B~lding Pemit pu~uant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ~d other applicable Laws, Ord~ces or Regulations, for the construction of build~gs, additions or alterations, or for removal or demolition, as here~ described. The applicant agrees to comply with all app~cable laws, ordinances, bufld~g code, hous~g code, and regulations, and to admit authorized inspectom on premises ~d ~ build~g for necessa~ inspections. (Signat~f applicant, or na~, if a corporation) (~ailin~ ad~ess of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · .~ ~.,-~...~ .I....CM .,.~r.~..o~,:,..~.. .................... ~.,.~ .......... . .................... Name of owner of premises .... ~.[ ~.~..~..~J...c~.~..J...~...~-T.(..'.C_~.. I .1.~.~ ~L, .~. .................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade s License No..~. J.o~ .~..~...~...a~.....~-~ (,a 1. Location of land on which proposed work will be done .................................................. ..... .O..g'..~..~T ....... ~ .."N..,. ~ ~,.~.~... ~.,,..~--~ ~,.~. ....... ..Pg..~.?cr.: .-r.~,..o. ~ ......... House Number Street Hamlet County Tax Map No. 1000 Section...) ....... O .~. .. .... .. Block ....C).~ ......... Lot .... ],~.<~ ......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .(~...~.o~y~... .~..o..rD..-~.' . .~x.. ?,,.c~. ~... ~ f-..o~, q~.l~7'..~.... 1 ~x~r.,~ ..... b. Intended use and occupancy C l.u .~ .q-~. J.¥'t. U..o.©..-V...o~.. C,4Cz.~,. I .v>..~r-~.. t,,O.. ~ .'-JT..~ ........ 3. Nature of work (check which applicable): New Building ...... ' ..... Addition. ~ ........ Alteration ........ .. Repair .............. Removal ....... Demolition ................. i · · · Other Work ...... (D ipli ) 4, Estimated Cost, ~ ~c~ o., .O, O Fee ..... ,~. ................. ' (to beI paid on filing this application) 5. If dwelling, number o f dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................... I ............................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7 Dimensions of existing structures if any: Front Rear i Depth Height Number of Stories Dimensions'of same structure with alterations or additions: Front ........... ~ ..... Rear .................. Depth Height Number o~ Stories --8. Dimensions of entire new construction: Front .......... ..... Rear ............. Depth ............... Height ............... Number of Stories .......................... 9 Size of lot: Front Rear I Depth 10 Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated ........................ 2 ............................ 12. Does proposed construction violate any zoning law, ordinance or regulation: 13. Will lot be regraded ............. , .............. Will excess fill.be removed from premises: Yes No 14. Name of Owner of premises .~.. I t ~ r'ie~ ......... Address.~.,~ ,~;e~eq ~¥~'r '.: '; Phone No. ~..%. ~'?. '.~ .~..O,. Name of Architect .......... Addresslq%Tr. *neo~(~vh,,,,~ ~,, Name ofContracto~*~,~.t~.rT.¥,~ .~.o?~.~h~,~s,,5S Addressgo~O~..~';~'..~e~,.l~]Phone Nol .~.(~'.' :~k:~52 .~' 15. Is th±s property located--~±thin 300'Jfeet of a t±dal wetland? *Ygs ..... I% .~/~J.. ~l~f yes~ Southold Town Trustees Perm±t may be requ±red. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and~inldicate all set-back dimensions from property lines. Give street and block number or description according to deed, and sho? street names and indicate whether interior or corner lot. APNIOYED AS NOTED / DATE: FEE: OY: NOTI UIEJ)ING OEPA ENT AT 766-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTION8: 1. FOUNDATION - TWOREGUIRED FO. POURBJ).,.CONi:21iIE 'g 2. ROL~H - FRAMINO & PLUMBINO 3, INGUI..ATION 4. FINAL. CONS'I'RUCI'ION MUST BE COMPLETE FOR C.O. ALL CONBTRUCTION ~ MEET STATE'~~ ~ ~ #.¥' ...... DESIGN OR. GONSlRUCTION.~JIROR8 ............... being duly sworn, depo (Name of individual signing contract) above named. ;es and says that he is the applicant ............... l. 't ..... day of ....... Notary Public, .......... County NOT~rllmlc.~d-N~.Yvikqf~] ~k~ ~ V (Signature of applicant) He is the ............................................................. (Contractor, agent, corporate officer e~c ) of said owner or owners, and is duly authorized to perform or have performed the said work and to mak~!~and file this application; that all statements contained in 'this application are true to the best of hisi knowledge and b¢:I[~and~- that the work will be performed in the manner set forth in the application filed therewith. 'r : ~ ~'.~'f' ~ Sworn to before me this