HomeMy WebLinkAbout17562-z Fosirz xo. s
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MU5T BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
~ o U 17 5 Ei 2 Z Date t 9.c~~
Permission is he b granted to:
.....~;1~--.....~
~o
ct premises located of .../?.Cl.~...`f~:~.'.?
.................................................c~Q.cL~`~~.........................................................................
County Tax Map No. 1000 Section Block Lot No........Q.~....
pursuant to application dated .......I~~~ 19.U.C~, and approved by the
Building Inspector.
o~ ~D~
Fee . .
-~ildi I actor
Rev. 6/30/80
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FORM N0.3
TOWN OF SOUTHOLO
BUILDING DEPARTMENT
TOWN CLERIC'S OFFICE
SOUTHOLD, N.Y.
NOTICE OF DXSAPPROVTAL c~
Date .~.li`~hll.lf°-:~-~T'.....-7...., 19. 0.4~
. ~Q.~ ..rv.4 , f QC,Jh1~.i S. /;-;l~lG .
PLEASE TAKE NOTICE that your application dated ..~Ct1!Cl~!l.tj~~.
z? 19.4.cJ.
for permit to , ~n4~s~~~~1...~L'N.f.>r; t4 ~?..~S S ..C-Cy4~ at
Location of Property ~ r?...: L~4+tJ~.`d.. • 'I~ ttr.4'.J
House No. Srreer Namlee
County Tax Map No. 1000 Section . , Block Q. ~ .......Lot .
Subdivision Filed Map No................. Lot No................. .
is returned herewith and disapproved on the following grounds . f-~,/y C;~ . ,r~..~~C~ . , , , ,
`t~.~.,~.'~.t.L[~ ....~:~:Ct`~..F~~i.4zl-~T...../`~R.Z"."~i.....~--~.tov-~~9,1
r~ .v.~~. er~.....,4 azT..~:.. tv a.-~.~
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l~S~ ~ 4M-.a.:-SJ ..~F.~G'J'~ . , "~L.l~ly t~ c~..:~43~-?.~ , .
Bui~ ding Tnnpec4or•
RU 1/SO
BOARD OF HEALTH .
D 3 SETS OF PLANS : 1:~:~:-P~'eeP:z-O
FORM NO. 1 SURVEY
TOWN OFSOUTHOLD CHECK
pp
v~~8 6UILDING DEPARTMENT SEPTIC FORM
• TOWN HALL
BLDG. DEhT. SOUTHOLD, N.Y. 11971 NOTIFY
TOWN OF 30UTHOLD TEL.: 765-1802 CALL .lP 9y-.~.~~P ~ .
Examined .~Q~~~. 194.8 MAIL T0:
Approved 190.0. Permit No. ~7J~'6~ ~ ~~ye~f~ . .
Disapproved a/c
K~uil n nspector)
APPLICATION FOR BUILDING PERMIT
' Date ~f/ .l/..........., 15 s~
INSTRUCTIONS /
a. This 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
or 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 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 Certificate 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
Building 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.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized i~t;;~c si~r~t?n7ks~s and in building for necess nspections.
~~SS S2 d
- (Signature of ap lie nt, or name, if a corporatton)
d ~
il4~ S?EJ1 _ (Mailing a dress of applicant)
~ s;a ,1:K:.
State wheUltdfl~.~~~~~~s~tp7tyrj~rRS~ssge,::agent, architect, engineer, general contr ctor, electrician, lumber or builder.
.
Name of ov7tr'F`~~is~i ,a4 ~
~ 11101'i,>?~ ;~iS.k (as on the tax roll or latest deed)
1f a plicant ~~e ~pr~'}~Y-(~~'f1 ~j~`~~uthorized officer.
i~"1.~~
~.7 -
~~y~ . !aF si ' ~ .
( d#C3E1~7o't~do"r~Sora~e°'offcer)
Builder's License No . .
Plumber's License No . .
Electrician's License No . .
Other Trade's License No . .
1. Location of land on which proposed work will be done. f'...~/..~', , , { , , , ,O y~, ,y ,f , • ~ ~
~ / ` /
House Num r Street Hamlet
County Tax Map No. 1000 Section Block .......d . • , Lot .
Subdivision Filed Map No. Lot .
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ..............11.''... .
b. Intended use and /occupancy 1 • • ~.i~K. • 7 •e'.`!4~--,-;f; df'~' ; • • . • •/Y,~, • , , ~ y~ ~N• • •
I
3. afore of work check which a
Re air . , , , , . (PPficable): New Building Addition • AlQerattro^n , f 3: •
p • . • . , Removal Demolition Other Work y'~•.,CV .
~ i ~ ~D~~~~iption)'
D
4. Esiimaied Cost .....~f?~Lb % Fee , , .
(to be paid on filing•this application) ;
S. If dwelling, number of dwelling'units Number of dwelling units on each floor .
If garage, number of cars l . .
6. If business, commercial or mixe',d occupancy, specify nature and extent of each type of use .
7. Dimensions of existing structurgs, if any: Front . .Rear Depth .
Height ...............NumberofStories........................................................
Dimensions of same structure vlith alterations or additions: Front Rear .
Depth l .Haight ......................Number of Stories .
Dimensions of entire new construction: Front Rear Depth , .
Height ...............NumberofStories........................................................
9. Size of lot: Front Rear Depth .
]0. Date of Purchase : ..................Name of Former Owner .
13. Zone or use district in which premises are situated .
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 . ................Address ...................Phone No............. .
Name of Architect , .............Address ...................Phone No............... .
Name of Contractor .Address . .Phone No .
IS.Is this property located within 300 feet of a tidal wetland? *YES....NO....
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate cleazly and distinctly all' buildings, whether existing or proposed, and, indicate al! set-back dimensions from
property lines. Give street and blockjnumber or description according to deed, and show street names and indicate whether
interior or corner lot.
~
APP 0 D AS NOTED
naTE~ ~ a.a. a / z
FEE. BY:
i NOTtFV UI 1 G OEPA AT
. 7fi8•t802 8 AM Tp 4 P FOR THE .
FOLLgWING iNSPECTIQNS:
1. FOUNpAT10N TWO REQUIRED
FpR POURED CONCRETE
$ RpU(iH • l:RAMINQ • Olt1MRp~
S. NIWLAIIpN
4. PINA14 ~~ppNNSTRUCI'ION MUgT
SE COMM.Lh'NI~pRQA.
ARR CONSTIIIlCt'R7N jyL ~
j 7HE REQUIREMENTa QP TNO ,K~
STATE CON8YIItICtK~? •
CODES. Nt~l'. p~
OESIGN OR CQNsEfRUC11Qli M1IRORA
i
STATE OF NEW YORK, S.5
COUNTY OF
• • . • • • • • . • • • • • • • • • g i• • • • • • being duly sworn, deposes and says that he is the applicant
(Name of individual si ning contract)
above named.
He is the
(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 contaFned 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.
Swom to before me this
............G~Q.........day of I, 19~
Notary Public, ~IN:,('!/il.(/.. ~•.i!~!~ /UU//~'....... County
Hq•~ ~ OE (5ignature of applicant)
fV N~470787R,SutfolkCo~untj~
Term Expires Merch 30,118
~ . ~ f~~ ~N~C~
~ " ~r~'~~`xi~~r,~w FORM NO. 1 ~
TOWN OF SOUTHOLD P
BUILDING DEPARTMENT I ~ NOV Z Z I9$5
TOWN HALL g
SOUTHOLD, N.Y. 11971 ""°"°""w
- F~E.~~. t)EPT.
TEL.: 765-1802 1'G~fur~ E~, scsu-rHOtn
~,~~,~aa.
Examined .................19... Received...........,19...
Approved 19 Permit No........... .
Disapproved a/c .
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date S~.'........, 19
INSTRUCTIONS
a. This 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
or 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 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 Certificate 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
' Building 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.
The applicant ag es to comply with all applicable laws, ordinances, bilding code, housing code, and regulations, and to
admit authorized~nspectors on premises and in building for necessary in pections.
{ ECRU ~L[~t C.° .
....„....,=w., ,....w _.~.~,..(,~natur of applicant, or name, if a corporation)
c~~ /
Ok (~G~ ~ L. ~c~ G6
(Mailing addre~ of applicant) ?~~y
State whether applicant is owner, lessees agent, architect, engineer, general contractor, electrician, plumber or builder/.
.........~.....~i.............................................
Name of owner of premises t`J.1.1?~? cj . s-4':'.u=P........ll .
b (as on the tax roll or latest deed)
If applicant is a corporati n, signat~of duly authorized officer.
(Name and title of co grate officer)
Builder's License No.L~~.:~~.~\'$~' .
Plumber's License No . .
' Electrician's License No . .
Other Trade's License No . .
1. Location of land on which proposed work will be done. ..~RS-F. , S~~X..t~.. c~p~
n /
House Number Street Hamlet
County Tax Map No. 1000 Section ....Q.V~. ~ Block Lot .
Subdivision . Filed Map No. Lot .
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ~~I-~?vc~ f....j...../............................. .
b. Intended use and occupancy ..~'E?tGC'..~V?..C~tY'.~°.`..~?E'S.~d~¢-.k~G91~cY.l.K'Gj....~c?~..~:s~?~~'c~.
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