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HomeMy WebLinkAbout17161-z i?oigaa 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) NQ 017161 Z Date 19..p.~ ~1 Permission is hereby granted to: VVNN .y .~Gi.rfetl.LR.r~s....... ...~o.os.. j~ ct premises locoted at .~~.~..~.....tJ..Kr~.... .4~.....~-.fr:!~:............ County Tax Map No. 1000 Section .......~..c}:..~...... Block ........Q...~.... LLot No...©.~ pursuant to application doted ..........`~,.,C.~m..R-..+~:Q.•••...•••......, 19...4., and approved by the Building Inspector. I Fee Building Inspector Rev. 6/30/80 r'lELD II~S:' C: iU17 ~~llAiE ~ i;OhfMENT° .U: - s m J 1 . a 3 H _ FOUIJDATZON (1st) POUNDATZOIJ ( 2nd ) m~ 2. o w ROUGH FRAME & b PLUMBING yC y 3. H IiJSULATZ0P1 PER N. Y. STATE ENERGY CODE x A r' m 4 . FZiJAL z ADDITIONAL COMMENTS: x(~ x ~ ^0 H N / ~ ~ ~ ~ ~ ..c y O .4 Z ~ i t~ 1 ~ 2 m ~V a • r~ H - S C7 m -o H BOARD OF HEALTH 3 SETS OF PLANS FORM NO. 1 SURVEY TOWN OF SOUTHOLD CHECK ...~~.~3~~.......... . BUILDING DEPARTMENT SEPTIC FORM • TOWN HALL SOUTHOLD, N.Y. 11971 NOTIFY TEL.: 765-1802 CALL MAIL T0: d~ ~ Examined . 19 l~j.~ Approved • ~ 19~~. Permit No. ~.7. ~ ~ Disapproved a/c ~ ~ ~ la®ST . BLDG. OEPT. ^ 4OWN OF SOUTHULd ...itC.X .u?•.. (Building Inspector) APPLICATION FOR BUILDING PERMIT ~'~Q/ Date d. . • • • • 15~?`J. 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 Pertnit 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 inspectors on premises and in building for neces ary inspecttions.//'' ~,~~G'~,,`~~e.,~~. ~(Signature~/oaf"applicant, or na(m~e,~if a corporation) ~~6~ CiI,~Q NC~ (Mailing address of applicant) State whether applic~~ a~w~~es~ e, agent, architect, engineer, general contractor, electrician, plumber or builder. ©c„tu\P~ aPraav~o as ~~:ftin........ . ' C.©'. mac:. ~ \c~'~ ~S . ~ v: p ~ . ,~,.s ~ . . . Name of owner of premises \ • • FEE• $y Y. C', LL L',' ' (as on the tax roll or latggg•~}F U~lLDINC; DFP=n~zT,,;ti_ r,z -qr 7$5.1$02 9 AM TO ~i = i e,r~ If a cant is a corpor tion, st nature ~uly authori,~ed offl~er. r ~aE ~ p Q -~}1LQ. \?1 FOLLOWiNCs iNSPF_C"~ it)rv'> ~ '1~.. • 1. FOUNQATION TWO RtOUiF?€O (Nam vand'ti~tl~e~~o^^f--"olorporate o ficer) FOR POURED CQNCRETE 2. ROUGH • FRAMING & a LuM6lNd3 Builder's License No. 8. INSULATION 4. FINAL - CONSTRUC7IONPAUST Plumber's License No. $E COMPLETE FOR C.O ' ' ' ' ' ' ' ' ' ' ' ALL CONSTRUCTION SHALL MEEt Electrician's License No. THE REQUIREMENTS OF THE N v, " " " " " " " " " STATE CONSTRUCTION & ENERGY Other Trade's License No. COPES. NO7 RESPONSIBLE FOR ' ' ' ' ' ' ' ' ' ' ' DESIGN OR CONSTRUCTION ERRORS 1. Location oGf~l?a~nfd~on which pjr/oposed work wilfl bte~ done . . House Number Street Hamlet County Tax Map No. 1000 Section ....I.~.'.......... Block Lot ~ . Subdivision Filed Map No. Lot . (Name) 2. State existing use and occupancy of premises and in(ten-ded~ use and occupancy of proposed construction: a. Existing use and occupancy ....r%k~t;? E' V~ ~!`f~,?,-;-~~,..~"r': • • • • • • • • • • . b. Intended use and occupancy ~P~~" .............Fs ,~a'...:...,, , 3. Nature of work (check which apjplicable): New Building Addition Y....... Alteration . Repair Remgval , Demolition Other Work . rte' (Description) 4. Estimated Cost ~ ~ Fee ~°74!.i..................... . (to be paid on filing this application) 5. If dwelling number of dwellin units , Number of dwelling units on each floor . . . . . . . . g I1'garage,numberofcars ..............t................................................... 6. If business, commercial or mixed occupancy, specify~nature and extent of each type of use . 7. Dimensions of existing structure's, if any: Front , , ,Rear Depth , , , , , , , , , , , . Height ....Num'berofStories........................................................ Dimensions Of same structure with alterations or additions: Front Rear . Depth .Height Number of Stories . " 8. Dimensions of entire new construction: Front Rear Depth , , , , , , , , , , , , Height Number of Stories . . 9. Size of lot: Front Rear........... Depth 10. Date of Purchase , ..........L . . . . . . . .Name of Former Owner , . P P P miles are situated . 13. Will lotrbe regraded in whic ,rate any zoning law, ordinance or regulation : . 12: Does ro osed construction viol 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 Conptractpor ..~~FfM•?~ .~-p~r-y,S:. , ...Address .......Phone No........... 15.Is this ro ert located within 100 feet of a tidal wetland? *YES....NO.Y.. *I:f yes, Southold Towrt Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all I~ buildings, whether existing or proposed, and, 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 interior or corner lot. r k. l R. 1--~N - ~F~~°r - 1 /,efj~~y { ~ ~ k~~'~~ ~ {~~'e 1'~ ~~UJYi Ck~v~ PC ~ Y. ~I 1~0~ 11~ ~'J•P t'~C1'~ ~S STATE OF NEW YORK, S.S ' OUNTY 0 n , , , L ~'F ~Q~- • ~ (Name of individual signi.T~ ~ ~ • ~ ~ ~ ' ' ' ' • • being duly sworn, deposes and says that he is the applicant hg contract) above named. fie is the.......~r~~~:~!,....~.~.~?1~ (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 all 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 tiled therewith. Sworn to before me this Not„~ry Public, .iKzaGT,~~j"P:~~ . . County ~ ~C: ~ ,~,~11...~, . C,S/-,-(Jc~_`-`-~_`-Naa~Public, Stat No.4822663,SuHolkCouMy ~ (Signature of applicant) Term Expfrea December 31,18