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HomeMy WebLinkAbout17812-Z aoaas xo. a 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) ©1781.2 Z Dote 19..9 Permission is hereby granted to: ...~:~P~ ~..~...~.y.......!.!.9.~f:g . ro ....l I......S.1w....4.~~.~-G~...~4~............................... ...............................................o . ct premises located at..µ:~.....~~..........~.~:a:!....~ :............~~-w!::~`......N...:~.:.................... Counh~ Tax Map No. 1000 Sectioyn .....L4Z.,~.......... Block Lot No.....I. U pursuant to applicotion dated ...~C.....~ 19.~.~., and approved by the building Inspector. Fee $...~.°'~~:..`.t~..... 3 ~cl ~2 - Fl r.~-u-=-~ /J ~z{~~ Building Inspector 11_1'-<-U'' .~tQ u~:~-p~,zG` ~ . Rev. 6/30/80 BOARD OF HEALTH 3 SETS OF PLANS FORMNO.t SURVEY TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM • TOWN HALL SOUTHOLD,N.Y.11971 NOTIFY ~-t~~~/ - TEL.: 765-1802 CALL ~ . MAIL TO:C~,.O•~dY~/~ Examined 19 _'~dut/-Q~ y 9 `fl' ! ~ ll Approved 19 Permit No...........,4 I' ' I U Disapproved a/c ~ ~ ~Ea ~ :0189 `u i-,~ i 6LCG.OEPT. - TOWN OF SCUTHOLD • • • • • • • • (Building Inspector) • . • • . • . - APPLICATION FOR BUILDING PERMIT Date 15 . INSTRUCTIONS a. Tltis application must be completely 511ed 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 pan 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 Perini[ 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 par[ for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. ~ -APPLICATION IS HEREBY MADE [o the Buildin; Department for [he issuance of a Building Permit pursuant to the Buildin; Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or [~eaulations, 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, housin, code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~.w~.~. . /s/ Name of owner of premises ..vv!`.~~!?~~1/• , ~GT . (as on the tar roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No . . Plumber's License No . . Electrician's License No . . Otfter Trade's License No . . 1. Location of land on which proposed work will be done . . G A~i.2EG..... !v.~!-.......... . ......ya-? , ~o~~ . douse Number Street Hanilet Counq~ Tax Nap No. 1000 $dChO? ...w~.......... Block f Lot ~d............. . Subdivision Filed flap No. Lot ...6. 7 . (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy OGU~~1.N, ~ . b. Intended use and occupancy V !V S-!":=•~ 3. Nature of work (check which applicable): New Building Additio Alteration . Repair Removal Demolition Other 1Vork . / {Description) 4. Estlmatcd Cost ~©P.4.~.O,Q Fee ~..~?J.°. ~o (to be paid on filing this application) 5. If dwelling, number oC dwelling units Number of dwelling units on each floor . If garage.numbcrafcats 6. IC business, commercial or mixed occupancy, Specify nature and extent of each type of use . 7. Dimensions of existing structures, if any: Front . Rear Depth . Height Number of Stories , . imensions of same structure with alterations or additions: Front Rear . Depth Ileight Number of Stories . 8. Dimensions of entire new constnuction: Front Rear Depth , , eight Number of Stories . 9. Size of lot: Front Rear::.................... Depth 10. Date of Purchase . . Name of Former Owner , , , , , . , • 1 I. Zone or use district in which premises are situated . . . 12. Does proposed construction violate any zoning law, ordinance or regulation : . 13. tVi11 lot be regraded \Vill excess fill be removed from premises: Yes Nc 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 clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions fron property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. ~~~`t'3""`R'`~• L-~-+-'~IC. APPROVED AS NOTED t J•"""+~t.o OATS ~_B.P, q I 4! FEE: ~~y ~O BY G. L . - (F~~ QQQ 0 Q n 1~ NOTIFY BUILDING DEPARTMENT AT . ~ 1 0 o'~R'r't'I.tJ~. -w~ C ~~M 765.1802 9 AM TO 4 PM FOR THE Y ~ FOLLOWING INSPECTIONS. ~°~.dc ~a.yv Sd,,,,,~ „Q ,f 1. FOUNDATION - 1W0 REQUIRED "^`"t'~ FOR POURED CONCRETE 2. ROUGH -FRAMING & PLUMBING 3. INSULATION fff 4. FINAL - CONSTRUCTION MUST BE COMNLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REpUtREMENT3 Of THE N.Y. STATE CONSTRUCTION ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS STATE OF NE\V YORK, S.S COUNTY OF . ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' • • ' • ' ' • • ' • • • • • • • • • • • • • • • • • • being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the (Contractor, agent, corpdrate officer, etc.) oC said owner or owners, and is duly authorized to perfc,Fm or have performed the said work and to make and file this application; that all statements contained in this applicatj'on 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 me this Notary Public, t`!'.-5=??!~. ~A U?~:..... , County HELEN K DE YOE NOTARY PUeItC, State of Nerr Yak • • ~ . • , . No.4T0787(i,SuttolkCou~ (Signature of applicant) Term Ecoires Akrch 30,1