HomeMy WebLinkAbout17817-Z FOBlt NO. f
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)
Na 017817 Z Date ...~.:~.....•1 19...1.
Permission is hereby granted to:
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to ~.f.~'re~c°.::~:~-:!.!.'!.... C?'°.... Q~ /1 V,ctd...)4~,d.~
................................................................................................................U...vn.'.'.'.'.~.~.~.~.~.~~.~.
77TT~
ct premises located at ..~.5~.~.....~:Q: c-~'t-t,~-...:! ~ `v`'~C'
ct ~
....1~.......~ ~ ~....G~.~
Caunh/ Tax Map No. 1000 Section ..~..~.~~~$4..:-!-.~.,. Block Lot No...1:.~
pursuant to application doted ..~.1=k"'•'w V....4 19~~.., and approved by the
Building, Inspector,
Fee
~
Building Inspector
Rev. 6/30/80
_ BOARD OF HEALTH
3 SETS OF PLANS
i~
FORM N0.1 SURVEY
" TOWN OFSOUTHOLD CHECK .
i,jL ~ € BUILDING DEPARTMENT SEPTIC FORM
~ ~ r ! TOWN HALL ~ ,C~.
.,OUTHOLD, N.Y. 11971 NO FY
TEL.:765-1802 CAL
Examined ..va:~`~r: i:-:, , 19 iJ.
• ~ n
Approved 1_,.., 19" Pcrmit No./ 7,8 17 ! `,L/ LJ V
Disapproved a/c ~~1~ - 9
f - 3. DEPT.
(Building Inspector)
APPLICATION FOR BUILDING PERMIT 11 c
Date . !l-29 J.... t 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 accordine 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 inspectors on premises and in building for necessary inspe(c7tions.
. 4r~.~~,~,ros~l\t3 .
(Signature of applicant( or namiyif a corpotatton)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises J.. vI N -Y`.~.~Y"r?!".~ G~"s~~• • • • • • • • • • • .
(as on the tax roll or latest deed)
If app/lica~nt is a corp~ora~tion, signature of duly authorized officer.
(Name and title of ca rate officer)
Builder's License`No. 5
Plutnber's License No . .
Electrician's License No . .
Other Trade's Licensc No. .t4'.v'~~- ~ - • ~ l ~ ~ 4~~
1. Location of land on which proposed work will be done . . .
~.c~s~~L 4..
House Number ~ Street ~j Hamlet
County Tax Riap No. 1000 SeChOn ......~.a~........ Block .......1........... Lot....~~
Subdivision Filed tap No. Lot .
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupant U~ c;c~_ >~~...(';?S~N«- .
y
b.ln[ended use and occupancy ...y.••,•-.
3. Nature of work (check which applicable): New Building Addition • • • . • • • Alteration .
Repair . . Removal Demolition ...k`~..~ • • • • • Other SVork .
(Description)
4. Estimated Cost t.0R4. ~ ~ Fee .
(to be paid on filing this application)
5. If dwelling, number of dwelling units ......Z...... Number of dwelling units on each floor , , • .
If garage. number of can
r•,.__6.,, If business, commercial or mixed occupancy, specify nature and extent of each t of use .
t 7. Dimensions of existing structures, if any: Front - Rear Depth .
Height ...............NumberofStories..........................................
e lions of same structure with alterations or additions: Front ........Z~?...... Rear ,~o,~, , , • , • • , , •
...:..................Height Number of Stories - .
Dimensions of entire new construction: Front Rear Depth - .
Height Number of Stories .
.
«..9: Size of lot: Front Rear g. Depth ......Z:............ .
10. Date of Purchase .............................Name of Former Owner .
1 1. 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
14. Name of Owner of premises ....................Address ...................Phone No.............. - .
Name of Architect .....................:.....Address ...................Phone No............... .
Name of Contractor . . .......Address ...................Phone No............:.: .
15.Is this property located within 300 feet of a tidal wetland? *YES.~C.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 from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
oLA.2 ~.~•u, w-c~P a G~.~. 'to ~ ~,~?~,.~Qd.. Qa.,~~Q ~,.CQ ,iri~,,~.
Q
pPPROL`ED AS ~:'~JTEG
DATE ~ 3. P H. 1 7 ! ~
FEE: - e~
NOTIFY Rl11LOING OFPR::2'rn,1Et.•T
785.1802 9 Ann m r;? ;•+E
FOLLOWING iNSPECI!ti;~~
1. FOUNDATION - TVVl~7 REGilli;c6
fOR POURED CONCRETE
2. ROUGH -FRAMING & PLUMBING
3. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMNLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REOUIREMENT^s OF THE N.Y.
STATE CONSTRUCTION r! ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
STATE OF NEW 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, 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 tltis
application; that all statements contained in this application are true to the best of Iris 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
9 ..........day of...~~ .............19~~
/1~
Count
Notary Public, . ~ ~'C :.../~%LBG- y ~~W~~ .
HELENKDEYOE (Signatureo applicant)
IIDtI1RY PUBLII, Sute of Nen Yat
Ter~m~4wG~all{uth
0.1W9_~
New York State Department of Environmental Conservation
Building 40-SUNY,"~Stony Brook, New York 11794 q
ebn~j P0'f'O.Y Y'PS\~n DATE: ~/dO~~/
1 J(llhl`PS ~(.U~1hS ~~I . Re: -A ~-YOISS ~
Mor\clr\~e I~ly I I t55 ~11~ -~lo-~~-oa3y Thomas C. Jorling
,A~N • _r1 ~y h ` ~ r ~ ~yy~ Commissioner
Dear ~ ~11„`i~~~
A review has been made of your proposal to: kE~vo~e eX\S~i~~l S~YVC't-t/f~~
o~ s't~e Cov~s~~c-F- r~ s~rr~t~, ~mi d~.;~~l~v~ l~c.~~ec9
Based on the information you have submitted, the New York State Department
o Environmental Conservation has determined that the parcel
project is:
_ Greater than 300' from inventoried tidal wetlands.
Landward of a substantial man-made structure v w
greater than 100' in length which was constructed prior to 9 20 77.
_ Landward of the 10' above mean sea level elevation contour on a
gradual, natural slope.
Landward of the topographic crest of a bluff, cliff or dune which is
greater than 10' in elevation above mean sea level.
Therefore, no permit is required under the Tidal Wetlands Act (Article 25
of the Environmental Conservation Law). Please be advised, however, that
no construction, sedimentation or disturbance of any kind may take place
seaward of the 10' contour or topographic crest without a permit. It is
your responsibility to ensure that all necessary precautions are taken to
prevent any sedimentation or other alteration or disturbance to the
ground surface or vegetation in this area as a result of your project.
Such precautions may include providing adequate work area between the
10' contour or topographic crest and the project (i.e. a 15' to 20' wide
construction area) or erection of a temporary fence, barrier, or hay
bale berm.
Please note that any additional work, or modification to the project as
described, may require authorization by this Department. Please contact
this office if such are contemplated.
Please be further advised that this letter does not relieve you of the
responsibility of obtaining any necessary permits or approvals from other
agencies.
Very truly yours,
Cam- G ~-p~~
Deputy Regional~rmit Administrator
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