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HomeMy WebLinkAbout17905-Z FOfLM 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) ~ 0 7 9 0 5 z Date .....I. ~ 19..9 Permission is hereby granted to: ~j i ~ s~ n Y~o x1~ :.................??.................................'.}..'.......................j....................................................................... at premises locoted at G.:^.1....1°~.~..`l..~.........~.~,¢-:~-!.s.r Caunty Tox Map No. 1000 Section ......Q.~~........ Black ....Q.T.......... Lot No..~.~ pursuant to application dated ........~.U!SKYI...~ 19~~..., and approved by the Building gqnspector. Fee 5..~,p.1.:..1~.'.0....... ~ Bui ing Inspector Rev. 6/30/80 BOAaD OF HEALTH 3 SETS OF PLANS - FORM NO. 1 SURVEY . TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC r•oarl • TOWN HALL SOUTHOLD, N.Y. 11971 NOTIFY - TEL.:765~1802 CALL Examined..~fl.4C1!r.l.Q..,19~.J. MAIL T0: Approved ~.RMtl~l . f •D• • 1~. ! .Permit No. ~ ~ ~ Disapproved a/c ................................~e/~o~ ..............o................. (Buildin^ Inspector) APPLICATION FOR BUILDING PERMIT Date l~ ri?-t~-, 15~ / INSTRUCTIONS a. Tlvs 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 appii- 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 an 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 Yark, 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, housin~code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspectll ns~ ~ ,r . (Sig:,"' re ot'applican , or tame, t a cotporauon) !S.JK Via.°......a°P..~... ,,.N:y . • (Mailing address of applicant) ~ ~ s l State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder. w N vz APPROVED AS MOTED © ~ .~.a ~J h ci, ,pp ~ , L . OATEN ( 9 B.P. k .....o S Name of owner of premises S~/....:". °.:S.. ~ ~ 34 ...BY.. Y...G..~.,...... . FEE•• (as on the tax roll or la[d5tftdtfe~d)BUILDWG DEPARTMENT AT If applicant is a corporation, signature of duly authorized officer. X65. 1802 9 AM TO 4 PM FOR THE Fr%~tOwING INSPECTIONS. t. FOt1NDAT10N - TWO REQUIRED FOR POURED CONCRETE (Name and title of corporate officer) ,2 ROUGH -FRAMING & PLUMBING Builder's License No . _ 3 INSULATION ' • ' • • ' • • • • • ' • 4 FINAL - CONSTRUCTION MUST 8E COMPLETE FOR C.O. Plumber's License No . ALL CONSTRUCTION SHALL MEET Electrician's License No. , , , • THE REOUIREMENTS OF THE N.Y. • • • • • • • ' • • " " " " STATE CONSTRUCTION & ENERGY Other Trade's License No. CODES. NOT RESPONSIBLE FOR DESIGN OR NSTRUCTlONERRORS I. Location of land on which proposed work will Gc dfln~~..C ~ r' ~ ~e ~0~~ o House Number Street. Hamlet ) County Tax i\fap No. 1000 Section ~ Block Lot J ~ . Subdivision Filed t•lap No. Lot . (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existin^ ~ u G~- yuscand occupancy b. Intended use and occupancy • • - • • • • ~ o l ~'~j, ti . 3. Nature of work (check which applicable): Nett' Building Addition Alteration , Repair Rcrnoval;t. !?;l+?-:! , emolition ? ..b.Q Vii..... Other Nork . r' (Description) 4. Estimated Cost f „1 ~O. ' - s Fee...........:.........•............... (to be paid on films this application) 5. If dwelling, number of dwelling units Number of dwelling units on each Moor . If garage, number of cars . . 6. If business, commercial or mixed occupancy, specify nature,and,extent of each Sype of use , , , , , _ , _ , , • 7, Dimensions of existins structures, if any: Front , . , .,r'~• ; , , , ,Rear , , , Depth . : . . Hei_ht , , , . , , , , • Number of Stories . imensions of same structure with alterations or additions: Front , , , , , , , , , , ; , , , , , • Rear . Depth Flei t . ~ ••••••••........NumbcrofStorics imensions of entire new construction: Front . . Rear Dc th p Height . ............Number of Stories . rzeo lot: Front Rear...................... Depth 10. Date of Purchase " " " " " Name of Former Owner 1. Zone or use district in which premises are situated . , , , , , , • , , 12. Does proposed construction violate any zoning law, ordinance or regulation: . 3, ill lot be resraded • , ..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 within300 £eet 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 from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. w C•~~ ti _ . , . . 2~ t J ____.Y._.._ t~ STATE OF NE1V YORK, COUNTY OF S.S beinsdulysworn,deposesandsaysthatheistheapplican[ (name of individual sinning contract) above named. tie is the . • • • • • • . • • . • . • (Contractor, anent, corporate officer, etc.) . . . . . . . . . . . . . . . . " of said owner or owners, and is duly authorized to perform or !rave performed the said work and to make and file this 1Pplication; that all statements contained in this application arc true to the best of his knowledge and belief; and that the 'vork will he performed in [fle manner set forth in the application filed [herewith. Swom to before me this ` .Votary Public, ~f!..!~.•,...~,C ~~ir2_ , • • • • • , County ~ y~J HELEN K OE VOE • • ) ~ ~`''~J,''~.2- L ;~L;t . NOTARYPOBtIGSteteMNe~rYak C/ J r (Signature of applicant) N0. 47W878. SaHOlkfau~ Tum licpires MtucA 30, ty.-•L+-/