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HomeMy WebLinkAbout18116-Z rosac xa B 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) N°- 18116 Z Date ...:s~s .9~r Permission is hereby granted to: - ~ ~ ~~s~iS ~s~:~o.......~,~..~...: :.....~r~. Vii... ct premises located at ...Z::,~l'..:3P........ .~~.......~4.. ..........~6~~-.~.~. County Tox Map No. 1000 Section Block .........~z.......... Lot No....... pursuant to application doted 1~., and approved by the Building Inspector. V d Fee S.•(•`"'~/.•.?4~:.. r........ .:.Q'C-:.::.. Building I for Rev. 6/30/80 80.1RD OF HE.\LTH 3 SECS OF PL.1NS FORM NO. 1 SURVEY . TOWN OF SOUTHOLD CHECK . BUILDING DEPARTMENT SEPTIC FORM ' TOWN HALL EOUTHOLD, N.Y. 11D71 NOT 7 / L~~ j G~ • • • . TEL.: 765-1802 CAL%- PIAIL T0: Examined .>~~.5........, 19 j~~ / / ' Approved 19 S!~Pcrmit No. ~ OMC~( Disapproved a/c ~ iii ~ ~ I~ a~ ~ ~~~~~PI'L'. .'....Lf~?..: TOW~I~OFSC~1t~!0~ ~3udd' inspector) ; APPLICATION FOR BUILDING PERMIT Date ,~~n,~.. o?~...., 15.°.l INSTRUCTIONS a. Tltis 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 throu=pout 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 Recula[ions, 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, hc{jpj~$AIQ~f"e~klations, and to admit authorized inspector on premises and in building for necessary inspections. ` ..1 (Si antre ~a~~r'~l~' j~fEjgmrpor8uo ) X2-.4. ~P.~'. 3tfTZ}~~' 3 X147./ ~.~1N(}'f ~'19gl.tt vi ut, , Stale whether applicant is owner, lessee, agent, architect, engineer general c r S~4'S~Ri~P'~lutnbefsr builder. Name of owner of premises C-~.. lC . + ; ; . + (as on the tax roll or lak~t ¢©edht IC applicant is a corporation, signature of du]y authorized officer. 1 '~''t ` ' ~ ; (Name and title of corporate officer) $uildci s License No . . Plumber's License No . . Electrician's License No . . Outer Trade's License No . . ~3~~~~/ 1. Location of land on which proposed work will be done. . , /t (Jq j/v , , , . „ .SOt,IrclQ ~ ~ _ , ~~I~~-~' ...s~~.... a~-...~~.n-Q Flouse Number Street. Hamlet 7~ ~ ~ ~ County Tax M1tap No. 1000 Section • Block Lot . Subdivision ...~!'~~I:~~L!~:..~/~f?~C'.......... Filed t,tap No. Lot . (Name) State existing use and occupancy of prem'ise~s and intended use and occupancy of proposed construction: a. Existing use and occupancy ........(/uQ~/~GS~->.Q b. Intended use and occupancy ~.t~ 1'•^•~ ~ IOKD - ~~.l~ . ! ~ ~Q - • - • • • . • • • • 3. Nature of work (check which applicable): New.lluildin .Addition .Uteration Repair . Removal , , b~molition Other Stork - . n ~ ,r~(Description) 4. Estimated Cost .......~.YUw.°l_,_ Fee ~f~ • •.(~~j...... (to be paid on films this application) 5. IC dwelling, number of dwelling units , j , , , , , • , , , Number of dwelling units on each floor , , • , • If tiaragc, number of cars ' 6. IC business, commercial or mixed occupancy, specify nature and exlenC o(cach type of use , , , , , , , , 7. Dimensions of cxistin~ structures, if any: Front , f?`~, Rcar ~ ....~.C9.Tl.... Depth ..~0 l'J..... Height . , , ,T~, , ,Number of Stories , , , , , , , , Dimensions of same structure with alterations or additions: Front ,Rcar , . , , , , , Depth IIcight Nuntbcr of Stories • . 8. Dimet~~n~e new construction: Front ....ter---- , , , , Rcar Depth Height Number ofStotics 9. Size oflot: Front...,r.---=:~,.,,,,,,,,, Rcar......, - De th p 10. Date of Purchase . ,~JP'A.I, , , , J9'~,~, , , , , , , , • ,Name of Pormcr Owner .,c.~p~J@ 11. Zone or use district in which premises are situated . . . . . . . . . _ o 12. Does proposed construction violate any zoning ]aw, ordinance or regulation: . l3. Will lot be regraded tiVill excess fill be removed from premises: Yes Na 14. Name of Ownerafpremises ....................Address ...,•..,.•,,,,•,,,,PlroneNo. Name of Architect . ,Address~7... ..Phone No. . Name of Contractor ~RI,~, , L.r~i.llttP,v?1S, • , • , • Address I":Q,$Q,~, , (q~ f-; • , ,phone No. ?ft.~%!/3 IS.Ts this property located within 300 feet of a tidal wetland? *YES....NO~~. *If yes, Southold Tovn Trustees Permit may be required. . PLOT DIr1GRAh1 Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property tines. Give street and block number or description accor tng to decd, and show street names and indicate whethe interior or corner Lot. t qp `~1 _ At NdTEO / ~ , u DAZE: /5 BJ! • ~ ~ so FEE: /.5' N0T1 AT 786.1801 8 AM Tp 4 MII FOIL THE _ FOLLOWING MISPECTIONS: 1. FOUNDATION TWOREOIlIREp - FOR POl1RED CONL~lETE ~ 2. ROUGH . FRAMN'!G a ~BMIG i 3. INSULATION '~jD ~ A - 3 4. FINAL - CONSTRUCTION MUST 8E COMPLETE FOR C.O. ALL CONSTRUCTION SNAIL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION 8 ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION-ERRORS STATE OF \EtV YORIti, ~U~-i~ COUNTY OF . S.S • • • ' ' ' ' ' ' • ' ' ' ' ' ' ' ' ' • • ' • • • • • • • • • • • • • • • • • • • . • • • being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. ilcisthe (Contractor, agent, corporate officer, etc.) ~ ~ " ~ • N said owner or owners, and is duly authorized to perform or have performed the said work and to make and tle 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 filed [herewith. iworn to 6etorc mUUe this ...........aJ.. dayof...., ...,19~y ;otarl' Public, ,/,•',e;eY.;x~. Jl S/.~...... County l/~ HELEri K. DE VOE • f^'~• . NO[ARY PUBLIC, SMe of tieM Yak / No. 4707878,SutfdMCautdy~r ($igna[ure of applicant) term Expires Nlarcb 30.1