HomeMy WebLinkAbout18750-Z maac xa s
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
CQMPLETION OF THE WORK AUTHORIZED)
N°- 18750 2 Date ....'/`'`"'3 1~'~~..
Permission is hereby gran to: ~
ta ./.~.~.%~~.Qt'flc....~'-~B.:f!~~~. a..X.~Se....rl!~~ ..~1S/.~....~!CY~
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at premises located at ...,,~?....?f
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County Tax Map No. 1000 Section ...........i~.f`.'... Block Lot No....s~..~..........
pursuant to application doted 19..1~...~ and approved by the
Building Inspector.
0
Fee S..~Q...'
Builds Inspector
Rev. 6/30/80
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L~~r'';e'~~cz~~~ ~ ~ 80ARD OF HEALTH
i' f 3 5ET5 OF PLAaS
hyry.~!/./j,.£! !~LU ~,!~~u'/ •FORM NO. t SURVEY
y°-~,~ U TQWV OF SOUTHOLD CHECK
BUILD.INGDEPARTMENT SEPTIC FORi`I
TOWN HALL NOTIFY
EOUTHOLD, N.Y. 11rJ71 CALL
? . .
TEL.: 7G5~1802 ? MAIL TO : . • • • • , - • • • • _
Examined ~ .J 19k~!' -7" DANiEG FisC/,~~it
Approved .,1~~. ~ ~~7~~ olaSvYiv~ .P6}n
, 1 Pcrmi[ No.. GRf,`.Y~Ati
Disapproved a/c
(B tiding I pector)
APPLICATION FOR BUILDING PERMIT
Date ....Ta., • f 8 19 90.
INSTRUCTIONS
a. This application must be completely filled in by typewriter or iri ink and submitted to the Building Inspector, with
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 streeT
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 Buildin; Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Fermi[ to the applicant. Such permit
shall be kept on the premises available for inspection throughout the work.
e. tv'o building shall be occupied or used in whole or in part for any purpose ~vha[ever until a Certificate of Occupant}
shall have been granted by the Building Inspector,
APPLIG~TION IS HERESY MADE to the Building Depaztment for the issuance of a Building Permit pursuant to the
3uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Re~tilations, fo he ar~struciion of buildings, additions or alterations, or for removal, or demolition, as hezeiz described.
The applicant a~ees
to comply with all applicable laws, ordinances, build
o code, housing code, and regulations, and to
admit aut::oIIZFd inspectors on premises and in building for necessary inspe ions. `
, ~1t~.~.r.~
• (Signature of applicant, or name, if a corporation)
, .
......a0 Soe~,Nb.;joA,IJ,...GR;EFJV,R?e~r N.y..
(hfailing address of applicant) II 94 t
State whe'Eh2!'4pb]tcant is owner, lessee, .agent, architect, engineer, general contractor, electrician, plumber or builder.
~:'2'MffiYa~ .CO n f',r{^~tta+e ? j. , .
\ame of b#f~erdfi~remises .!?/t~IQAN _IS~P~~/Y
{ ~tT (as on the tax roll or latest deed) •
L` appliS~g is a eotporatiorr, signature of duly authorized officer.
• • • • • • (Name and title of corporate officer) ~ V ~ •
ALL CONTRACTOR'S gT BE Sllr•OL~$, COUNTY LICENSGD D L~fi`
Builder's License No. ~~NJ~L..li:.~J~Grt~!Z , i {
Plunrbcr's Liccnsc No. ~ ~ '
i.__._._..__y____._
Electrician s License No . T01NY~ OF SOS H(it_D
Other Trade's License No . . :
1, Locatio~nl of land on which proposed work will be done . . .
$~(.5 ....................FOU nclE rs••~4}~......... ........~0t^J. ~?D
House Number Strcct Hamlet
County Tax hlap No. 1000 Section . , , Dlock Lot . , , , , • , • • •
~ n ~ /
Subdivision :y~~,~t!:...~, ~s,~~ Filed \tap No. C~ Lot ...4~ .
(Name)
Stott existing use and occupancy of premises and intended use and occupancy oC proposed construction:
a. Existing use and occupancy ..r'c•s,.~@~n-I-, a; l
b.lntendeduse 1;gs;der,}.~a!
and occupancy
3. I~'ature of work (check which applicable): 1~`cu• Building Addition Alteration ,
Repair . Removal Demolition .1~........... Other Work
4eme%j~ rirrslinl w,h~eahe.rrr~brcli aa` +ta~ ~~•hous~
(Dcscripjion)
4. Estimated Cost..y Q d Fee ,
(to be paid on filing this application)
5. If da•cllin„ numUcr of dwelling units ~ Number of dwelling units on each floor .
If garage. number of cars .
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions of existing sttvctttres, if any: Front ...............Rear Depth , ,
Hcigftt Number of Stories , ,
Dimensions of same structure a•i[It alterations or additions: Front Rear
Depth . Height , .................Number of Stories
8. Dimensions of entire new construction: Front Rear , ......Depth
Hei_ht ....._.........NurttberofStories
9. Size of lot: Front . Rear . . . Depth , . - , , ,
0. Date of Purchase...! f ~LBI Name of Former Owner .~,{oA~s!cF, ,~7T,Xp,R, ;t! , , , , , , ,
1. Zorte or use district in which premises are situated .
2. Does proposed construction violate any zoning la~v, ordinance or regulation: . ~Ir~ . .
3. \1'ill Iot be regraded ...i1!o Nill excess fll be removed from premises: Yes
4. A'ame of Owner of.premises iWgRioiv, iro?S;F~, . , , _ ,Address ?•.~Iz??. Sou~one No. ~ .
Name of Architect ........................Address .........Phone No. ,
Name of Contractor .7J64'(64 . L~>riSG~'Fi~.......... Address t~° s.°~!['P.~ Ge~E.+'~. Phone No, ~ of , .
5. Is this property located within 30D feet of a tidal wetland? *Yes No
*If yes, Southold Town Trustees Permit may be re uired.
PLOT DIAGIgAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frcrn
:operty lines. Give street and block number or description according to deed, and show street names and indicate whether
acrior or corner lat.
• ti
A .jIO ED AS NOTED7,So
DATE:/ .z B.P. K
o BY:
~ Sur F1FY Bt Ifl ING DEPARTME AT
7fi5-tgpy 8 AM Tl~ 4 PM FOR THE
• FOLLOWING INSPEf.T10NS:
1. FOUNDATION - 7W0 REQUIRED
~ FOR POURED CONCRETE
p, ROUGH -FRAMING dr pWMBING
iii Q 3. INSULA7fON
~L° ~ A. FINAL - CONSTRUCTION MUST
Cti, BE COMPLETE FOR C.O:
ALL CONSTRUCTION SMALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION f• ENVY
CODES. NOT Ia~SPONSt'wiE FOR
So is c SIGN OR CONSTRUCTION ERRORS
JGC.7NOt D'
• tOUNOC°/7S PaT//
TL Or 1. i', 1~~1.. J.J
~c ~-rY or
. .
F sc%. ? _ , , , being dui P Y PP
_ DEt•n, i41 , , , , , , , , , , , , , , , , , y sworn, do ores and sa s that he is the a licant
(tiamc of individual si^_nin~ contract)
ovc Warned.
' is the Gonfrarl0i
(Contractor, agent, corporate officer, etc.)
e
said o~vncr or owners, and is duly' authorized to perform or have performed the said work and to make and file this
~ticatian: that all statements contained in this application are true to the best of his knowledge and belie(; and that the
rk will be pcriormcd in the manner set forth in the application filed therewith.
orn to before me this
...............~~....day ot]./. U 19
tar7• Public. - ,~,4-Q~
; ~ jJ; ~f-.r/•~,~ . County / r
R38i K OE TOE
IItAAlIYN9lIGSleIedlNwNdt • • . • . - • • - ~ • (Signature of applicant)
Tern
t.sgree MereA30.