Loading...
HomeMy WebLinkAbout19201-Z YORK NO. 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) N0 7 2 Z Date .... 11y....................................... 19. � Permission is hereby granted t ... .. ...... ..... �- to .X T`R� '""""�tk....... �� .. ......................................................................................... .......... ........................................ at premises located at (r�.t�rr1� .........W;-/''J........ ........................................ . 4 :G'1 .................................................................... ........................................................................... ............................... ............................... ....................... County Tax Mop No. 1000 Section ........ �, V/....... Block ,T.LLot No. /..��/3' pursuant to application dated ....� ..� ........................................ 19.o .., and approved by the Building Inspector. Fee $.•lr . �. .. -'- B ing I actor Rev. 6/30/80 NEW _,� BOARD OF HEALTH 3 SETS OF PLANS . . . . . . . . . . . • FORM NO. 1 SURVEY • • • . • . • • • • • • • • • • . . TOWN OFSOUTHOLD CHECK . . . . • • • • • • • . . . . BUILDING DEPARTMENT SEPTIC FORM . . . . . . . . . . . . . . . . BLDG. DEPT. TOWN HALL TOWN OFSOUTHOLD SOUTHOLD, N.Y. 11971 NOTIFY TEL.. 765.1802 CALL . . . . . . . . 5� MAIL TO : Examined . . !_ . . . . . . . . 1 p , Approved . . . . . . ., IV.( ' Permit No. / . . . . . . . . . . . . . . . . . K? . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Build' g Inspector, APPLI ATI FOR BUILDING PERMIT Date . . . . . . . �. . . . .. 15 W. INSTRUCTIONS a. This application must be completely filled in by typewriter cr in ink and submitted to the Building Inspector,with 3 sets of plans,accurate plot plan t6mcale. 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 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 Reculations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to compl with aki applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized nj) L111r$At{l 'remises and in buifng for necessa inspections. Vp (Signature oP applicant, or name, if a corporation) TI. TSV!' M1 74 A�13C, ' 7 . m n1. . . . . . . . . . . . . . . . . . . . . . . Ad. .� . . (Mailing address of applicant) a s State whether�appG��ppcaip j . own r,,lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. AIMA P A . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . .... . . . . . . . . . . . .�. . . . . . . . . ...-.y. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :arae of owner ofpremises . . .'7.Q1 . • • . • t •ip� • • : "• . 0 . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed) applicant tr jIil4n nature f u authoriz offices (Name5f � title of corporate officer) Builder's License No. ...444.--^€Sr. . . . . . . . . . . . . . . Plumber's License No. Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . Location of land on which proposed work will be done: �asYs house Numbcr . . . . . . . . . . . . . . . . . . . . . . i . . . . Street . . . . . . . . 'Hamlet . . . . . . . . . . . . . . , County Tax \lap No. 1000 Section . . . . . . . . • • • • . Block , , , , , , , , Lot . •' Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . (Name) State existing use and occupancy of premises and ii,nttennd�edd use and Occupancy of proposed construction: A. Existing use and occupancy. . . •p • • • •A.. • • • • • • • • • B. Intended use and occupancy. . . . . • . . . . .. ' i. Nature'of work (check which applicable): New Building . . . . . . . . . . Addilicn . . . . . . . . . . Alt p . . . . . . . . . . . . . . . Repair . Removal . . . . . . . . . . . . . . Demolition V Swimnin 1 :' . . Tennis Court . . . . . . . . . essory Building . . . . . . . . . . Fence . . . . I . .Other ldork . . . . . . . . . Estimated Cost . . . . . . . l/?. . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) >• If dwelling, number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . . . . Ifgarace. number ofcars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i• if business. commercial or mixed occupancy, specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . . . 1. Dimensions of existing structures, if any: Front . . . . . . . . . . . . . . . Rear . ... . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Number ofStories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . ; 3. Dimensions of entire new constnmction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Size of lot: Front . . . . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . . ), Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Former Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . 1. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . • . 3. Will lot be regraded . . . . . . . . . . . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes . .. , No . . . I. Name of Owner of premises . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . . Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . . Name of Contractor . . . . . . . . . . . . . . . . . :. . . . . . . .Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . : . . . . 5 .Is this property looted 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 from roperty Lines. Give street and block number or description according to deed, and show street names and indicate whether uerior or corner lot. APPROVED AS NOTED DATE: ______ lip N FEE. NOTIFY BUILOINp P 765-1802 8 AM TO 4 PM FCR IM FOLLOWING INSPECTIONS: '. FOUNDATION . TVMOREOUIREC FOR POURED CONCRETE 2 ROUGH , FRAMING & PLUMBING 3 INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS TATE OF NEW YORE, S.S :OUNTY OF . . . . . . . . . . . . . . . . . • • • • • • . . . . . . • • • • • • • • • • • • • • • • • • • • • • . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant . (Name of individual signing contract) bove named. ,� " n fc is the . . . . . . . . . . . . ►��QRA-1-Z5 . . . . .0 DTZ, CC?ry�. . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this pplication; that all statements contained in this application are true to the best of his knowledge and belief;and that tt�c lark will be performed in the manner set forth in the application filed therewith. Ivom to before me this . . . . . . . . . . . . . 1. . . ...-day of. .. ./ . ././ . . . . . . 19 :Otary Public. . . . . . . l K . . 1:: . . . . . . ? �/. . . . County R{�� .U/. IIOAIRY NNLN,�Sh�M rf IYtt �EomMarch 306 7tt kp*j/ (SignatnreofapplicanU 1 - - - _ - - - -------------- 1 _ I - } ?ulq 7-60. O 9 F'a72r , ' LSFc Cn is C"7" GN'rE f:F;k"!'I'SE S , 1hf(.:. a O ,G, WI.LLIA {pf 7.tO L t ax QOAJD wRl ,y } N `Y I,•l t�DM!~,._.- ('."�1 I � � ' � � � �V,; a -, �su�rrk�j `'� _ �- ,i 1 . as, l 13 T FF.A.CN PIPEj7e. f ,a,Lr,v', INC. - Pr I 1 L 19'Pll'TO Er h F" I 1 ,.,(�..% J;' `7 'k'�0h49 •' ;3 � ��.P " � � ' � h '�' ;I � ' � � �' _ . Ar APR te�a 80A8soD 40- ,�-k F 'I Ih"�`T-"�'�' ! '✓ I _ . a' ' �. Ic )) .C+:d. � ♦, i ' i k � d'� �q I^ .n Fnnatb usMmrd ; B"UEICH .ht? : 'F4T H1GH 'Vv�?H13�i ,,," "1 'l � i � � 4 hi' _ E Im.a<ea tier°op anal;., j x xh P san for wham tM10 sural powD L J 1L I � "I. � � _ .� �� y af'a.xnl lllctltWone ar eubeaUuelh q `try { Ar L I + w Ntr i j'�t. � ",; � .. �, a 'i I, --�,iti�c� Fl�.NE�N,D�d F'l�t��a; f93�_ ✓�z��,��cK�I>,ti°,� jj I IJFF{� Jd. _h}6AP . ' �_ r rta. k ? , go 1"'4557 ( TM Epi;,, Vit.., I kf�4` ." 2'"�L;;�SY�r`�'ti7t" a" 6t»C�ri1:'!'�?1,1�'�;P..�' utc fib',l!r�AAN �S'�A 1;.E��t 1 W ` �-=, •----�" ' � 'CL Wa 5 9 iP *ham 1$ �45!QV'M4la'twZr "?�5'. �r y,,