HomeMy WebLinkAbout17065-z noaas xo. s
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 Q 017 0 6 5 Z Date 19.~s~
Permission is hereb gr t d to: ,
........r......~..._.....
.
ct premises located of ..~./:~'36 v~.........7.~.
...................................................................,~....//.l!...~~..................................................................................
County Tax Map No. 1000 Section .......T.7....... Block Lot No.......3........
pursuant to application dated 19.. ~~and approved by the
Building Inspector.
pp~~ d ~
Fee
. .
Buildi Inspector
Rev. 6/30/80
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D ~ ~ ~ BOARll OF• HEALTH
3 SETS OF PLANS
FORM NO. 1 SURVEY .
MAY 181988 TOWN OF SOUTHOLD CHECK • • • • .
BUILDING DEPARTMENT SEPTIC FORM
°`°°'tl` TOWN HALL
BLa:; C~.',~'F NOTIFY
TO~NN a'r suu~'HOIr~ SOUTHOLD, N.Y. 11971
CAL L
TEL.: 765-1802
GG MAIL T0: p
Examined .'..(0.~~........, 19 P.9~~ ,f~i,~- 1 ® ) l
Approved 19 .~4'Yermit No. ~to;'~ /y y
Disapproved a/c f?•(~',' 0"`
(Building pector)
APPLICATION FOR BUILDING PERMIT
Date 19 .
INSTRUCTIONS
. sa ~ c
- a. This application must be completely filled in by typewriter or in ink and submitted''~b . Buik~ing`~nspbec'tor, with 3
e~; ~
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 ~f~o adjoining p ises or public streets
or areas, and giving a detailed description of layout of property must be drawn'on tie diagram wl°}~l~ is part of this appli-
y~Qf. .
cation.
c. The work covered by this application may not be commenced before issuance o€ 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. ` , ~ A
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 Depaztment for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New Ydrk, 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 inspec ~ ns. / /
(Signature of applicant, or name, if a corporation)
5,~ ~tti1,~ ~v~~n oy~Ny
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
..........C
o~. ~~.J. ~ f,~{~../ .
Name of owner of premises !r t? ~.c°... c r~ a tn; 3 ~ .
(as on the tax roll or latest deed)
If applicant is a corporation signature ofd ly authorized officer.
(Name and title of corporate officer)
ALL CONTRACTOR'S MU T BE SUFFOLK COUNTY LICENSED
Builder's License No. ~ !`tom
Plumber's License No . .
Electrician's License No . .
Other Trade's License No . .
1. Location of land on which proposed work will be done. !!.'!Y. a:`. kT.rs ~Gn~ d °~-t ~ •3
House Number Stree~t/~//VovT~p ~ca~ Hamlet ,_~yzla-~,~
Block rn Lot .
County Tax Map No. 1000 Section
Subdivision Filed Map No. Lot .
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy/~~~' Qw~L~zvz
.aryN..4~ ~ r .
b. Intended use and occu anc . ~ ~l~iz ° ~ ~i°~
P Y .5
3. Nature of work (check which applicable): New $uildingDemolition .Addition : ;Other Workatio~~.~.~:~ . .
Repair Removal , , .
I (Description)
4. Estimated Cost.........~~~.d Fee......... li...................,........
` (to be!, paid on filing this application)
5. If dwelling, number of dwelling units . Number of dwelling unlts on each floor , . , .
If garage, number of cars 1 , .
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .
7. Dimensions of existing structures, if any: Front ...............Rear , Depth , .
Height ...............Number of Stories.............,..............................:..........
Dimensions'of same structure with alterations or additions: Front : Rear .
Depth ......................Height . • Number of Stories .
Dimensions of entire new construction: Front .......Depth .
Rear
Height ...............Numberof5tories...........................:..........................,.
9. Size of lot: Front Rear ......................IDepth
10. Date of Purchase .............................Name of Former Owner 1 , , .
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 No
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 tgidal wetland? *Y~s No
*If yes, Southold Town Trustees PermitPLO~ DIAGRAM ed.
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.
~n1~~~ O+~ l~~ftc. 5lc~~.~ade ~rauc-~
I~PP,RO/~V•~E~D AS NOTE/D~j~
DATE: ~;e~~~GQYL_ B. P. M _G_.G~ r? s~~
h~
NtlTIFY 1111, ING DEPART T ~
765-1802 q AM TO 4 PM FOR THE
FOLLOWING lNSPF.CTIONS:
1. FOUNFIATION TWO REQiMEb
FOR POURED CONCRETE
2. ROUGH -FRAMING $a P{,I~ABING
3. INSULATION
A. FINAL', - CONSTRU'`IIDN MUST
BE COMPLETE FOR QA.
ALL CONSTRUCTION SHALL MEET
THE RE("lUIREMEN'IE OF THE N.Y.
STATE C,ONSTRUf3hON 8 ENEROV
CODES. i NOI' MESPONSIBLE FOR
DESIGN bR GONSTRUCTION ERRORS
STATE OF NEW YORK, S S
COliNTY OF .
• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • being duly sworn, depbses and says that he is the applicant
(Name of individual signing contract)
above named.
Heisthe I
(Contractor, agent, corporate officer, eta)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application are true to the best of hi~ 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
Notary Public, .~XF~!....T.i ..../.~•!....Q....... County ~ G
~ l4iitA ~ .HELEN K. DE VOE t....................... .
p A~tY PUBIIG state of New York
No. 4707878,SuafolgCouniyg~ (Signature of applicant)
~ . - ' , , TOr1n;EXplres March 30,19--8,7
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