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HomeMy WebLinkAbout17100-z " ~ FOSat NO. ! ~ l `""~C. 0 ~t~;,2~/.!t>J ~ TOWN OF SOUTHOLD c~ ~ BUILDING DEPARTMENT TOWN HALL v SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 017100 Z Date ......~.,~.~!~!-~,.....I...~ 19.$ Permission is hereby grante to: ...Y.... ~.~.....~t~...'.!'! U / p .--y~., .C.I.rAJ....ll..~:f.f?~:..,.I.U~!!J....... ......4:5irfs(..'if'Y.)~..........,,. ~ ..........n.............. at premises located at ..1.~~~... .~~?.T.'1.....~l:~Y..!-nA.....~.:.......1.L.1.G4~.L,~r.......... i Caunty Tax Map No. 1000 Section ~..~..1...I./..~5........, Block ........~.~........`.1 Lot No....r°.~ pursuant to application dated .........:Jni4l~kt.R....~ 19..1F.~., and approved by the Building Inspector. 111 Fee $..r~Y..'.. Building Inspector Rev. 6/30!80 BOARD OF HEALTH ` y 3 SETS OF PLANS d i~h'w'!"~~\~J~'_':) ~ FORDMN0.1 SURVEY .....~.d: ~ 0 f6~ t r TOWN OFSOUTHOLD CHECK ~ fa ;~~i~ BUILDING EPARTMENT SEPTIC FORM i TOWN HALL '04NNOF50U1'hiOL17jI~~~ ~ SOUTHOLD,N.Y.11971 NOTIFY ~si,DG. uEl T. TEL.: 765.1802 CALL n /y~~ T ..,a.,, ......._,,..n....~~ ~q MAIL T0: ~~-a~ Co-c,rCL'o Cif Examined .....,lr~~~'....., 19,~.C0 ?'-~i+y1.~'l v<-t1~:C- I/ 37~` Approved .2-/`~......, 19Q~Permit No../,'~~©IJ~~ / ~~.c~ v~ Disapproved a/c . Pr%~71 ~ o y,~ ~E~idt.C '~1"l' ' . "_r c%~ , ~ uildin ns ector) ~J ~ APPLICATION FOR BUILDING PERMIT dti~~ Date .V.G~.~.... ~~...I 15~~-~. INSTRUCTIONS a. This 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 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 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 inspections. (Signature of applicant, or name, if a corporanon) .05.~..L?~~T'. NoL~:.p~:. tt2c.~-cT~'ruc.~ • (Mailing address of applicant) • ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..lSW l.J Name of owner of premises .+a!"N.~~N~ . C~,~?AcGE, ~ F}Yh CSI 1'JO (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No . . Plumber's License No . . Electrician's License No . . .~,~uL-w J- . Other Trade's License No. ..~4~ . ~P'"'~-~- 1. Location of land on which proposed work will be done . . House Number Street Hamlet //AA County Tax Map No. 1000 Section Block Lot .....vld 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 ........~~!V~t':~^• • • ~'~`"•'l~~ • . !Q~S~~ l1 N _ b. Intended use and occupancy , , , • • • • , , , , , .f.4`!~:.... ?t: ~2,-.... . 3 Repair of work (check whiRempplicable): Now Building Addition Alteration , . • , oval Demolition Other Work ...'F~~.~, , escription) 4. Estimated Cost U Fee ..;10...~r??~'~t • (to be paid on filing t is application) 5 if garagennumber of cadwellin units . : Number of dwelling units on each floor . 6. If business, commercial or mixed occupancy; specify nature and extent of each type of use , , , . , , , , Dimensions of existin structur g g.... es, if any: Front Rear Depth............... Hei ht Number of Stories , , Dimensions of same structure with alterations or additions: Front Rear . De S h • Height ......................Number of Stories . p ruction: Front Rear ...............Depth . 8. Heit htsions of entire new c Nufmber of Stories . 10. Date or use district in which •r........... ' Rear Depth . f Purchase . ......I.] ame of Former Owner . M.~S.:. ttr. H.&~? , , , , , , , , , 11, zone IZC51 DL 1 L p emisesaresituated ..............':'."?".1.~:...,,,,,.,,,,.,,,,,,,,,. 12. Does proposed construction viola~tt,e any zoning law, ordinance or regulation: N~2 . 13. Will lot be regraded ........!.N.4 Will excess fill be removed from premises: Yes X No 14. Name of Owner of premises , , , , , , ,Address 1.1?!9TI! 7~?"., , , .Phone No.o?°J$ -!-I-~°J~p, Name of Architect . l~?Sir?. ,Y,-+:5$~.~:' 'P• G, ; ,Address 8°.K!°:1'^! .Phone No.SS43,-~-$ eio Name of Contractor a! rh!9 • • • • ....Address 3"S.l;~~~ , , , ,Phone No. a..$.: ~ 15.Is this property located within 300 feet of a tidal wetland? *YES....NO.... • *If yes, Southold Towh Trustees Pe may be required, , T DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block, number or description according to deed, and show street names and indicate whether interior or corner lot. i 1 _~tl 3S r ~ _ rll r X I ..~L.~ ~ ~ J I' l ~o ~5e o_ ~rSi. , ~ trNs /A't"I /~lcd~ p _Q " ~ ° v sl-~~ pLv~rv ~ I, ~n ~ ~ 4 ~ I X ' ~ ~ , 0 x ~ r- tai ~o ~ ~ 15 c95 ~,o ~ ~ STATE OF NEW YORK, ~ COI,tNTY O)~...... g~ ©1 ~ IS.S NTk~P Fps g • • • • • • • • • • • • • • . • being duly sworn, deposes and says that he is the applicant (Name of individual si nng contract) above named. He is the...... 01~u~.1t12... GOI11:J~'YZ/?C,`('OM` (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manne~ set forth in the application bled therewith. Sworn to before me this ...dayyofi. 1~~ . Notary Public, N~:~! , 1, ; /k.!-L. UB-~, , , , , , County HELfq'NK,DEVOE (Signatureofa ]rcant) NOTARY PUDI,IQ Stote of New York FP No. 4707578, Suffolk Couoty~~ Term Ezpire(Mcrah 30,19_.._.. D (-1C~/71~~ ~ BOARD OF HEALTH LIB/l 3 SETS OF PLANS FORM NO. 1 SURVEY . TOWN OFSOUTHOLD CHECK BUILDING DEPARTMENT SEPTIC FORM BLDG. DE#'T. c TOWN HALL TOWN OFSOUTHOLD v0UTH0LD,N.Y.11971 NOTIFY TEL.: 765-1802 CALL '~~~J~a d ~ MAIL T0: Examined ~/.'!'tR I.3 19 ~ r?~ p- . I -7 D Approved .r'..~, 19~$Permit No. ~ ~ Qt~ Disapproved a/c ~/i~~~> d m 'r 'i ..~.R1~CK~ [.t yY pp '`t~ddAE3 ` x*~i;S;N~.x~'nf;$d ~Kh~ i`,:4~+t~ iii" S..fiv`Pide.6.d.~"i ~txl1.Y~~~r ~y~ if,:. (Building Inspector) ~,~1. ~~rtt_,_Il;,~~,~, ~ z „ ~ E` APPLICATION FOR BUILDING PERMIT 1"1" ksttm= e~rt°r; ` a ~ ~ _ e„~ Date'; ~~%~aa:'...,t~.%:} . , 19=~~ zvt, i 7a' u:~tn INSTRUCTIONS ~ aYS"'•t~tl ° ~rN'~a~~ - a. This application must be completely filled in by typewriter or in ink and submit~~~'to$~it'~)ildina'Ix~s~ecto'r, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. ~,F,} ' ~ • b. Plot plan showing location of lot and of buildings on premises, relationship t" ad'~6r iYfg,"premises of'public streets or areas, and giving a detailed description of layout of property must be drawn onr~•#~dt~.:~z7iich i§ part df ;this appli- cation. c. The work covered by this application may not be commenced before issuance4~i9'fi~u'~mg'T~er"mit; , " d. Upon approval of this application, the Building Inspector wIll issued a Building Petm~lto,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 Regulations, for the construction of buildings, additions or alterations, o; for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinanc uilding code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessa 'ins a •ons. ~1~-: (Signature of applicant, or name, if a corporatr ) • AkITI-4otJY AN 2A,GL=. Gh.M ~t t1o • (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~~.k'~4?~?`.1~ .r!~:'~~• .~I~/~~~-. • • • • • • • • • • • (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No . . Plumber's License No . . Electrician's License No . . Other Trade's License No . . 1. Location of land on which proposed work will be done . . House Number jj Street Hamlet County Tax Map No. 1000 Section .....44~......... Block Lot ~ . Subdivision Filed Map No. Lot............... (Name) 2. State existing use and occupancy of premises a/nd intended use and occupancy of proposed construction: a. Existing use and occupancy ....~dLJL?G~L-~+• • ~~~aa:~~•~• • .~y.~. ~(Q~1~C?~ . 1t b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Alteration . , Addition~~~ . Removal . Repair Demoliti n ~ Other Work . I,-/~~1~~.Y-F`QC ~Y-~~~.T1' L.i t.~~• ~,.+4~iniV ~ ' • CSI C>~~'~2Dj (Description) . . 4. Estimated Cost .........~..~.`.,.0 Fee .`~d,~r, I , . (tole paid on filing this application) 5. If dwelling, number of dwelling units ~N~....... Number of dwellin nits on each flo r . . If garage, number of cars `~.~...~k'7.~. ~..lj?~?'L, , ,~,C,tp~p~~ , 6. If business, commercial or mixed occupancy, spec>fy nature and extent of each type of use . 7. Dimensions of existing structures, rf any: Front . . Rear Depth . Height ...............NumberofStories.....................,..........,....................... Dimensions of same structure with alterations or additions: Front Rear , , , , , , , , e Hei t , , Number P ~ ~ofStories...,........,.......... ' 8. Dimgensions of entire new construction: Front Rear , ..............Depth , , . Hei ht Number of Stories . P , 9. Size of lot: Front ~ o~..0........... Rear . rd~E..~(~?. l-4<.?(.~. C~Q•~4~.YDepth ....1~~ : . 10. Date of Purchase ~.°.-a, `F~? ~ , , , Name of Former O~ynerl .'1~!-~~b5`3 .+..~1:~ ~q~ , , . , , , , 11. Zone or use district in which remises are situated . , ~ C~~N'j-(,~1,, , I, , , , , , , 12. Does proposed construction violate any zoning law, ordinance or regulation: ..1.:1`~A. C;~~~ .~14t?~!!9ayG,G'S~ 13. Will lot be regraded r~?Q... , Will excess fill be remolded from premises: Yes No 14. Name of Owner of premises ~~,~.~~C~l~,~t?-address .:vhf,-}-Tl.?u:cK.. , .Phone No.v~`.~~. ~'`~~'.~°xo Name of Architect Wl~f'-t?..f~'SSC?C, . ~,G., ,Address ...~r:f:~4•kti/'~-.. , ..Phone No. ~.rP.•~.--T:c~'O4. Name of Contractor . ~~I?? :~1!U~, , .........Address .1?~LY~I:"'~T(.Z~iS-C'.~ ..Phone No.~.'~? :.1;~:' :7,°-~Cp 15.Is this property located within 100 feet of a tidal ~.retland? *YES. .NO..... *If yes, Southold Town Trustees Permit maq be require',d. 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 corner lot. • y KC`~ W N A-s I o E. r` 0 o APPROVED AS NOTED _ ~ .s~ DATE: ~ ~ B.P. q ~o'n ~ ~ NtJ~IFY BUILDING DEPARTMENT p,T 788.1802 8 AM TO 4 PM FOR THE •z ~ t ~ ~ F04LOWING INSPECTIQNS: ~ 1. FOUNDATNN~1 TWO REQUIRED A~~~(L. ~j FOR POURED CONCRETE + 2. ROUGN • PAAMING & PLUMBING •-lg,~ 8. INSULATION v I I U 4. FINAL - CONSTRUCTION MUST STATE OF NEW YORK, ~~0~ ~ 8E COMPLETE FOR C.O. COUNTY OF . S'S ALL CONSTRUCTION BHALL MEET ......~~U~.~(-}~'J..~, TH4 REQUIREMENTS Of THE N.Y. • • Q • • •I• being duly sworn, $Oifl'DE@sG'GfNIl1'~lRld~Ne S t~lE~Ycant (Name of individual signing contract) a, ~ pESppplgl~ RIyR above named. tSE~ICdNO~''r1KICT10NERRORB Iieisthe.........~.~~~(~ (Contractor a ent cor orate officer etc , g P i,) of said owner or owners, and is duly authorized to perform or have performed the (said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application Gled therewith. Sworn to before me this \ 4 I 4 ....day of ~!~w?~........ , 19 . P~ I' Notary Public, ~L • n'•...... County NOTARY PUBLIC, Slate of New York . NELENKDEVOE (Signature o , No. 4701878, Suffolk ~~aau~ Term Eaplrea Mach 30,1l~ x.<• f applicant) ~ w vi x w ~ ~ ~ s" J a3 & t4'vori 1 vL e( 1~ Z SW'1 W L~ ~ ~ ~ 0 ~ _ ' ~ ~ ~ ~ r ~ " " ~ ~ F ~ ~ , ; Q 2 ~ S~ ~,~yq,A" ~ ~~i y ~ F V1 R 1 d Q y V yyy ~ A y ` z` ~ ~ W ~ *4 ,,'$z 'n 7 =T) , w Z w O W F; ,a, a 0 fl `4 ~ ~ ~ d~ -.,.5 ,~\J j~~ f p w Q d ~ 5 r4 s` J ~ ~ y ~ ~ ~ ~ Lq ~ - - _ - VI ~r+ Q ~ w} rZ- w r ~ O z 1 x-~ 4 ~ ~ x a ~ ~ ~ r ~7~ Y ~rc~Od ~ DyQ O ~ ~ ~ ~ m w~a ~ ,N ~ y W ~i 2p 1~ 4 W Z a t/! ~ Uf ~ . +'L WW Mme-. ~ ~~n°uu0i ~ivauOBi~t q - ~ , i, ~ ~ ~ o w..~.._.....~..~ , a. i 3 p 4 ~ yet i ~ ~ r ~ ~1 v~ ~ ~1 C~ lJ k ~ tjY ~Ay~ ~ E O i ~ ~ ; ~ ~ T~"F is , ~ a r ~ ' i a ( ! ~ w ~ ~ 1 \ M yj ~ ~ t~ ~ ~ u. r, f, _ i k - ~ ~ .fit ~ F.~ ~ . > Y ~ (q i ~ ~ c" t r ~ ~`~"y~~ ~ ~ r~ k , I ~ ,,1}if, 1 , - . ,yti ~ ~ . I j^ , r j- A / V, p / ~ ~ xn1 ~ ~ ; , rag'"~ ~ y r ~ ~ l~ ~ ~ i ~ ~ ~ , ~ U X ~zror kz X dal ~ x 'JC _ Aye ~ ~ " ~ 3 R . . ~