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HomeMy WebLinkAbout22803-Z FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD,N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UN11L FULL COMPLETION OF THE WORK AUTHORIZED) Date.. .� � ............................................., NE 22803 Z Permission Is hereby granted to-� .....................................�.... ...... �..� ..� ...................................................... to ...a. .44�.4 ......... � .. ......... .. : ............................................................................................. .................................................................................................................................................................. ..............................................................................Y0.10................................................................ ........................................................................................................................ ............. ........................ at premises located at......... .......... .. .. ........................... ..................... ..................................................... .....� ........................................... ........... County Tax Map No. 1000 Section ......................... Block.......................... Lot No. -`.�.�............... ow r" pursuant to application dated ....... .... %................................ 19i�.......... and approved by the Building Inspector. Fee$........... �... r a....: .......................... Building Inspector Rev. 6/30/80 G�v/?' �✓ v� �z ND /lee - ti 15 0 s � rry Ll 21 �- 995 00 7z /J FIELD INSPECTION REPORT DATE COMMENTS --------------------=------------i--===_______=________________________________________= o� H FOUNDATION OST) 1�— IIS �I FOUNDATION (2ND) u II it _ �I II�II O ROUGH FRAME & It q if jl _ PLUMBING � II ii INSULATION PER N. Y. STATE ENERGY ;; l —11 . CODE ii IIS_—�I I II ii � L I j IN- -II FINAL I -n _II II ADDITIONAL COMMENTS: h x � H O ri b H BOARD 'OF KEALTH . . . . . . . . . FORM NO. 1 3 SETS OF PL.INS . . . . . . . . . . i TOWN OF SOUTHOLD SURVEY . . . . . _ _ . . . . . MAY Z 6 1995 BUILDING DEPARTMENT CtIEcK . . . .. . . _ . . . . . . . . . . . TOWN HALL SEPTIC FOAM -_—• _ -_-- ;.�--_ ,e-.�l . . . . . . . ... . . . . . . SOUTHOLD, N.Y. 11971 TEL.: 765-1802 r�OTI FIE ; Examined "" .,;;? .+ . . . .Y.�. 19 � CALL . . . _ . . . . . . . . ... . . . •' (_ MAIL TO: 0 . Approved . . ./. ? . . . . . .. 19�J Permit No. ® . . . . . . . . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (tuil�,- Inspector) APPLICATION FOR BUILDING PERMIT Date . . . . . .. . . . . . . . . . . .. 19 . . . :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 throughcut the work. e. No building shall be occupied or-used" in,who_le 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 alI applicable laws, ordinances building code, housing code, and regulations, and to admit authorized inspectors on premises and,in building fornecessary inspections. • �?�rLs .ls:� . �l��.:. WX K Use (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect engineer,\general contractor, electrician, plumber or builder. . . . . . . U : . �. l.l . . .Q �1 :�-• . . . . . . . . . . . . . . . .... . .. :. . Name of.owner of premises . . . . . . . .5�. . . . . . . . . ., . . . . . . . . . . . . . . . . . . . . .. . . . . " . . . . (as on the tax roll o'r 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. . . . . . . . . . . . . . . . . . . . . . . . . .lo�iiit;ian's License No. Other Trade's License No. 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . House Number . . . . . . . . . . . . . . . . . . . .Street • . . . . . . . . . . . . . . . . . .Hamlet . . . . . . . . . . . . . . . . . . . . . . , . County Tax Map No. 1000 Section . . . . . . . . . : . . . . . Block . '. . . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . .(. . . . . . . . . . . . . . . . Filed Map No. . . . . . , . . . . . Lot . . . . . ... . . . . . . . . (Name) ?. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and o.ccupancy. . . . .C'-: . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use andoccupancy .`. .'S l?- _, . , ;y? GU (`1' . . . f 3. Nature of work (check which applicable): New Building . . . . . . . . . . Addition . . . . . . . . . . Alteration Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . Demolition Other Work . . CIG� (Description) 4. Estimated Cosh d. ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . .'. . . . . . . . . . . . . . . . . (to be paid on filing,this application) 5. If dwelling,number of dwelling units . . . . . . . . .. . . ' Number of dwelling units on each floor . d. . . . If garage, number"of cars i _ • • • • . . 6. If business comm . . . . . . . . . . . . . . . . . .;, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . commercial or mixed occupancy, specify nature and extent of each type of use ... . . . ..: 7. Dimensions of existing structures,if any: Front ... . . . . . . . . . . Rear Height . . . . . . . . . . . . . . . Nu of . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Number Stories .-,� Dimensions of same structure with alterations or additia;ns: Front• . • . • . . . . . . . . ' Depth . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . • • . • • . Height . . . . . . . . . . . Number of Stories . 8. Dimensions of entire new construction: Front . .� ..• • .. . Rear r .Z w Height . . � , . . . . . . . . . . . . . . . . . . . . . . . . . . . Depth . 2.41 . . Number of Stories I. . 9. Size of lot: Front .:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rear . Depth _ _ 10. Date of Purchase . :-1 ,-N . • • . . . . • • . _ . . . . . . • Name of Former Owner �I�� r • � • � - 11. 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 • . • •.N r 14. Name of Owner of premises/ .ijC } . . . . . r 6 ,• . Address/'f:�ti',;. .�.,��.�?lP,�l . phone No.'lk�:':%�.jS,l Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address �• • ' Name of Contractor ' ' ' ' ' ' ' • • • • • • • • • • Phone No. . . . . . . . . . . . . . . . 15. Is this property • • • " ' • • • - • Address . . . . . . . . . . . . . . . . . . .Phone No. . . . . . . . . . . . . . . . P P y within 300 feet of a tidal wetland? *YeS. . .. . . . . No. .�. . .. . *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM e Locate clearly and distinctly all buildings, whether exir;ting 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 Iot. c C2� • �/� AP �6� 0 AS NOTED DATE*: -7 " , + 13.P I_rJV NOTIFYIMNG Y�EPAIRT 765-1€02 9' AM TO 4 P1+a01 FOR THE FOLLOWING INSPECTIONS: i. FOUNDATION TWO REQUIRED / j2l FOR POURED CONCRETE �� G✓ �� 2. ROUGH - FRA1'AING t_ PLUMBING s. INSULATIOr, 4. FINIAL - CONSTRUCTIOIR1 MUST BE COMPLETE FOR C.O.- , ALL .CONSTRUCTION SMALL MEET TIDE' REOUIREmENTS OF THE N.y -/OIL STATE CONSTRUCn•IO€y & .EIYERGY CODES. NOT RESPONSIBLE FOR DES1GN OR CONSTRUCTION ERRORS A"W07 -14 0'1,%,UPARCV OR CnrTE�rNrOF � L-c�-- S.S USE m j vlt°� r�!F- ITE"1064-C-1 Z- �FMHOUT CERTIFICAn • • • • • • • • • • • j • • • • . . . . • . being duly sworn, d Fs d- � jhat. he is the applicant (Name of individual signing contract �u�� �I above named. He is the . . . . . . err, C.ou'rQ.4ey•�,ti-. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly, authorized to perform or have performed the-said work and to inal;e 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 filed therewith. Sworn to before me this . . . . . . . .. . . . : . . . .day of. . . .,`�' ./ . . . . . . . . . . ., vola Pu v votary bloc, . . . County q \• � �HER�JR. Nek8i�/PUlslic State of New York . . . . . . ._� "• • . . . . . - No.4806559 " " " • " " yglffipa in gutfolk Coupj�ty (Signature of applicant) TOM Expido8 13131/96