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HomeMy WebLinkAbout14765-Z FORK NO. 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? 14765 Z Date .......... ...•........./.X................... .. 19.a..� Permission is hereby granted to: ... a ...S..... sZIA...................... .. .c�. ...4. .. .. ......�v; to .. . ....................4.... ..�-- ,. .. ....�....�:.�. ..�..`.�.`!'.�'.�f .. of premises located at Z. .�,,,,.�����.........................��C�!!�..S..r................ .....V. ....�5;.........0...................................................................................... .:....... County Tax Map No. 1000 Section ...WQJ....... Block .....0 .......... Lot No. .!................... pursuant to application dated ........ ...... . . Lc)....................... 19. .6., and approved by the Building Inspector. I D Fee $........................ ..... ..... .... . .. Building Inspector Rev. 6/30/80 lz TG5-1802 BUILDING DEPT. ll� � �- - INSPECTION l �r [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] �FNDATION 2ND [ ] INSULATION [ FRAMING [ ] FINAL REM S. DATE INSPECTOR FIELD INSPECTION DATE 11 COMMENTS H y (/� FOUNDATION ( 1st), c FOUNDATION ( 2nd ) m 2 . o Rd OUGH FRAME & 11 U �LuM J � a. PLUMBINGco y 3 . t� INSULATION PER N . Y. y STATE ENERGY CODE x J ' a � 4 . y r � FINAL (J O ADDITIONAL COMMENTS :ogxn in e, 7a.� � v A H •� a 6, H � O z s� x a d . �a ''FORM NO. 1 V . TOWN OF SOUTHOLD APR 10 19% BUILDING DEPARTMENT TOWN HALL BLDG. DEPT. SOUTHOLD, N.Y. 11971 TOWN OF SOUTHOLD TEL.: 765-1802 Examined . . . .�4 . ., 19 �.I(P Received . . . . . . . . . . . . 1 9 . . t� . Approved . . . . .�. ., 19 .P. Permit No. .�. ! .�D � B k Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Building Inspector) APPLICATION FOR BUILDING PERMIT / Date . . . . . �. .!l. �. . . ., 19��. 4 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. . . . . . . . . . . . . . . . . . . (Sign re of plicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises t!T: . .V�. 5=. . . .c � U . •. . `�.` )a.�- ! �. �p• . . . . . . ... . . . . . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ��W1'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Koi�co -C.daCZ�C.C'� 1 (Name and title of corporate,officer) Builder's License No. . : .. g . . . . . . . . . . . . . . Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . .:r!''. . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land ori which proposed workDwill 7be done... L1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S� d . . . . . . . . . .V.hGt . .Vr�¢✓ 77 Ve . . . . . . . . . . . . . . . . . . .4 d.0f .�. . . . . . . . . . . . . . . . . . . House Number Street Hamlet �* County Tax Map No. 1000 Section . . . . . . . . . . . . . . . Block . . . q . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: r 60. ( . a. Existing use and occupancy . . . . .L.4 JO.6.r'. . . . .�G.w�.�. . .". . A . .>. b. Intended use and occupancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v 3._ Nature of rk (check which applicable-)-- New Building . . . . ... . . . . Addition . . . . . . . . . . Alteration . Repair . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . ... . . . . . . . . . . (Description) 4. Estimated Cost . . . d� ��•.dam . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling,number of dwelling units . .. . . . .` . . . . . . . . Number of dwelling units on each floor . . . i. . . . . . . . . . . . If garage,number of cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy, specify nature, Lnd extent of each type of use . . . . . . . .. . . . . . . . . . . . . . 7. Dimensions of existing structures,if any: Front . . ...7_ZY, - :t". . Rear . . . C 2 d .T . . . Depth 3 i . . . . . . Height .. . . . . . . . . Number of Stories . . . .r. . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front . . . .-/: . 4P:t". . Rear . . . :%-:Z:6P.•1171f1_ Depth . . . ;�.If. .3'. . . . . . . . . . . . Height . . . f - -. . . . . . . . . . . . . Number of Stories . . . . 8. Dimensions of entire new construction: Front . . . ./ )-.0 .. . . . . . Rear . . . . Depth . . . . . . .. Height . . . . .11'. . . . . . Numbe- of Stories . . . . . . . . . 1 . 9. Size of lot: Front . . . . . . . . . . . . . . Rear . . . . . . .i . �7. . . . . . . . . Depth . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Former Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Zone or use district in which premises are situated . . . . . {e:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed constructs n violate any zoning law, ordinance or regulation: . . . .N. o . . . . . . . . . . ... . . . . . . . . . . . 13. Will lot be regraded g . . . . . . . Will excesn�fill be reoved, r r mises: Yes No 14. Name of Owner of premises Q� .v�.fi. . ar""��. . . . • . Addresses. t`�c sscu . 1� CC e No. .O:zI. . 009 . Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . Phone No. Name of Contractor . . . . . . . Address. . . . . . . . . . . . . . . . . . . . Phone No•1015141 . . . . . . 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. STATE OF NEW YORE, COUNTY OF .s_c S.S • • • • • • • • �..- . . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant ry Name o2individual signing contract) above nam . , Heis the . . . . !n•Y. .��G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 manner set forth in the application-filed therewith. Sworn to before me this f . . . . . . . .day of. . . . . . .��. . . . . ., Notary Public, . . . .l�� !. .n. . . .! lJtl�_. . . . . County �z• .tid HELEN K.DE"E . . . . . . . . . . .` . ..l 6 . . s f NnyARY PUBLIC.Suffolk NOW Yak , .s•} No.4707.878.Sut of 19 jyry"M K DE VOE a ;(Signature of,app-lica ) PUBLIC,Sto ofYork t, s'• r d j }�} No.4707878 Suffolk Co Turn Expires A�uch 30 19 / :: . i I - c i r I - F' WEFT �UtlldF VEW7 i Lj ci :i f, .t r 1• i fKEx 7- N i = T: , , ! ' 1cN II VVP\ f i C, F�,t L, .. w .. i ... .. :•r5';v: ..t:, rL.ai;.'�.;�Xkc�P+'�' 'i!!i.�� �G7G"�-.';yti a. � r. � - � �_—__ .. hyy JSi �"ft.„ f' �•.. 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