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HomeMy WebLinkAbout16306-Z FO~"~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILD!NG PERMIT (THIS PEPd~tT MUST BE ICEPT ON THE PREMISES UNTIL FULL COMPLETtON OF THE WORK AUTHORIZED) No_ 16306 Z Oote .... ~,/.~.'.....~......~ ................ , ,~.~.] Permission is hereby gronted to: A K-",, . ................ ~.=...~.~.~ ...................... ...... ...................... .~~.....~:.%!.:..~.~..~. ~..,.--...----......,.,..,...,__ ...... ~~.~..L,, ......... ... ........................... ot p~,,,ses ,o~o,,~ o, ....q.~ ....... ~..~.~.~...~......~.....~ ~ ......................... County Tax Map No. 1000 Section ...... L.~.....~.. ....... Block ....... .C~t...~. ....... ot No .....}..-~- .............. pursuant to opplie~tion dotal ......... ~ .................... , 19-~..'.i., ond oppro¥~t by the Building Inspector. Building Inspector Rev. 6/30/80 UNDATION (]st) UUDATION ( 2nd ) UGH FRAME & PLUMBING SULATION FER N. STATE ENERGY CODE FINAL Y. I ADDITIONAL COMMENTS: BOARD OF HEALTH ~ . 3 SETS OF .... FORM NO. I SURVEY iOW,%i ©F SOUTHOkD CHECK BUILDING DEPARTP~ENT SEPTIC FORM TOWN HALL ~OUTHOLD, N.Y, 11971 CAt~ ~- .~ TEL,: 765-1802 ~ . MAI'L TO: Disapproved a/c ....................................... t~,uzld.n~ Inspector) APPLiCATiON FOB BUILDING Date INSTRUCTIONS a. This application must be completely filled m by typewriter or in ink and sub,_' n.'-~ed t.. the Building Inspector, '~r-.. 3 sets of plans, accurate plot plan to scale_ Fee according to schedu!~.II b. Plot plan showing locatmn or ~o. and of buSd~ngs on premises, re!at'ionship,to aaoommg premises or puo~c streets or areas and oivin~, a detailed de,criDtion of layout of property must be drawn on ~he diagram wh;.ch is part of thcs apph- c. The work covered by this application may not be commenced before issuance f Bui/ding Permit_ Buiidin Permit to the Such permit d. Upon approvalofttusapp!ication, the Building lnspector will issued a ~ applicant. _ shall be kept on the premises available for inspection throu~__hout the work. e. No building shall be occupied or used in whole or in part for Shy purpose warever 2n..n a C~rtmcat~ of Oecuprmcy slrall have been granted by the Bui[dLng Inspector. MADE to the Building Depm~tment for the issuanck of a Building Permk purs:'aant ~o the APPLICATION IS HEREBY Building Zone Ordinance of the Town of Southold, Suffolk County, New York, rang o.h~...ppLcab~e Laws, Ordinances or Regulations, for the coi:snuchon of buildings, additions or alteratioas, or mr rem~yal cr aemonnon, as ...... ~ ..... chord. The appl!cant agrees to comply with a~ applicab!e laws, ordinances, bh//ding eode,lizousing code, and regulations, and to /'7. "(Stone,ute of ap~hcant, or name, ~t a ccrporznonj .../%x. (Maiiihg address of applicon6 <.rate whether applicant is owner, lessee, agent, architect, engineer, general contr¢ctor, elec*-rb.'ian, plumber or builder. N:~me of owner of premises . . ; ................... ~ .............................. (as on the tax mii or 12test deed) avp cant is a co~oration, signature of duly aumonze~ of~ cer. (Name and title of co.orate office~} ALL Cc'hITRA. C~OR S ~ST BE SUFFOLK COUNTY LICR~{BEB Builder s Lzcens No .... i~.~ ~. ~ Plumber's License No ........................ E.ectr ctan s License No, O~her Trade s L~cens No ...................... I. Location of land on which proposed work wiii b~ aerie. }J? P t ' :..C~. (~ -~..~ .' ............ ............... .,.,, ............... House Number S~reet H~raIet /3?* ? . v , ' ' County Tax Map No. 1000 Section .../~;-.-.a ............. F~ledMapNo ..... ~ .......... Lot..~.t.t..¢~.&.. (Name) 2. S.a% existing use and occupancy of preanses and intended use and occuppncy et proposed construcao,,: b. Intended use and ~ -nco ~Ox~j,~L~t,~t . '?/~ ,/~¢3~/Z 9( '.¢'::/~z-~ ~ ~' . ........ 3:. Natsre of work (check which ssplicabie): New Building .......... AdditioM1 .......... Alteration ~. .... ':.. · Repair ............. Removal ............. ~.zmolmcn .--~ ....... Other ~k'or}: ............. (Dc~c~s~ion) - 4. Estimatedzost .......... /-e./. - Fee .................................... ' (to be paid on filing this application) 5. if dwelling, number o[ dwelling units ............... Number oF dwelling units on each floor ............. If ga-age, numb:r of cars ...... ~ .............................................................. 6. if business, commercNi or mixed occupancy, specify nature and e?:ten~ of each ty~ o~ use .................... 5. Dimensions of existing stn~ctures, if any: Front ............... Rear .............. Depth ............. Height .............. ;',~umber of SioNes ..................................................... D~:enslens'o[ ~a:me st~cmre with alter~t!ons or additions: Fron: ................. Rear ................ Depzh ...................... Fef~ht ..................... Number of S:ofies .............. . ...... 8. Dimensions of entire new consWactiorx Front ..... ~ ~':.. Re~ ... )~,q .~ ...... Depth . ?-.~. ....... He~gLt ............... Number of Sto~es ................................................... g. Sizeoflo? Front .................... Rear ...................... Depth ..................... 10. Dat~ cfPurch=se ............................. Name of Foyer Gwner ............................ i '..Zone or u=: district in which premises are situated ...... ~z-. ........................................ i 2. Does c:vopoxe2 construction violate guy zoning law, ordinance or regulation: .............................. ~3 '.Vnl io[ ~e regr~ded ....... ~(.~; ................. Will excess fils be removed from premises: Yes N 14. 5ia:ue cf Owner of premises .................... Address ................... Phone No ............... ........................... ~.. ...... ~ ....... =... Address ................... Phone Nc .............. ~,;mne or Coniraa~or ./~ <./t6<,.4%~.)0 ~,.... Address .,~: ~.~..~ ~,~.. Phone No. i5. rs this propar~y located within 300 feet of a tidal wetland? *gas ..... No .~ · !f fas, D~u~gota To%~ Trustees Permit maybe reeuired. PLOT n~ ~eUA~ loca~ cle3r!y mid dis~inct!y ~ buildings, whether exlsti~g or propos:d, and.~dScate ~1 s~t-back dLmgnsions fro: prcpe~y Hne~ Gi',g szre~t mhd block numk~r or desc~ption accordhng ~o deed, ~d show street names and ~dica~e wheth~ inlehor or corn=r ioL C ST ~ '~-F n~ NE% YORK ....... ' S,$ COU~¢I'Y OF ............... (bi'am~ o f individual signing :ontr:ct) He is ti:z ........... r ....... ~...: ............................................................... (Contractor, agent, corporate of fleer. of sa~d owner o. owners, and is duly ' ' ' ' perform or have performed the sa~ work and to m~X~ an~ file ~'~' :o~i~catmn:' ' that all s~a~ments ..... contained ~.a ':h,.s: appEcation are true to the best of his knowledge aha' belief; and that ~h work w~i be oerfonned in the m~ner set forth in the application filed .... ............. ...... of... ............... .C (Si~atur~f appHcan~ m. 4~7~7R