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HomeMy WebLinkAbout16241-Z FORM NO. 9 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL a X SOUTHOLD, N. Y. ylo 1 BUILDING PERMIT 0 C-�q 641 (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N2 16241 Z Date qq Permission is hereby granted to: 5�� :!-L✓.I..... ............... . . ..... ... ...5..: ..�2.g �.Q....... !.!....... ........................... to .10.0 V�.. .. ........................ ....ff ................................................................................................................................................................ at premises located at .��.. �. ... !.1.�!:':`.. ................... ........... ................................................................................................................................................................. ................................................................................................................................................................. County Tax Map No. 1000 Section .......1................. Block .......Q(A....... Lot No. 1 T ..... ............... pursuant to application dated ........ ..................... 1911, and approved by the Budding Inspector. / Fee .4............... ... .. ............ ... .. . .... ..... .... Building Inspector Rev. 6/30/80 UNDATION ( 1st ) (!� P M UNDATIOtd ( 2nd ) - m ir o � 00 UGH FRAME & J PLUMBING G 1n H m m SULATION PER N . Y. STATE ENERGY CODE • x m y 2,GC, a a n r i v-e FINAL _ CIO ADDITIONAL COMMENTS : Ell x x H os O • z a y � x tv. m -o H BOARD OF HEALTH . . . . . . 3 SETS OF PLANS . • . • . FORM NO. 1 SURVEY . . . . . . . . . :•� TOWN OFSOUTHOLD CHECK . . . . . . . . . . BUILDING DEPARTMENT SEPTIC FORM - - - - - - - - - - - - - TOWN HALL NOTIFY SOUTHOLD, N.Y. 11971 CALL - • • - • • • • • • TEL.: 7651802 • • • • - MAIL TO : Examined . . 9. . . ., 19% ra Approved . . . .�.�. . ., 19� �. Permit No. �.�.�µ1• �� i �r4 ``" L.�? I_�LL����� �f l;, Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 31981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �;' .. -. (Building 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 scliedulei. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public street: 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 bf this,application, the Building Inspector will.issued a Building Permit to the applicant. Such permil 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 of 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 tc admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) A). XY0 1. �UV'y. 0 «�: . .� ( .yam . (Mailing address of ap' licant) State whether applicant is owner, lessee, agent, architect, engineer,.general contractor, electrician, plumber or builder. �uJ�✓E �. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . . . .✓.. . . . �. ..'. . e:``� �G.`�I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax,roll or latest deed) If appli' t is a corporation, s•gnattire of duly authorized officer. ��,,, � J �,�, nak , �/c (Name and title of corporate officer) ALL CONTRACTOR' S MUST BE SUFFOLK COUNTY LICENSED Builder's License No. . . . ""' ✓. . . . . . . . . . . . . . Plumber's License No: . . . . . . . . . . . . . . . . . . . . . . . . Electrician's-License No. . . . . . . . .. . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . --�9~�70 A/ lleo A D 1. Location of land on which proposed work will be done.. . . '. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E�s7' o . . . ,!�F, ? .T�. . . . . . . . . . . . . . . . .�ezT'.ifC3� ��� . . . . . . . . . . . . . . . . . . . �I . House NLiniber Street Flamlet County Tax Map No. ]000 Section . . . . . . . . . . . . . . . . . . Block . . .l. . . 6 . . . . . . . . . Lot./� . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . . . 2. State existing use arld occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . . .!1Ju:�.!.✓E�5 Gi-F/c E. 5 b: Intended use and occupancy . . `SEn p.rL c 3. Nature of work (check which applicable): New Building . . . . . Addition . . . . Alteration . . . . . . . . . Repairs' . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . . (Description) 4. Estimated Cost . . `•7 o..'. . . . . . . . . . . . . .. .... . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling,number of dwelling units . . . . in f dwelling units on each floor . . . . . . . . . . . . . . . Ifgarage,number of cars . . . . . . . . . .,�� . . � ° ' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed oc ��, p �a extent of each type of use . . . . . .. . . . . . . . . . . . . . . 7. Dimensions of existing structur �y: . . . . . Rear . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . .el dr o�S1 . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . Dunensions-of s me stru tt -it a �e"�tio or%V iti '"f ront . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . Depth . . . .x. .i'1I`.. . . . . . . . . `°_ ei . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . S. Dimensions of entire new co 1 ®� Rear . . . . . .4`� . . Depth � . . . . . . . . Height . ../=?. Num •0 to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . 9. Size of lot: FrtSnt . . . . ear .'. . . . . . . . Depth 10. Date of Purchase . . �r .� � . . .. . . Name of Former Owner W41_rZG-'., .�. .� . .. . . . . . .L.�. IL. Zone or use district in which premise situated . . S . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13. Will lot be regraded . .!v'�? . . . . . . . . . . . . . : . . . . . . . . Will excess;fill be removed from premises: Yes Nc 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 tidal wetland? *Yes . . . . . No ©. *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions fror, property lines. Give street and block number or description according to deed, and show street names and indicate whethe interior or corner lot. 4/'D �i = , I C'vi✓v7,L't�c 7'�D ®f a X- v eta� i .�1e, I , APT PrAVVEX" _,.PATE: �_ FEE: NOTIFY BUILDRI+ICS DEPARTMENT AT TO 4 PM FOR THE _Qh�,rl 7615-1 A>J2 Aate F0LL0WINQ INS ipECTION' : F00NIDA'10N "'No C' Fop P(�t.1F9Ft;� CONCRETE ROUCt-t (_-gAIt IpjG & pLlJMBIN0 FINAL (;(jrJ!STRkjCV0N MUST BE Ct3MV'L.L-f-*E Fog O.O. STATE OF NEW YORK, ALL G0P,lr`,j,r-t,1CT10N ,S.HALL. TWEET COUNTY OF . . . . . . . . . . . . . . . . S.S THE NEC UIRIEMEN-fS 0I' THE M.Y SATE C0Et STRUC'" &4 ENI ' being duly sworn, s ' i 9i�1wE (Name of individual signing contract) - IGN 0E n above named. Ileis the . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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.thi application; that all statements contained in this application are true to the best of his knowledge and belief; and that th, work will be performed in the manner set forth in the application filed therewith. Sworn to before me this . . . . . . . . . . . . . .r!3 . . . . . . .day of. . , 19V Notary Public, . . . . . . . . . . . . . . . County i HELENIL DE VOE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . NOTARY PUBLIC,State of Mery Yolk (Signature of applicant. No.4707878:Suffolk COu fnt Term Expires Batch 30,19 BOARD OF HEALTH . . . . . . 3 SETS OF PLANS • • . . . . . FORM NO. 1 SURVEY TOWN OFSOUTHOLD CHECK . . . . . . . . . . BUILDING DEPARTMENT SEPTIC FORM . . . - . - . • • - - - - ; TOWN HALL NOTIFY SOUTHOLD, N.Y. 1.1971 765 /Q�3 a-v TEL.: 765-1802 - CALL - • • - • • - - - - MAIL TO : Examined . .1AAJY 9. . . ., 199q 1 Approved . . , . .�.1. . ., 1911 Permit No. . D �f Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .r�1L 1 31987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � P l.f:s,.T (Building Inspector) APPLICATION FOR BUILDING PERMIT Date . r . . . . .. 19 41 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 ora 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 agi•ees� 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 corporation) (Mailing address of a licant) „State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. QccJN�'. . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . .?. . .✓. . . . . . . . .i. . . . . . . ......I ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax.roll or latest deed) If applic t is a corporation, ss. ature of duly authorized officer. >n r'e s ) (Name and title of corporate officer) - ALL CONTRACTOR' S MUST BE SUFFOLK COUNTY LICENSED Builder's License No. . . . . . . . . . . . . . . Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . -1P 21�127 . /�.9�A✓ �oAD 1. Location of land on which proposed work will be done'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .B. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . House Number Street Hamlet / County Tax Map No. 1000 Section . . . . . . . . . . . . . . . .+. . . . . . Block olP . . . . . . . . . . . . Lot . .�7'` . . . . . . . . . . . . . . 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 . . . . . .! !� . .g`F i e-E S • • • • • . . • • • • . • „ , • • • • , . . • • • • • b. Intended use and occupancy . . . . . . . .a:.. . .`• . . . . . `s . . . : . . . . . . .t . . . . . . . . . . . . . 3. Nature,of work (check which applicable): New Building . . ✓. . • . . Addition . . . . . . . . . . Alteration . . . . . ... . . . Repair . . . . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . . . . . . . (Description) 4. Estimated Cost . . 0 0. .—. . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling,number of dwelling units . . . . dumbeof dwelling units on each floor . . . . . . . . . . . . . . . .. If garage,number of cars ` . . . . . ... . . . . . . . . . 6. If business, commercial or mixed ow .g nat extent of each type of use . . . . . .'.. . . . . ... . . . . . . . . . . . . . 7. Dimensions of existing structur . . . . . . Rear . . . . . . . . . . . . . : Depth . . . . . . . . . . . . . Height . . . . . . . . . . . . . 0'R o t ` . . . . . . . . . . . . . . . Dimensions-of s me stru Xvit al do or €fit' rout . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . Depth . s. .. �: . . . . . �, . . . . . . . . . Number of Stones . . . . . . . . . . . . . . . . . 8. Dimensions of entire new co to o2.d' r' . Rear . . . . . ./a . . Depth .��.... . . . . . . . . Height . ./_?en . . . . . . Num•r✓� � to . . . . . . . . . . : . . . . . . . . . . . . . . . . 9. Size of lot: Fr . . . `.� ear '. . . . . . . . . . . . . . . . . . . . . Depth . . 10. Date of Purchase . ..,��../... sit . . . . . . . . . . Name of Former Owner .GJ�I�T��E' .F. .9`.!4:°�°.•. ' 11. Zone or use district in which premise uated . . Aju:S!!t.11 S 5 . . . . . . . . . . . . . . . . . . 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. . . . . . . . . . . . . . . . a 15. Is this property located within 300 feet of a tidal wetland? *Yes . . . . . No .A..j0. *If yes, Southold Town Trustees Permit may be ,reguired. 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. t�V M A/ io 9 b X I '�� � ► �k �®,✓Sre��TE,o of �x� 'S uloob .!ooiC W.-7-H S/�i�t/6LE5 y dd4ve 3►,v r4 1� Q J l' A FX �'1 1 -7 B.P AT.E: .. ;FEE: �.S' ��,�. v G'• 1,. JY 6 NOTIFY €UtLDWG otiP ,�IT-P IE1 AT 76 _q ,? .4 TV,A P m,KM THE �-�aer� 9e -�� F®LLO 4o4RIC� INSPEC'°CtO S'. FQ�l,a►i'11DA'1' U N s" O Ef��19�tE® ''Fop P0001r?) COKICRE(E ROUGH 1°LlII1f9BiNG I I3F- COlVikPLE VE �01R C.0. ALL.CCN S�T RVCTION Seib. MEET STATE OF NEW YORK, S.S THE r3EO�,IIE6E€AENTS OF THE N.Y COUNTY OF . . . . . . . . . . . . . . . . . STATE COP45 RUVO� & ENERGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . being duly sworn, s sty $.E (Name of individual signing contract) <r tON O . nt above named. Heisthe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 . . . . . . . . . . . . . . . . . . . .day of. . . . . . . . ... . . . . ., 10. Notary Public, . . -Q4P�,c%. . n s. ^' . .v -. . . . . . . . County HELENK.DEVOE - • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NOTARY PUBLIC,State of New Yertc (Signature of applicant) No.4707878,Suffolk Coty! Term Expires March 30,19un