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HomeMy WebLinkAbout16244-Z FORK NO. 5 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL VVV SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N2 16244 z Date ............ ................. 1911 Permission is hereby granted to: i I-OL o...... 1. . ............ ............................................. 9 t A ....bq .............. ................ ... .... ..........r.................. to .................... ...... ............. .. ... j . ............................. ........A.... . ..... .... ................................................................................................................................................................ at premises located at ...... ..........I.................... ......... . ..................... ................................................................................................................................................................. .......................................................................................................................... County Tax Map No. 1000 Section .....L ........ Block ......9Lq...... Lot No. ..Ie.13........... pursuant to application dated .....1.4AJ2 ..... ......j, .................... 141, and approved by the Building Inspector. Fee .............. 11,1111,11"ill(l000.............. ............................................... Building Inspector Rev. 6/30/80 `.Ll) li �.v....L. .. ... ' a N U14DATI0:J ( 1 s t) ..� c UNDATION ( 2nd ) - --------------------- F O W UGH FRAME & 0 - PLUMBING y SULATION PER N . Y. STATE ENERGY CODE . x r FIidAL l7 nP� ' anftAnq n z) D G O . z ADDITIONAL COMMENTS : x � Zt- x y '\ H � ' z � x • y -ti H m 0wz BOARD OF HEALTH . . . . . . P 3 SETS OF PLANS . . . . . . . FORM NO. 1 SURVEY . . . . . . . . . . rJ. i 11987 TOWN OF SOUTHOLD CHECK . . . • . . . . . BUILDING DEPARTMENT SEPTIC FORM BLDG. DEFT. TOWN HALL NOTIFY TOWN OF SOUTHOLD OOUTHOLD, N.Y. 11971 TEL.: 765-180Z� CALL • - • - • • - - - - - - • • • - MAIL T0 O. Examined . . . ., 1941. n� a + p Approved . . . . . 1 . ., 191.1 . Permit No.1. . ?. . . .Z. Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Building Inspector) . APPLICATION FOR BUILDING PERMIT Date . . . . . rg . 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 ins ctions. `-. . . . .`. . . . �. . . . . . . . . . . . . . . . . . . . . /(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. dGri�v /. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises ���✓9 . . . . . . . . . . . .. �� • • • • • . . . . . . . . . . . . . . . . . . . • • • • (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. y 1. Location of land on which proposed work will be done. .. ..2 . !. `. .. . . . 3�.! 9. . . . . . . . . . . . . . . . .z l! w). . . . . . . . . �✓��✓C���C. . . . . . . . .... . . . . . . .. . . . . . . . . . . . . . House Number Street Hamlbt County Tax Map No. 1000 Section . . . . . . . . . . . Block . . . . . . . . . . . . Lot . I. . . . . . . . . . . . . . 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy . . ��. . .�. . : . . . • • • . . .,'� • • • . . . . • . • . • • 3. Nature of work (check which applicable): New Building . . . . ... . . . . Addition . . . . . . . . . . Alteration . . . . . . . . . . Repair . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . .... .. . .(.,O he eV ork—.: �I.T zhIr,,.��, � +tl dP (Description) 4. Estimated Cost 3 dP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling,number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . . . Ifgarage,number of cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of•use . . . . . . . . . . . . . . . . . . . . . 7. Dimensions of existing structures,if any: Front . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Number of Stories . . . . . . .. .*. . . . . . '. . . . . . . . . . . . . . . . . .'. :. . . . . . . . . . . . . . . . . . . . Dimensions-of same structure with alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . -,8. Dimensions of entire new construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Number of,Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . . . . . . . . . . . . . . . . . Rear'. . . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . . . . . . . . . ... . . . . . . . . . Name of Former Owner_ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 No 14. Name of Owner of premises . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . .Phone No. . . . . . . . . . . . . . . . Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Contractor .I. . . . . . . . . . . . . . . . . . . . . . . . . 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. i 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. r��/ .r��'j��IT� ,CAI-�� �•�/T�it/�/✓� . �ccQn�I/�� . STATE OF NEW YORK, S.S COUNTY OF . . . . . . . . . . . . . . . . . • . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Heis 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 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. . . . . . . . . . . . . . .I 19 NotaryPublic . . . . . l/dL � •<��:X•�tv. .�. 1��. . . . . . . . . County FIELEM K DE VOE `cam {VOTARY PUBLIC,state of Now Yogic No.iolr6s M rch 3 ,Gaunter (Signature of applicant) Term Expires March 30,15 A0 3T�i i$aM 1 NO;� J Y.L� Q /J ,Q / 9 i. UO I� lT A"N . i 0 St�;3�i�;�'�i��3L 3H1 0/ 1 ��D/ ►� / � LJ: � ��°s Loft ' o �� �wH � .� ��� lam �� ?9��a��rr�1<;b°��,� ""NIA 'tom k'N 341 S.�..�,���`a� �s I �.joil.�''i VW '£ 13.30 11% 11�r a �1V uo 9-04 Ili-ldvoo ae a � N -LsnR "' oNclo. 14 31 3uifl` -% o6E%i.A. N 6.3 T 4 • ��.:��;�61l�'�>`° �0�5������� ��� 1rI LN�YiilHV 3� Jfiii®�i('it3/%l�ilON dwina� -°i am k. 4�`b9,x_.. a.. 0 As '� dLv :S'C 33:1 1 I . \�la�'i.�`dls82s`.,I�Bcr�S3t) _ O Q i Z�2 5/y d "soa we .ees. 9.0 h a V ry N v k 6.5 O h �v � o Frames ,B/dy '4 h O i Lv 14'3 tl Fsome� Vl 29.3 ,w a � 41 sod CERT/F/ED 720= `✓/L L/,4 N! SPDONE.Q ✓,P /�A� DF DESCFi'/BED f�Q�EI�Ty STEPh�f1N/E Sf�DDit/E�P S/TU,4TE0 X7 y/.4TT/TUC. �/T/,8Ai1/0�, IV,A, TDL!/N OF SDUTh'OL.D �OMMOit/!-Q/EAL Tf� 1,41 Z:) T/TZ E /NS, L-49 SUFFOL.K COUNTS! NEI�/ 0157 /DOD SEC/DO 5Zk' 4 Z 0 7 6,3 UNAUTHORIZED ALTERATION OR ADDITIONS SE THIS SURVEY IS A VIOLATION OF SE �iV//�ON}� AB/PUZZD CTION 7209 OF THE NEW YORK STATI IDUCATION LAW. 0RK Sj, COPIES OF THIS SURVEY MAP NOT BEARING 0THE LAND r1Y EMBOSSED SEAL SURVEYOR'S SMALL NOTDBE SEAL CONSIDERED The existence®f right of ways H TO BE A VALID TRUE COPY. and Or easements of record, � o PD, BOX 5/72,�OCX`Y PT );I //778-5/7D CERTIFICATIONS INDICATED HEREON SHALL RUN if any, not shown are not 5/l0-7��-�293 ONLY TO THE PERSON FOR WHOM THE SURVEY IS PCEPARED, AND ON HIS BEHALF TO THE guaranteed. �y p°8561 TITLE COMPANY, GOVERNMENTAL AGENCY AND a'O f�`� SU�P!/EyEI�. ✓U/VE S,/9�/ LENDING INSTITUTION LISTED HEREON, AND SURv TO THE ASSIGNEES OF THE LENDING INSTI- rUTION. CERTIFICATIONS ARE NOT TRANSFERABLE 'O ADDITIONAL INSTITUTIONS OR SUBSEQUENT ')WNERS. SCALE.' 9"-30' /98D