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HomeMy WebLinkAbout18751-Z ~` n I 1. rOUNDATI0:1 (1st) II r 0U'.IDATI071 (2nd ) C U _--- 2. ~ I `c .;OUCH FRki•1E & PLUI•iHING I • c I 3. c c I77SUL;.TI071 PER N. Y. EflGY STnTE E71 CODE _~~' 4. . I _ ` c;JAL .- AL C0:^.MECITS t 1d ADDITIO / ~ ,/~ p r ~, ~•~ .. {4r lOEM N0. f 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 o 1~ 7 ~ 1 Z Date ........./.~.,3 .................................. 19.9..(1. Permission is here y granted to: /(~~f~~~y~~ C ~, ...................................::............................... > 7 .~,~~..~~~~t.......,.........~.. ............................ of premises located of ....4.~r..,.Jr'...j,~......... ............~~~r ......................................................... . ......................................................................//..~~....................................................................................... County Tax Map No. 1000 Section ......~T.3..... Block ..............~.... Lot No...........~ / qq ........... pursuant to application dated .........,/.~~ .................................. 19f..~.., and approved by the Building Inspector. / pd Fee S•••~/..D...P.~~%~j ~ ~-~Q ~~- Rev. 6/30/80 ~______ ~~ ~~~~~ ~~~ jar----~ t ~'o.e FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 // q TEL.:7G5.1802 Examined ..lj/..`~.'.~......., l9~~`y~ APProved .. f~?.•T......., 19,N//. Permit No..~~ 7~~~ Disapproved a/c ..................................... BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY J` CHECK ~/.~.I~.~J.. SEPTIC FORl1 ................ NOTIFY i CALL ..................... MAIL TO• •~.02.~... ... U ~{~~ (Build' g Ins ctor) Bl.Df3. DEPT. TOWN OF SOt1THOLD APPLICATION FOR B ILDING PERMIT p Date .~ :~ . ~0 "........, 19 ~.Q INSTRUCTIONS a. Tltis 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. a 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 :hall 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 unfit 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 appiicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as bereirt 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. „ ~ fT~TOM LA O~VtQa~gi !~~;~~-c ~p • ~cf /?l?(~'SC ( . . . ;. =. ~ N ~.! , • ,;,, • ~ (Signature of applicant, or/n~a'mle, if(a corporation] 'a~TM~11(ITPIAVitt ~N+re:i~~q~.~';,' ~ ..nl.!..z:~..l~!~:t!?~J.t~(~..tJl~n'"~~5._~._~% 9FtT ~~.~ ' ~ , < , `. _~ = r (Mailing address of applicant) ~'~_ ~Y 7 Q__ pp~ ~ ,:: ~•, : ~... ~. o ~ , g lumbtr or builder. State whether a lic~t~sl~ivNeYh~~ fe a ent, architect en neer eneral contractor electrician, p ~T jpON(T7 ? n; ~ rr'q Ai i Name of o~~at~ YR7rT:X1~lr ~a S,.. .. , !7 ~... ~.~ r!?!r./ ........................................ . ,,,.., p ~ i~O~ 3: i .•tr+ ~ to (as on the tax roll or latest deed) ICapplicanO~9lrtoydil~oN(bi~Akf!`lluly~authorized officer. 1+iM >Mi- ~ $?M3M3tMI1Q9A 3H' ....... `."°~>~°'. j'"~ ....... OCCUPANCY OR etutd>Mlp,~ot~6Mte dRS~A~j 81~IMF7 MOR9UIIT~k!A~„' 1 ': !, Builder's License No... , • • • • • • • • • • • • • USE IS UNLAWFUL Plumber's License No. ......' .................. WITHOUT CERTIFICATE E,ectrician~s License No ..................... OF OCCUPANCY Outer Trade's License No . .................... . Location oC land on which proposed work will be done; ' - .~~~~.. . ~~ ................... ,//~j~~ . I[ousc Number Street Haml~C~ • • •~ •k • .............. County Tax \fap No. 1000 Section ....... ~ ~~..... BI'Vck ........./ ........ Lot ...... ~ ...... , i , , Subdivision ............... .. .............. Filed R1ap No. .............. Lot .............. . (Name) =. State existing use and occupancy of premi-se_sllan~d, intended use and occupancy oC proposed constn~etion: a. Existing uu and occupancy .. 4'~" :'~ • • • ................. ...... ............ . b. intended ••.7,,.,.d "{{ , //~' ,q,.~,,~ uu and occupancy .. g!°'>~... ~~`~.. ,: -..lr.O~r/ y~ ~ . . ___ _ _ _ ,~ ~ -.At 3. Nature of work (check which applicable): New building .......... Addition ..... ,~ .~'~'J.Ute~• : Z.i *; Re air ....... Removal ........ Demolition ..............$wimain~ poo .:. Tennis Court......... Accessory Building..........Fence .......gth~r_Woi&i, ., :~r,t..•r;,t;. 4. Estimated Cost .....?-~~'~ .................. ..... Fee .................~ ..... _ , ...~......~:. ~. Y (to be paid onTiling this application) S, If dwelling, number oC dwelling units ............... Number oC dwelling units on each door .............. , . . IC garage. 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 ............... . Hci_ltt ............... Number of Stories ................................. ..................... . . Dimensions of same stnrcture with alterations or additions: Front ................. Rear ................. . . Depth ...............:...... Flcight .....................~. Number of Stories ...................... 8. Dimensions a const:ttction: Front ............... Rear ...............Depth .............. , Hci;ltt ... ~~.~~(dumber of Stories ........................................................ . 9. Size of tot: Front . .. _ .;;1 .......... Rea_• ...................... Depth .................... . . l0. Date ofFurcliase • ..:..., ~ . ................Name of Former Owner ............................. . 1 L lone or use district in whielt-prert~ises are situated .................................................... . . 17.. Does proposed construction violate any zoning law, ordinance or regulation : ............................... . . 13. iVill lot be regraded ............................ Nill 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... ....:... . IS.Is this property located within •I 00 feet of a~tidal•vetland? *YES...:~NO.... *If yes, Southold Tovn Trustees Permit may be required. 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 ntunber or description according to deed, and show street names and indicate whether interior or comer lot. -~l ~-~ ~©G~~~ ~~ ~ ~ ~~ DATE: A~' v ~ M 4 7S/~ 00 NOTIFY 811LDNIG DE AT 786-1H02 8 AM 10 d POR THE FOLLOWING INSPECTIONS: 1. FOUNDATION TWO FOR POURED METE 2. ROUGH - FRAMING i PLUMMNG 3. INSULATION b. FINAL - CONSTRUCTION MUST BE COMPLETE FORGO. ALL~~l~ THE REQUNIB~AENi'i Qf 11~ K~ a .,l+„~, ., . ,, STATE CONB'ifMlICT10N t`: • ~ V s+ '+ d- ~.. COOEB. NOT REMON DESIGN OR CONSTNUCflOM NIAIs STATE OT,IEEN YO$K,- ~.~,, a-+"°' 3 COUNTY QF ~.. .: a . ~ t~• •~ ..n .~ , ". . . . . .............., •.,.., . ~ .. a . v rs +-.. , .:..^, ........ being duly sworn, deposes and says that he is the applicant • (Name oCirtidiw~14t1Q ig~iJ~kontlact) •. above named. G~~~%~~'~J ~t Hcistltc ....... .. ............. ..................... .... .. .. ......................... (Contractor, agent, corporate officer, eteJ of said owner or owners, and is duly autltorizcd to pgrform or have performed the said work and to make and file this applicatio rthat all statements contained in this application arc true to the best of his knowledge and belief; and that the work will laic performed in the manner set forth in the application filed therewith. " i Swom to bciorc me this ,' Notary Public, ........,~1~t~:. 7l •-• . A/.4.Y.~.. County t IIDIAgYM~ ~a~Nw1MY .............(/.'~................. Tires W~•• -- _ (Sigaamre of applicant)