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HomeMy WebLinkAbout11616-Z FORM NO. a TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT 'JulD rO~ (eMov~t . ---- (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? lHJ16 z /7~.' I' /:- . Dote ...I.p-'r.:!:/.L...I...fY.....m.m.............., 19.tf.a Permission is hereby granted to:~. .' ." . ~. .,./ ........~~.:(.!:-:!...f.-.((::.....Ii..~.~!..:(:I.:?(;!/ ) ...... ..(....,..()J{..../!..7C............... .... ........ ..... ......... .............~:??:f(.7./!.~;;,/.Q:......!:!...:./.:.. ....../!9 7/ / 'c;/;::::7;-e- c7- r,'/ /.X:;/Ac' (,..' rror .)..-r' '~-V" ,/) 7..1. /r'/.' r" to .......v.... ..................................=......... .K.."...c:::.,. .... ..v..J.-<./.. lri............"...../..L.r..I..I'... ..<.c..C....... ...J:.!..q.e:::.............................................,...,.................................................................................................. 7.'.' .. /" ~.. at premises located at ..l";:.;z.:....!;'Zc.r{I&:9./-.....,.................._I.0..C..:'7.1zQ.(c;I................... ........-.................................,..................................................................................................................... ..;:.qf:-:7b~!?Qr;/......~.':1.:<1:<...... ................................1:.~7.:f(..f..2.Z.............. County Tax Mop No. 1000 Section ......r.,<:..Z~2.... Block ......1..1............ Lot No. ..Q/.tf.......... /. . pursuant to application dated ...:;~/,(?/..:<I:........................., 19.(,~,J., and approved by the Building Inspector. / ..-- u,-/ Fee $.....':-:':....=::-:..... . / , ..(c.tllk:.l/:~:..~~~.............. Building Inspector Rev. 6/30/80 FIEt') INSPECTION ;;:;:'''~ [DATE COMMENTS 1 , FOUNDATION ( 1 st) "'..... gJ~ :;:..... :~ 1. ROUGH FRAME & ~~ c~. ~ ~( ~ 2: 0-....\ . '^l \), FOUNDATION (2nd) 2 . PLUMBING INSULATION PER N. Y. ~ (JJ , >c1 .,.. :oJ t'l e:- ~ 3 . STATE ENERGY c,ODE '" ,. ~ } >c1 4 . FINAL ') O~ ."; 2: t'l~ ~ ...... .~ ,I ~~< <;//"'d~~ ~ / -.J ~ tz1.. . "" ~~ ,::0 ,'- ,. . ~~ ~~ , , ~ \ '''' t'l ,. " >c1 '" '" t'l .", >c1 "" .... '-1./1'-)/'1'1- ,'>.'"- "-'1~ I L-t'\.. 1 -J ~,.... EX:llnined41.--:'~/,!!, 19l.~ APprO\d~r<l. ./;S. rttfJ-:Pennit No. /((1.<"';: 0;"",,,,," 4< '. . . . . . , . . : . . . . . . . . 'il' " ...... '../' j' . ............ .....................-ai~u~ ./ ........................... ..t / (Building Inspector) FORM NO.1 TOWN OF SOUTHOlD BUILDING DEPARTMHJT TOWN HALL SOUTHOLD. ny. 11971 TEL.: 7G5-1302 Application No,!.!<:;>:'!:'. . . . . . . A?PLlC,;TIO~J FOR 8UIlDING PERMIT ., , , - i.l.nl / {L <: Date. . .,;;1;1/,'. .... .... . .. 19... INSTRUCTIONS 3. ThiS application na:s! bo cO'llplctcly filled ill .by typewriter or in ink and submitted in triplicate to the Buildi Ir:s;)(:ctor. ',','itl:. 3 s~ts of pbl~:.. :lCCt/fJ.tc plot pl.1H to scale. FcC' c.ccording tc schedule. b. Plct r!3n <;o',';;:i;; ]cc:I~:un of lot and of buildings on premis~s, rcbtionship to adjoining premises or public stre~ or :lr~:!S. a~~d ~;';;/l; a ddaikd ,!-.:scriptjon of layout of property mllst be dr~l\vn 011 the diagram which is part of this apr C:::1:0:l. c. The work covered by this :1j1pIic~ltion may not be commc:1c(;c! before issuance of Building Pennit. J. Upon "pprc:ol uf this cpplication, tho Building Inspector will isstle a Building Pennit to the applicant. Such pcrn ~;h;:ll L'c kcr~r on tJJ~ p::..';l; i~;..:s ;j\"JiJ;!l;]:: [or inspcciion throughollt the work. c. ~o hUild;;..; sIdl be uccupi,'J or used in whole or in port for any purpose whatever until a Ccrtificate ofOcctlpan s::311 k:!vc bC~:l granted by tll~ l.LliiJing Inspector. APPUC,\ TIO~< IS i lEEEIl\' :,L\DE to the Building Department for the issuonce of a Building Pennit pursu2nt to t ULJ:LJ;::~ Zone Ordill:lI1C~ of tlJ~ Town of Sotlthold, Suffolk County, New York, and other npplicable Laws, Ordin~lI1ccS R~':':'"lbtiol1s, for tile construction of buildings, ~Jditions or 8lkrations, or for removal or demolition, 35 herein describl' Tl~': :lPi'Jic.1nt J2fC('S to comply \vjrh all 3ppIicab!e laws, ordi!l3llCes, building codc, housing code, and rcgu13tions, 3nd 2dm!! ;tUthom.cd i"spectors on premises and in buildings for nccess3ry!nspect~~ ~ . . - /':"_CCcct...:.:-:t( t Cii!~:c.e~t!?~ i . . / . . . . . . . . . . . . . .__ . ._. . . . . . . . . . . . . . . . . . . . . . . (Signature of applicant, or nome, if a corporation) fkc;:v.. /(1f;./. .kl'#;-t~I:. ley.,.I /. f'l /..... (Mailing address of applicant) St.}t~ whc!her aprliC.1iH is o\\"nt~r. lessee, agent, architect, engineer, gener?l contr~ctorJ electrician. plumber or build ((1 {t~ - ............. ...... -........................................................................ -... ":!ine of owner ofl're!lliscs . J<<;~l'.c ,rH.. .tb.1.<'.-.t.~f:z.?f~......................................... (as en the tax roll or Jatest deed) . Ir :.Ij)r'Iic~lnt is a corporJtlOll, sigl1~Jtllrc of duJy authorized officer. ............. '" .............................. ("amc 2nd title of cOJporale officer) --, 4"') t /tl-:?F " -' "- .> ,'{ ..)..-':.:t/- III lider s Llc.ns. No. ....................../ .. ",4/ Plumber's License 1'0:0. ........................ Electrician's License 1'0:0. \( . . . .~. ~__? -:-. ~. . . . . . . Other Trad" 's License :-\0. ..................... I. Location of land on which proposed work will be done. .......................,....................... . . . . . .7} .~. . . . . . . . fih? Ie: W.l1 ! . . . . . . . . . . . . . . . . . . . . ~C~C!. T!.~:!-. V . . . . . . . . . . . . . . . . . . . . . . House Number Street HOll1lct County Tax Mop :-\0. 1000 Section '( . . .0.79. . . .. . . . ~- -'J( ) Subd' ," . ---.., ->..' : iOf '_....;~) ',,- 1\ISlon..~ ,t.................................. (N:llne) 2. State existing lIse ::md OCCUpJl1Cj of premises and intcl1lktl t:sc JIld occuP':H1cy of prof-osed constrw:tion: a Ex' .t' nl . . '~c.u~/I///, ~"" O/;r.::: -ra /. /I/, / /-A . b. .lS 1I1ollse 3nu occup.lI.cy ~;;;;1f;l'"~'~''' '6~':"""" .~7~:JL""'f"""""""""""" .f . .,Intended lIse and OCCllpJI1CY "./.'0. Hr-. ~.... .-~~.C:":'~<)...... .~'.<............,...........,..... Illock .....9((........ Lot..Q(~......... Fi!cd ~jJJ1 No C<I: .t',L,( . . . . . .. Lo! ;',~7. . . . . . . . . . 1 J. Nature of worK (check whid- applicable): Ncw Illlilding ..... . . . . . Addition.. . . . . . . .. Alteration .......... Rcpair .............. Rcmo"al . . . . . , . . . . . . .. Dcmolition .............. Other Work. . . . . . . . . . . . . . . (Description) Estimatcd Cost. . . ( . . . . (, .~ 9. . . . . . . . . . . . . . . . . . . . . . Fc~ /5. ~ . . . . . . . . . . . . . . . . . . ~. . . . . . . . . . . (to be paid on filing this application) " If d\\'dlin~l number of d\vclling units. . . . ., . . . . . .. .. 1\lIl1lbl?r of dwelling units on e~ch floor. .. .... . ... .. ... If ;;\;-::l~~, :ll::":1l'c[ of (:-Irs ........................................................................ ). Ii business, cOI:lmcrci.::.1 or mixed occupancy, sp~cif)' no.tllrc ::md extent of each type of use. . . . . . . . . . . . . . . . . . . . . Di:J1cnsions of ~,\j:rjng stnlcrurcs, if any: Front. . . . . : . . . . . . . . . Rear .............. Depth............... Hcight ............... NlIl11Lcr of Stories. . . . . .. . . . . . . . . . . . . . . . . . . . . .. . . . . ... ... . . .. .... . . . . .. . " Dimensions of SJi11C stnlcturc with Jltcf3tions or additions: Front ................. Rear................;. DO:ltl1 . . . . . . . . . . . . . . . . . . . . . . lJeight . . . . . . . . . . . . . . . . . . . . . . Number of Stories. . . . . . . . . . . . . . . . . . . . . . i. Di';iwsio'i5 of 'cntire Ii''''; cor.,struction: fro.nt . . .1& '1:' .;)..'t. Rear............... Depth. . . . . . . .. ... ... I !cigh t ............... l\unl ber of Stones. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J. Size of Jot: Front. . . . . . . . . . . . . . . . . . . . .. Rear....................... Depth ...................... ). D~tc 0'[ PurchJ$c ..........................;.. Name of Former O..vner ............................. I. Zor',:;: or us;:, distrh:t in which premises are situatr;d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . >. . . . . . . . . . . . . . . . . . _, Does proposcu construction viabte any zoning law, ordinance or regllIa~lon: ........:....................... ,. \\'ill Jot be r"~r3dcd ............................ \Vill excess fill be removed from premises: Yes No L ~cme of OWlier of premises. . . . . . . . . . . . . . . . . . . . Address. . . . . . . . . . . . . . . . . . . Phone No. .. . . . . . . . . . . . . . l\'~lJn~ of Arcl1it.::ct ........................... Address. . . . . . . . . . . . . . . . . . . Phone No. .. . . . . . . . . . . .. . N:-!Illc of ContrJctor . . . . . . . . . . . .~. . . . . . . . . . . Address. . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . ( r I 7\ PLOT D1AGR/,~1 LocJte clcJrly o.nd distinctly :!ll bUi~:JingS' whether existing or proposed, and. indicate all set-b3.ck dim~nsions from :-opcrty lines. Girc str~':t ::md block nUll ber or description according to deed, and show street 113mes and indicate \Vh2thcr tcrioc or corner lot. . -?f f&"'"~ \ / -- ~ , ;J-[J I - /G ~ ..- ~':C'It:. i-ADO.;?- 'l', . '. ;Ju 6: JV ?1 /"f' "f( Gr- C- c;. ~O ,. 4!-Oi/f:' e~OdG // 12- ~ -'/ <:: /' /-......,W C-C r e: . {/' '{IOU ,\6- I II 4o[f' t ZQY TATE OF NEW YORK, Omny OF . . . . . . . . . . . . . .". .. S.S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . being duly' s\\'orn, deposes 3:1d say.:: th~t he is the :!ppliC'~n' (Name of indi\'idu31 signing contr:1ct) Jor..: nameJ~ e is the. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (C()ntr~ctor, a~ent, corporate oft'iccr, etc.) f soid owner or owners, ond is duly authorized to peri'orlll ,)r ha,." performed the said work and to mal;e and file thi )plication; that 311 st:lt.:me:1ts conlaineu in this applic:J.tiOl1 ale trul.' to the' best of his knowkdge and beli~f: :md tll:t tll; 'ork willl:e performed in ~!'it: mJ.I1ncr set forth in the applic~tioll filed l>cr;;with. worn to before 111C this ............ .'::. :;i~'.. .d~VU ..,k:-:->.C-..........., 19.~ - --- -j .... . . /", 0 h otary Pubhc, :.Y~C:I' lCft.:::~~.."..~. . . :-?\0~foGcOlll1ty - - ~~t.IC, S',o:~.:,r ;-':C'.'.' Yor\. No. 52-465S322 . z;.u;fJ.; ...:d\.ihty' "Term Expires March 3::1, 19 fZ",,3 . .c;~~....... (Sj~natllre of applicont , J/07~ Z- TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [] ROUGH PLBG. [ ] FOUNDATION 2ND [] INSULATION [ ] FRAMING I STRAPPING [)<(FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: /Z- ~ ' DATE Lf-J7-0~ INSPECTOR ffi, ~