HomeMy WebLinkAbout30190-Z FORM NO. 3
TOWN OF SOUTHOLD
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BUILDING DEPARTMENT n�--
Town
ll
Southold, WOr`` N� 1 44,
- 15 -0(1
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 30190 Z Date MARCH 23 , 2004
Permission is hereby granted to:
DAWN BLANGIARDO
905 PEQUASH AVENUE
CUTCHOGUE,NY 11935
for
INTERIOR ALTERATIONS TO AN EXISTING ICE CREAM PARLOR AS APPLIED
FOR
at premises located at 28080 MAIN RD CUTCHOGUE
County Tax Map No. 473889 Section 102 Block 0006 Lot No. 008
pursuant to application dated MARCH 19, 2004 and approved by the
Building Inspector to expire on SEPTEMBER 23 , 2005 .
Fee $ 200 . 00
4r ze nature-
321
3*21 a/ 2t�Z L 15
ORIGINAL
Rev. 5/8/02
019 f4v so
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[
] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
DATE �9Zo —INSPECTOR��
FIELD INSPECTION REPORT DATE COMMENTS
o �FOUNDATION(IST) _
G
--------------------------------------
FOUNDATION(2ND)
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ROUGH FRAMING&
PLUMBING
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INSULATION PER N.Y. y
STATE ENERGY CODE
FINAL
ADDITIONAL COMMENTS
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b
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z
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TOWN OF SOUTHOLD PROPERTY RECORD CARD ,
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OWNER STREET VILLAGE DIST. ' SUB. LOT
a 1 oa 7�c�j ve y
FORMER OWNER NE ACR.
1a1v rdo v rc S W TYPE OF BUILDING
RES. 11�/ SEAS. VL. FARMOMM. CB. �111CS. Mkt. Value
S
LAND IMP. TOTAL DATE REMARKS
79 �i,ev /v-'ao o s/ca fo bo Ac.l p jr z
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3600 Soon 00 o3 /03 /97-Lll$ a ,c�75- y1a�� �vyY 4a 214 ,' 4 - oa3o
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a 0 7D 2 �
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9109163 P#09-147 ex--tricad (. nrK )n comrrelLs-jai bu,,Id i Lq
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Noodlan4 FRONTAGE ON ROAD d ° 4'
�Aeado�rlald DEPTH
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TOWN OF SO*HOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING D6ARTMENT Do you Kaye or need the following;before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 31 no dBuilding Plans
TEL: 765.-1802 3 a g o p Survey '
PERMIT NO. Chock
Septic Foim _
._ . N.Y.S.D.E.C.
Trustees
Examined 3 20 Contact:
Approved as20 Mail to:
Disapproved a/c
Z3 �� Phone:
Building]nspector
92004 APPLICATION FOR'BUILDINGPERMIT.
Date. 20
INSTRUCTIONS
a.This application MUST be completely filled in bytypewriter 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 ofbuildingsbn premises,relationship to adjoining'premises or`public`streets or
areas,and waterways.
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 issue a Building Permit to the applicant. Such a 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 what-so-ever until a Certificate of Occupancy
is issued by the Building Inspector.
APPLIGATION.IS HEREBY.MADE to the Building Department for the issuance of a Building P%=t pursuant to the
Building Zone Ordinance of the Town of Southold,Suffolk County,New York,and otherapplicable Laws,Ordinances or
Regulations,for the construction of buildings,additions,or alteonsor for removal or dcmolitrggas eia described.The
applicant agrees to comply with all applicable lavas,ordinances,burldi g code'housing code;and regulations,and to admit
authorized' ectors;on remises and in building for recess.. _ ; . .
MSP p duig necessary inspections. J
It l
G.xdlad t/C Ll
(Signature of applicant,or name,if a'co ration)
�c-PC/
( g`address'ofapplicant) ,
State whether applicant is owner,lessee,agent,architect, engineer, general contractor,electrician,,plumber•orUilder
hh
Name of owner of premises �eAV4JtItL16
(as on the tax roll or latest deed)
If li is a cation, si f duly eu rued cer
(Name and tiff-e- corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
)ther Trade's License No.
Location of land on which proposed will be done:_.
d2S U Vv , ,f-.
House Number Street HfAialet -1�o�OQ.tlht -
County Tax Map No. 1000 Section �' Block ,asea0orn.oN
Subdivision Filed Map No. a"
(Name)
2. State existing use and occupancy of premises and intended use and o pancy of proposed consliulon:
a. Existing use and occupancy (WAW JAn4_4
b. Intended use and occupancy c�
3. Nature of work(check which applicable):New Building Addition Alteration x
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost 41910 0 D Fee
(to be paid on filing this application)
5. If dwelling,number of dwelling units Number of dwelling units on each floor
If 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
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 situateda _.
12. Does proposed construction violate any zoning law, ordinance or regulation: �j U
13. Will lot be re-graded Will excess fill be removed from premises: YES
14. Names of Owner of premises ALvlu �'"&Address Phone No.2r F_ 3�S
Name of Architect w/ rt R-n Address god o 1 o Phone No
Name of Contractor Address Phone'No.
15. Is this property within 100 feet of a tidal wetland? *YES NO
• IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED
16. Provide survey, to scale,with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below,must provide topographical data on survey.
STATE OF NEW YORK)
SS:
COUNTY OF )
2 /V ✓V2__ being duly sworn,deposes and says that(s)he is the applicant
(Name of individual siTwIng contract)above named,
(S)He is 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.
Swo lq�before me Nis I
day of c_ 206
No Public gnature of Applicant
sONNIEI.QORO�
Netery Pebk ftW 01 NWVA
No.OID0609S3Z3.SditoN�
Term Expitalrb