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HomeMy WebLinkAbout24040-Z FORM NO. TOWN OF SOUTHOLD / p1 BUILDING DEPARTMENT V U /v\ TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N° 24040 Z Date ........�� ..s.............................. 19Y/ Permission is hereby granted to: ,1.... ..... �•. ./..... . Ems: r .4 ........�... ,....... .......... ro .. 11 . 7.-.....P ........ �?! ..... T... ..... rT.Q.�J./✓. G?�✓......... ...... ✓.......... s... ,8�°0 ......... . �� ......... ......... ...... ........ ........ -................. . . . . ................ ........................................ �............................................................................................ at premises located at.....Ajf ...... ,/ .c...11.... t��1�fl. l ........./................... County Tax Map No. 1000 Section Block / ... �............. ... .. ............ Lot No. .... ....`0............ pursuant to application dated //4 J7. ..... .. 19./../.., and approved by the Building Inspector. Fee s..�13............ ild p Inspector Rev. 6/30/80 loll III roll I I UUIn1n l'111F1 In r) 1 I:Uutlllnl'toll (2til) 1 1I 1111(:11 I'II AI II: h _.z (7 1'I.Ilflll I H1: f O +. ----------------- ---------- ---- Ts.T,nTTr!.—rn—.-r——ra e.n.wnTer.e..ra—wT....—.r T..»——Ta»..-T I II!.III.A i I off I'hlt fl. Y !I I A I I! ICIII•,II I:Y �'I (.11111'. ' � Qvr —nr+..rn (NVQ » _»»T»» » » » TTl » ..»_ » » » T»T_ -.._»» PI } 1 IIAI. --------- ------.»»T»-»»..,..r.» --------------------------------------------------------------- ..».,,»»»»»..»»»..»»T»»TAUI')Il'1I111A1•�CUHNISI ..». »»»..� \ _T»_ »_»_-T»T___, »»»T__»T»T»»» _ y of FI Nk) w f., n v \1 BOARD OF HEALTH . . . . . . . . . . FORM NO. 1 3 SETS OF PLANS ` : .. • • • • • . . U uA TOWN OF SOUTHOLD SURVEY . �� . . . . . ;BUILDING DEPARTMENT CHECK . . . . . . .�,�5. . . . . - - • • APR 11%7 h TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . . ` SOUTHOLD, N.Y. 11971 TEL: 765-1802 NOTIFY: BLDG. DEPT. //TfJ1AJN Gr'SQ;CQj':In!!l CALL . . . . . . . . . . . . . . . . . . Examined...-- /1. ..., 191.., _.._ MAIL TO: . . . . . . . . . . . . . . . . . . . . Approved....�1��,� ..... 14-7 Permit ND. c.. . . .................................... Disapproved ...................................................... (Building •tor) APPLICATION FOR BUILDING PERMIT . Date. .J. . . . . . 19.�.7 INSTRUCTIONS a. This app1icati6q_!t!t 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 application. 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 permit shall be kept on time 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 ICY MAIB 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 inspections. . . ............... .............. (Signature of applicant, or name, if a corporation) TZ-1 ......'...G' �lUv4.. .).Sw (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............. ..................... ...... ........................................................... Nance of owner of premises ..... :0 � ........................................................ (as on taxrollor latest deed) If applicant noture of duly authorized officer. (Mare and title of corporate officer) Builders License No. .fl r Plumbers License No. ......................... Electricians License No. ..................... Other Trade's License No. .................... 1. Location of land on which proposed work will be done.. .��.�....�°<<' :4.... ?:�.............................. ... ........................V..,n ................... scx-pk�,o ............................... House Nwber Street Hamlet County Tax Map No. 1000 Section ....�, ... Block�,. ..... Lot_,—. ........ Subdivision ...................................... Filed Map No. ............... Lot ............... (Name) 2. State existing use and occupancy of emi s and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... ..0........... `.-......................................... b. Intended use and occupancy ......... �— ...... ...................... .. ................................... .. 3. Nature of work (dheck which applicable): New IkAlding .......... Addition .......... Alteration .......... . Repair ............ Removal ............. Demolition ............ Other Work ..m,` o,............. .� T�scri�in) 4. Estimated Cost ...I Q}....©©......... fee .............................................. (to be paid on filing this application) 5. If dwelling, nmtriher of dwelling units .....1...... Numi)er of dwelling units on eadi floor ................ If garage, rsumber of cars .........�.`........................ G. If business, commercial or mixed occupancy, specify nature and extent of eadi type of use..... -........ 7. Dimensions of exiWng structures, if any: Front.. /...... ... �.!.... Depth ,........ ."X.�.. Rear .�..�. height ....ZiF.............. Rnber of Stories .....okA.......... � Dimensions of,same structure with alter6joys or additions: Front .......� Rear ............... Depth .z7.............. lleiglht ............ Nrniher of Stories ... -r:...... t 2-1 B. Dimensions of entire new construction: Front .... ......... Rear ...... ... Depth .............. 2 1leight ....��.......//........ Nhni)er of Stories .. ............. / 9. Size of lot: Front ...[.2 6 ...r...... Rear ..../.?r. O f....... Depth ....t. �........ 10. Date of Purdhase .......<.�......... Name of Former Owner IMO" .. ....................... 11. Zone or use district in whidh premises are situated ........1�.4�:-............................................. 12. Does proposed construction violate violate any zoning law, ordinance or regulation: ......w :. ?............ 13. Will lot be regraded ......L1.,1 5....... Will excess fill be removed from premises: YES U 14. Names of Owner of premises�C ICPq ..VsUa ...... Address L..1�.> 1ka....0. ....... Rhone Mme of Ardhitect ..._....nn.... (( ...... .. .. Address .............................. Phone No. .............. Name of Contractor oe..v,kgrL`._Cq SAS� 61 �k � tYooe No. 15. is this property within 300 feet of a tidal wetland? * WS ......... *1.F YES, SOUTIi(AD 7C]IiN 71t11SIIiGS PERMIT MAY BE REQJIRM- . PLOT DIAGRAM 1 ; Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bade dimensions ,from property lines. Give street and block nmbher or description according to deed, and show street nares and indicate , wlhetlher interior or courser lot. Sxtf C SIKII's (A' Nil Y(AM, SS QJIINIY (lC ....................... Q ... ��.�r -... .... �1..............Ix�irq; duly sworn, deposes aril says tt><-it be is Lhe applicant (Mane of individual signing contract) above named, lieis Lhe .... ? ............................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to rake and file this application; Lha L- all statements contained in this application are tnv to the best of his knowledge and belief; and LhaL dw work will be perfonred in the rammer set forth in Lhe application filed therewith. Sworn to before me this r � //"....;ay Of .. ......19.� .,l._Notary Public E WILKINS .....Noteiie,StateofNowYork (Sig)ature of Applicant) No.4952246,Suffolk County Term Expires June 12,18