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HomeMy WebLinkAbout23252-Z FORM NO.3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTNOLD,N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL �J COMPLETION OF THE WORK AUTHORIZED) 9/ NG 23252 Z Date..........� `O .................................. 19...(...`P Permission Is hereby granted to: d //v� ��K !t. �MDDi4r1 /!?.t`-r✓T .9�/�u/i��? nly.. �:.....!T G (fmxzZ/i✓/ 1.:.o:.. /. ....................................... /� �9rf�T..�.....N ........ l� Tf............. to ..LL)rtSi7Lt .GT......�� ........ ��/T1 ?✓......... ....... '`�..... �� /J . ........... /TrF. .......... c, ................ .............../�f...... / , ��....... Z.c.,...........�.............. .............................................................................................................................................................. ... .................................................................................................................................................................. V,:....................................................................... 9z.z �, ...... / A 1V� at premises located at.. ............................................... ............................................................. ✓Po?; .. .. ....................................................................... County Tax Map No. 1000 Section ... 33............... Block........© .......Q./Lot No. ......o.V.. ............. pursuant to application dated ................ �( f.........................1 19... <.Y!...... and approved by the Building Inspector. Fee S.... ....v...l.... ..................... a.. As .. .......................pector Rev. 6/30/80 ,. f t � UAI _ ---atSm--mxmamm------aaaI =az am=Ca---aSa F01INDATION ( I s'I ) -- ---------- - -- - - - c CAFourll�n•r1oN (2Nr)) �I------------ ----------- --------------- . xmxmaa=a xxa max=mas=aaaaa - =====aaN:aaaa=_ex�aa>>aaxa="==amxa>aaax as==aaa====v amaaaaa amxa m= - ml.a n i I ROIIGII FRAME. 6 I w 1'1.11"11 1 NG ----- _ p la xa=axaxaamaa==a>===magma - a ==—I._—xaa_.t:=axaoaaxat:aaa==x.=a==ao=a=a=ats=a=aaaaaa=t:xamaxaa rpd INSULATION PER N. Y. STATE ENERGY COOIi j I I F• III Al. =amxa=as=amaaa=aaaaa----- >a>aaax>a=aaa=ma======>a=_aa==m@a=a----- ---- � N - AUD1"f f ONAt, COMMENTS: =-=a=a==axmx=a=a_a=aa=m_aaaaa�=a=a===_====aaax_===a==x==aaa_>a_sa.a=aaaae,amasaaa==a>xaaaax � � x ..--...........------— - - - -. .. _ . _. _ .. --------- - ..- -------- --- ----- ------ - - -- �� aj r*I td t� BOARD OF HEALTH . . . . . . 3 SETS OF PLANS • - - - - • • FORM NO. 1 SURVEY TOWN OFSOUTHOLD CHECK . . . . M. . . . . . . . . . . . . . TOWN HALL NOTIFY SOUTHOLD, N.Y. 11971 - - - t - - TEL.: 765-1802 CALL - ��� � MAIL TO Examined . . . . , 19,/ Approved . . . . . . ., IV. Permit No. 3a��" Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �. . . . . . . . . . F�.B 5 X996 ( g In ector) APPLICATION FOR BUILDING PERMIT 3,P T. -Date . .+�. . . .•, . . . . . . . ., 19 . INSTRUCTIONS' a. This appltcation 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, an&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 A4pect10n 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 oY 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 i ections. .R �. (Signature of applicant, or name, if a corpor ion) PR (Mailing address of applicant) State whether applicant is owner, lessee, agent, ``architect, engineer, general contractor, electrician, plumber or builder. .4? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V,l6.,cle e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . . -—- - - �. . t.L. . . .Cot.474)l."i . .7R,. . . . . . . . . . . . . . . . . . . . . . (as on the tax r 1 or latest deed) If applic is a coj-porati , gn of duly authorized officer. . . . . . . 7er'sLicense . . . . c . . . . . . . . . . . / �. . . d title of corporate officer) ALL TOR' S MUST BE SUFFOLK COUNTY LICENSED Bui No. . . . 30 �. . . . . . . . . . . Plumber's License No. . . . .JIf'. . . . . . . . . . . . . . . Electrician's License No. . .WR . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 `a . . . . . . . . . . . . . . . . . . . . . N. la. .L. N. �.- . . . . . . . . .�-•1�".R �+ o : . . . . . . . . . . . . . House Number Street Hamlet County Tax Map No. 1000 Section . . . . . . . . Block . . . . . ..3 . . . . . . . . . . Lot . . . . . . . . . . . . . . . Subdivision kf? IF4$tq rN,SJ�o red (ar +�?�o Y}rFiled Map No. O ZI. . . . . . Lot . . . . . . . . . . . . . . . (Name) 2. State existing use and occupancy of premises and intended use 11and occupancy of proposed construction: a. Existing use and occupancy . . . . b. Intended use and occupancy . . . Y!^A. • IC. . . C]u . wnicn applicable): New Building . . . . ... . . . . Addition . . . !'�. . . . . Alteration xepair . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . 4. Estimated Cost . f.cc C• "M . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . ` (to be paid on filing this appli S. If dwelling,number of dwelling units . . . . . .1 . . . . . . . . Number of dwelling units on each floor . . . . . . If garage,number of cars . . . . .?: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy,specify naturp ind extent of each ty eof use . . . 7. Dimensions of existing structures,if any: Front . . . . . .( . . . . . . Rear . . . . . . . . . . Depth . . . .i�i Height . . . . .1.4!. . . . . . . Number of Stories . . . . . . .i. . . . . . . . . . . . . . . . Dimensions,of same structure with alterations or additions: Front . . . . . . .it. . . . . . . . Rear . . . . . �. Depth . . . . . . . (: ... . . . . . . . . . Height . . . . . . . . t.L. . . . . . . . Number of Stories . . . . . . . �. . . . S. Dimensions of ent4e new construction: Front . . .ZA . . . Rear . . . 4`.��;. . . . . Depth . . .$.'. . Height . . . t to . . . . . . . Number of Stories . . . . . . . . .T . . . . . . . 9. Size of lot: Front . . . .1 l (S !. . . . . . . . . . Rear . . . . . . . 1.1. r. . . . . . . . . Depth . . .� 16 . . . . 10. Date of Purchase . . . . J V%/ . $4. . . . . . . . . . . . . . . Name of):orrner Owner . . . . . .W1,1(4 . . . . . . . . . . . 11. Zone or use district in which premises are situated . . . . . 0514 rs1't, L . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction vio)ate any zoning law, ordinance or regulation: . . .No . . . . . . . . . . . . . . . . . . 13. Will lot be regraded" . . . . . .V* . . . . . . . . . . . . . Will excess fill be removed fr premises: Yes 14. Name of Owner of premises . ts��.. ++r'Any a)iry i. . Address .M 4 C�grN�. L !e .C-,{ Phone No. . . . . . . . . Name of Architect . . . . . . . . . . . . . .... . . . . . . . . . . . . Address . . . . . . . . . . . Phone No. . . . . . . . . Name of Contractor Rift-. .$v� Jq r3. . . . . . . . . . Address P.Q-'6eA 67(r ' . Phone No. �7.Z:' 15. Is this property located within 300 feet of a tiida��l�� wetland? *Yes . . . . . No 31i.. *If yes, Southold Town Trustees Permit may e requMed. PLOGRA Locate clearly and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimension property lines. Give street and block number or description according to deed, and show street names and indicate; w interior or corner lot. STATE OF NEW YL Q-v COUNTY OF . . o.� S.S . . . . . .��A� .Q. '.kkk (. . . . . . . . . . . . . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applii (ft me of individual signing contract) above named. Heisthe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, gent, corporate officer, etc.) of said owner or owners, and is duly autho ' perform or'have performed the said work and to make and file application; that all statements contained in this application are true to the best of his knowledge and belief;and that work will be performed i e in ner set,forth in the application filed therewith. Sworn to before me th' :r te. . , 194 'Notary Public, . . . . . . . . . . . . . . . . County ROBERT t. SCOTT, NOTARY PUBLIC,St Of N.Y. " ' " " " " " " " " ;�;_" '" " No.4725089.Suff k CorsQ� Term Exeirea Msv nt_ t ayh t 1600 PIE OF CO otiSIC/C�F%_ r 7 `525622 4 1 1�4Yt �t{Vd lyHD SURIJO 3 45' i to this surve y is,3�v orlon Ort�Rf. i - 1 Section 7208 of the ration rf education t.aW New York Slate !� t Con the 1`s d�t re survey mei r.,!blaring s ur Yorsin;s 9 cr {1 1. ... to be^•ssed seal sco It not be ccnsidered t vatid true PY - { Y o the Person herecn shat!n is c for Wham tha surra '!f i tier `fdcnhisbehaatorhe y \3T ler h3 ICY and cs croonand + a fuGcr ah0 end•' (V) t - to addi or net transtarable -••u�wns orsubsaq 13 lvi A P OF LAND *C A L IL 4.0.* 1" 0 % t ren i }? 1 AT su ffal-k �o�Nf� 7"dx �'��Ge'1;ipc�fl-o33 . -02--r q . : i ; I r i ; ; ; ; i : : f � � ; I I ; � i ; I ; ; ; . . i � ; i i i f � ; : i i i i i 5 i ; i i � ; ; ; I i ; I � ; ; ; I : ; ; i 5 ; I I i i f ; ; I � � � � i � � 5 1 i � � � i i i 5 i � ; � ; � I i f f ; i I I i i � i � ; I I i 5 5 1 i i : ; ; i � I . i I � i ; I I I i � � � � � � � � � � � � � i , , I I � � � � i � � i � ; ,I 111.1-4 -, i- --� - �, ­ ,...............................;...... ....: : ; ; i i i i I I ,JI ..---i , , , I , ; I I ­.........� _ . , I � � � � ; � I I......,-1_11�__...I........ ...I­...i.l..l..",,,,I I , 11 I I ; ; i � ; I ............-;l- A­­­,i,""..11-11,.....I..........�.......................�.....�...............�.......�........I i � , i � � ; � � ; i : : ; � � ; i ; ; i 11 I"I'll�I I 11...-,-7-,.---,-11.1111111.411-.......I.......".."--1...........�......I............4............I.I.F.11.1­1111IJ I I� � i I � ; i i ; ; i ; : ; i ; I i ; i .......................i.........I...........................I.......+­­­__­_'_­__, '.11.1........ill...1.1.11­111i'll, ­......11.1'..­11­�...I I....11�1,I I....___1_1_11111111 11.111.111.11.1......_,_.11...11.... � " 5 1 1 1 . 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