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HomeMy WebLinkAbout16503-Z FORK NO. 9 , (� TOWN OF SOUTHOLD rte` �I BUILDING DEPARTMENT TOWN HALL \\J \ SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N 2 16 5 0 3 Z Date Ze/?......................................... Permission is hereby granted to: , �t...../.�1.���•.{//./ �. ..... .. .. .. f.•P�•v. J.... .^. .............. 7 to ...... ......�!- .... .. ...... ........ ..... ....... .................................................................... ............................................... ......................... at premises located at ....l.Y .;t. .. ... ...... ....... ................................ ............ .. .�... ,.. >................ ................................................................................ ..............................................................................�...............................................................:.................... f..i. County Tax Mop No. 1000 Section ...... TPJ......... Block ... ............. Lot No. ... ............ pursuant to application dated ...............zo..../&....................... 191..7, and approved by the Building Inspector. Fee $.pcJ..s. .......... . .... ...... .... ................ ........ .... Build g Inspector Rev. 6/30/80 U14DATION ( 1st) UNDATIOt1 ( 2nd ) z o � UGH FRAME & - PLUMBING cn y :Z [=J 4,�4SULATION PER N . Y. STATE ENERGY CODE x H FINAL z • ADDITIOPIAL COMMENTS : ETI x �p O-D UYN U'l 66A x ^d ' H H H O� Z • x rn a r Ilk r� -v y BOARD OF HEALTH . . . . . . 3 SETS OF PLANS . . . . . . . FORM NO. 1 SURVEY . . . . . TOWN OF SOUTHOLD CHECK �� ' ��<<!`� ` BUILDING DEPARTMENT SEPTIC FORM - . . - - . - . . , . : TOWN HALL NOTIFY SOUTHOLD, N.Y. 11971 CALL -2 c? -`�`��? • : • - • = TEL.: 765-1802 MAIL T0 : Examined .M . . . . . . . .. 1967 Approved . . ./� . ?. . . . . .. 19e7Permit NoA/ -P--�. a� D Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 09 - 61987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " . . . . . . . . . r� BLOO. EPT. �) TOWN OF SOU iMOLD (Bu' in nspector) APPLICATION FOR BUILDING PERMIT Date . . .�® �. . . . . . . . ., 19�� INSTRUCTIONS f a. This 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. 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 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 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 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 inspectio s. (Signature of applicant, or name, if a corporat•on) PIP". 1 ox �� . L .2.1. . . . . . . . . . . .�. (Mailing address of applicant) State whether applicant mown 'r, lessee '; agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . . . . . . .'�( Vt?. . :C�. .�..% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises (4e.f1.1:•. . . . . . v d .� g C7 l/�` ? �" • • • : • • • • • • • • • • • ` (as on the tax roll or latest deed) If applicant is a corporation;,signature of duly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and title of corporate officer) ALL CONTRACTOR' S MUST BE SUFFOLK COUNTY LICENSED Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . . . Plumber's License No. . . . . . . . . . . . . . . . . . . . . . . . . Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . . .. .. . . . . . . ��014 C. . . . . (! c, . . .e.. . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . House Number II Street Hamlet /� County Tax Map No. 1000 Section . .f.�. . . . . . . . . . . . Block . . . . . .. . . . . . . . . . Lot . . .� .l. . . . . . . . . . . . . . Subdivision . . . . . . . . . . . .N./A . . . . . . . . . . . . . . . . . . Filed Map No. �!� . . . . . . . . Lot . .14JI.( . . . • . . (Name) 2. State existing use and-occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . . .�. . m d. . . . . . . . . . b. Intended use and occupancy . . . . x . . . . . • • . • . . . . . . . . . . . . . . . :�. . . . . . . . CO hs Tk u CT10 r1 �Y LA//W 8 jt,S& 3. Nature of work (check which applicable): New Building A ""1 . . Addition . . . . . . . . . . Alteration Repair . . . . . . . . . . . . . . Removal . . . . . , . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . : (Description) 4. Estimated Cost . . . . . . . 0:. . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . t kto 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 . . . . . :y w`!d . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . 5. Dimensions of entire new construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Number ofStories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . . . . . Depth • . . . . . . . . . . . . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Former Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Zone or use district in which premises are situated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded . . . . . . . . . . . . . . . . . . . . . . . . . . . . Will 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. . . . . . . . . . . .}. . . . 15. Is this property located within 300 feet of a tidal wetland? *Yes . . . . . No . . . . . *If yes, Southold Town 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 number or description according to deed, and show street names and indicate whether interior or corner lot. a � See-- I h - i. PANC a.'4'0 0 C� fo P-' U r a, Im U 5 E �in c)J- Ur IS UNLAWIFUL :�: a 0 tr Zf 7 '0" CERVICATE 04 VVIFH UT 1% V it," _ '� '-"F OrCUPANCY 0Q0 P.L.- _ r, tS STATE OF NEW YORK, S.S COUNTY OF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Heisthe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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. Sworn to before me this . . . . . . . . . . . . . . . . . . . . . . .day of. . .QnnC-7.//.//. . . . . . . . . . . . .. 19?7 Notary Public, . . . . County RnEN K OE YOE . . . . . . . . . NOTARY PUBUC,State of Now York (Signature of applicant) No.4767878,Suffolk CouPPt� TOM Expires ft4srch 30,1 o 1 1 O O C 1 1 � per % \q�b 04 m ' OOH �h0 00 0 R� / o / S9os 3 ` ., aF 0 BG�s fir, Seo /y 20 0 o0'` 00, Aci o \h h h \� �h OF NpY rNor OPEk) \• � RIG h� D� u, a 9p0p�u, E nn 9 , o U1 A 4 $`o m O o A '� nJ lk p�� G 9 O 6 �9 ti°'p z. U pAON Rr WAY 05� � o C` v a 53 0 �} to NOTE d = MONUMENT �/ P REVISIONS YOUNG & YOUNG NOV 30, 1977 400 OSTRANDER AVENUE, RIVERHE OF N r uu// Oq,Q ALDEN W. YOUNG ARO NG PROFESSIONAL ENGINEER AND ��LANC�d�SU..RV LAND SURVEYOR, N.Y.S. LIC. NO, 12848 �! N •, .•�.r7.. NOy 89 SURVEY FOR: �11�;,�' UNAUTHORIZED ALTERATION OR ADDITION TO ,a THIS SURVEY IS A VIOLATION OF SECTION JOHN J. B E R D I N K A � 7209 OF THE NEW YORK STATE EDUCATION LAW. 4 5 S93 COPIES OF THIS SURVEY MAP NOT BEARING/ O THE LAND SURVEYOR'S INKED SEAL OR - ysF AHD Sq- EMBOSSED �� SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY AT _ LAUREL GUARANTEED TO: SECURITY TITLE & GUARANTY CO. ,+ GUARANTEES INDICATED HEREON SHALL RUN _ THE NORTH FORK BANK & TRUST CO, ONLY TO THE PERSON FOR WHOM THE TOWN OF SOUTH 0 L D SURVEY IS PREPARED,AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED Bir HEREON,AND TO THE ASSIGNEES OF THE SUFFOLK CO., N.Y. - LENDING INSTITUTION GUARANTF,ES ARE NOT TRANSFERABLE TO ADDITIONAL SCALE: II I DATE- NO " INSTITUTIONS OR SUBSEQUENT OWNERS. — I "-40 I APRIL 25, 1977 I ' 77-243