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HomeMy WebLinkAbout23890-z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 97 No23890 Z Date .......... . ...........I....�..................... 19..... . Permission is hereby granted to• .....�.-�� ../ . .......,-;, ........................ . ...... ...............?' . 1-1-01 atpremises located at .................. ./ . ..... ............................. ................................................................. .......... ... ............................................................... ................................................................................................................................................................. County Tax Map No. 1000 Section ........V%�A' .... Block ......z............ Lot No. . � pursuant to application dated ................ .... [..............1 19.z., and approved by the Building Inspector. �.. Fee $.... .. � ....... .` ..... ::::.`.. ....../........... Building Inspector Rev. 6/30/80 Ln10 ( RACKETY -- - ---- GLF-N N-_RAC. �_E--.---167 T`T AT u — - -- - I C :O E -- iC. - — -� ;C W N00 CF �^C;TG•_ '�;`. :67 + I _ _.d'���.='S1i 'ATE r ri�r . . -E IeV� TAL—tvl �l ,G :b lye pRDFENCE- wlEE rc rIC.E 2C Al. ~l © -� ,�_ s7DCIp4D1= fp �►v'gtTt �. 2 ,+ 5fa�rt—� � ��ECyCLE END (/ ✓e �;LMNSIET aim )12' () � 'S CAL ti 9. P.�^O N 0:MOU'J M E N'+ DATE — LL 7 RAcieErT !;'asr'Y. eecK N SUFE CO.TAX MAP: 1000- - 0 T 9LACKr`•v Ap � � V -- - ----- -Ar, �fHE^v (;70',-1 _ ;BOA 0 �P��Q\CK I/ D15TANCES (N FAI�E�V�HE�E AR - -- - -- — E2GM D EE E v5. BOARD or nrAl.•rn . . . . . . . . . . . . . . . FORM No. 1 1/3 SETS OF PLANS . . . . . . . . . . . . . . . TOWN of SOUTHOLD '-SURVEY BUILDING DEPARTMENT %CHECK DEC 3 1 TOWN HALL % SEPTIC FORM . . . . . . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL: 765-1002 NOTIFY: Examined.. .... . ., 19 � MAC TO:, ��. �- - • • . 7 Approve( J I-r Permit No. C....... .................................... Disapp /c ?ding .................................... tor) APPILDTNG PERMIT p/ Date_ �'�. '. .2�l . . . . , 19. 0 INSTRUCTIONS a. Ibis application must be completely filled in by typewriter or in ink and suhnitted to the building Inspector wit.' 3 sets of plans, accurate plot plan to scale. Fee according to schedule. h. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or lxibl.ic 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 T1te work covered by this application may not be cmu enced 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 the premises available for inspection throughout the work. et No Imilding 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 IIEREl1Y MADE to the Building Department for the issuance of a Building Permit pursuant to the luild'ing'Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulat'icns, for the construction of buildings, additions or alterations, or for re!mval or demolition, as herein described. 'Ibe 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, Oor m--m, if a corporation) (Mailing address of applicant) State wlteUter applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or lxuil.der. .......................................................................................................... Name of owner of premises .Glum....;���P-.............................................................. (as on the tax roll or latest deed) If: applicant is a corporation, signature of duly authorized officer. (Name and title.of corporate officer.) Builders License.No. .........1.!. .......... Plud-)ers License No. ................ ........ Electricians License No. ... .............. Outer Trade's License No. ... ............... I. Location of land on which proposed work will be ....................... 406.T ..................... (g .................... ............... house Umber StreetQ llauilet ('.county Tax Map No. 1000 Section ....0......... Block _. ......... L,ot .(73........... Sulxlivision ...................................... Filed Map No. ........ Lot ............... (Name) 2. Stake existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ._ +?S1���t�; .......................................................... b. Intemled use and occupancy ..-J fl-1 ................................................................. 3. N•ature of rlurk (d►ec:k wl►icl► apl)licahle): New Ikiiidinl; .......... Mktition ..... Alteration . a Itc:lxa i r ............ 1(8►aoval ............. Beim]i t ion ............ Ol:her Work .rP�lL-( ,r'.S 14�31 ....... 01 (Description) 4. I?st:iaarated Cost: l..[.D (�(7............. fee .............................................. (to Ice paid on filing Lhis application) 5. If rkaell ing, rxnirer of ckaell ing units .1 ..Z..... Unirer of chrel I ing units on each floor ................ Itgarage, axid>er- of cars ..1..................................... 6. If Ixasiness, ccnmercial or mixed occipancy, specify nature aril extent of each type of use...................... 7. Dimensia►s of existing sLrucLures, if any: Frcx►t: ..... hear ............... Depth ................. Ileiglat ......................... Umi er of SLories lyz,................. Dimensions of saint' strr►cture with alterations or auklitions: Front ..... .. ........ .hear ............... Depth .................... lleio, it .... .... ...... lAirix:r of 9wries ............... r 0. Diiiensions of new ew constnrcLicxr: �i �+\ Alt � ...... l ........ ... .. Ileil;l►L ......................... l4wher of Swries ..................... ). Size of lot:: front .................... hear .................... Depth. .................... 10. ilal:e of P►►rchase —74ne... 19qgIf-r.... 11.'nre of Fornier OAier G.o)&i.\.-.I.q 11. Zcx►e or use rlisl:ricL in %Aiidi premises are situated .(90*4: r'Por,&..... ...................................... r 12. l)x:s proposed consl.rrx:Lion violate any zcxaing lava, ordhimice or regulation: At#3.................. H. Will lot. Ix- regraclecl ..�` ............. Will excess frill. be renrnred frcxn preinises: YES W. Mwies of. ()caner of premises GItym...1 ....... Acklress 7o�lal..�liodc...h_V_F .. Pf►orx- No. e1?�- NaY►r- of Ardiitect ... l` Mdress ......... ..................... Ptaone No. .............. IN Nance of Cont:ractor ................................... Mklress ...............................Mane No. ....... ....... 15. is (his property within 3(X) feet of a tidal wetlarx)? * YES .......... NC) ........ *IF YES, Saill l) -lam '.fRlIslus 11--IL1M1'I' tiAY IV?, lug pIRED. I'LO'1' DTAGRAM imate clearly aril distinctly all Imildings, w)►ether existing or prolmed, and irxlicate all. set-hack dimensions frmi prolerty lines. Give street and block rxrd>er or description according to deed,,arxl Mimi street manes and irxlicate %Aiether interior or corner lot. Alf -e4Fb JP` `A �jS �qP nR ,'JED AS NOT I.3.R 9 FEE:� IY hK)TIFY 8l.l LOING DEP eA�' 765-1 SC2 9 AM TO 4 FOR THE FOLLOWING INSPECTIONS: I. FOUNDATION m TWO REQUiRED FOR POURED CONCRETE 2. ROUGH - FRAK41NG & PLUMBING 3. INSULATION 4. FiNAL, w CONSTRUCTION MUST RE COMPLETE FOR C.0 ALL CONSTRUCTION SFI. LL MEET THE REQUIREMENTS OF THE N.Y S'r,ATE CONSTRUCTION Ott ENERGY CODES. NOT RESPONSiBLE FOR srnn. (N M1J Y(NtK, DESIGN OR CCHSTRUCTION ERRORS SS UXINIy (X .......................u'm/ ..! .•.���-:1...........................Iwinl; duly stmrn, delx)ses aaxl says that lie is the appi icanl (Nalaae of imllvidlwl. signing contract) above auirrecl, Ikei:; II►e ...CJIU�. .................................................................................. ((hn)L'ractor, agent', corlxrrnte officer, et.c.) of said lacier or owax:rs, aaxl is duly anrlhorized to lxarforin or have 1►erfornr:d the said work arxl to nadce and file Ibis applicaLion; Owl: all. sLaLenenLa contained in this application are Lrue to the best of his klKmledge aaxl lxifief; cord Thal Lhe work will. be per.fommi in Lhe Milliner set Forth in Lhe appl.icn0on filed LlrerewiLl►. f;<acarn Lo before me this ./........ .clay of: Notary Publicj JOYCE M.WiLKINS (Signature of Applicant.) Notary Public,State of New York No.4952246,Suffolk County Term Expires June'I2,i 97