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HomeMy WebLinkAbout23331-z FORM NO.3 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) Date........... /,,.� .................................... 19...1...(�� N9 23331 Z Permission Is hereby granted to; cs..........f�......... F,, /... ........... ...... ... �'cal>-s.... T .-................... rf to ... ,ec ........��........ �--?�4=f ............ !L�......�� '......... � ✓ mil...,... ............ .......... .. ...... ............... f.......... ................ ..................................................... .................................................................................................................................................................. .................................................................................................................................................................. ............................................................................4., ........................................................ r at premises located at........ ... .o............ .� �j' ........ 1 ............................................. ....................... ...........................................� . 0 .............................................. ............ ! County Tax Map No. 1000 Section ....!l! ........ Block.......... 1 ........ Lot No. .. ............... pursuant to application dated ......... ��� ......... ..... 19... �G'..., and approved bythe Building Inspector. Fee$............................ B ' ing Inspector Rev. 6/30/80 :.( �{_=�2 - << ..LI . BOARD of nrnLTn . . . . . . . . . . . . . . ! L FORM NO- 1 3 SETS OF PLANS . . . . . . . . . . 14 's '! TOWN OF SOUTllOi.D SURVEY . . . . . . . . . . . . . . . . . . . . . . • - MAR 1 9 1996 f' BUILDING DEPARTM9NT CHECK - - - - - - - - - - - - - - - - - - - - - - - - - TOWN HALL SEPTIC FORM - - - - - - - - - - - - - - - - - - - BLDG.OL-=; SOUTHOLD, N.Y. 1 197 1 - TOWN OF SOUTH'OL D .� 4 TEL: 765—I802 NOTIFY: 9 CALL . . . . _ . . Eximined......�oo.�.. 19.1.� l2 MAii. TO: .. . . . . . . . . . . . . . . . . . . . Approved...... . 19, � Permit No. J J� ..... .................................... Disapproveda/c .................................. .................................... ...................................................... (I]uild �spe tor) APPLICATION FOR iUILDING PERMIT ..Date. .:?'. . . .� . . . . , 19 . INSTRUCTIONS a. 'lhis application must be completely filled in by tYpm,7riter or in ink and sulmi.tted to the iluilding 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 appl.ication- c. 1be work covered iy this application my not be canrenced before issuance of iuilding Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit sliall 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 airy purpose whatever until a Certificate of. Occupancy shall have been granted by die Building Inspector. APPLICATION IS IiEREI]Y MADE to the iuilding 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. 'Ibe applicant agrees to comply with all applicable laws, ordinances, ilding code, housing code, and regulations, and to admit authorizes] inspectors of premises and in lxiildi for c s t inspections. fl., �\ . ................... (Signatur&JP applicant, or name, if a corporation) (Mailing address='.of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, pluniner or builder. ...............me r- `. ..................... .`. . ...ff....t................ ...... .........................._ Na of owner of premises .. � A-I: . � t(.,� .:` ..K/ f!�. ?� � ... ,✓�•r e'.�. .i. ........................ (as an!itlie fax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ......................................................... (tJ.-me and title of corporate officer) Builders License No. ......................... Plumbers License No. ......................... lilectricians License No. ..................... Other Trade's License No. .................... 1. Ioaation of land on which proposed work will be clone.............................................................. [louse Nuni)er Street / hamlet Ccxnty Tax Kip No. IOOO Section ...0�.�.... ][lock ......J......... Lot ....©:�..... Subdivision ...................................... Filed Map No. ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: oci s t i ng use and occupancy .._.: J.±"..��....A.? ........ ��.�''.�.� a. F ....�.:[.'�. ��..� & 1). Intended use and occupancy ............................................................... .......... 1. 1"•hire of: nmrk (dw_-ck widdn ai,)llcable): N�-w Iknilding; .......... Aeklition .......... Alterat:ion .......... RepaiI. Itai)oval ............. Ile(r)l it ion ............ Other Work t? `0 (De sc:r11*)L ) 4. list im�;nte>cl Cost .. fee .................................... .......... (to Ix' paid on filing; this application) 'i. iC (krellini3, (xni)er of ckaelliry; uniaaL's _.. ... iltuher of (hselling units on each floor ................ If garage, rxnl)er of cars ...... ! ...................... b. If Ix)sioess, mnnercial or mixed occupancy, specify nature a(xl extent of each type of use...................... 7. Dimensions of exisl:ing structures, if any: Frank................ Rear ............... depth ... .............. Ik:ig)iL ......................... Uni)er of Stories ...................... Dimensions of: sane structure with alterations or .xklitions: Front Ite-ar ......6........ Wi)t.l) .................... lieigj)L .................... Usiher of Stories. ............... 13. Dimensions of entire new construction: Fran Itear ............... iDepth .............. Ileig))t ......................... Uither of Stories ..................... 9_ Size of lot: Front .../0.0............ Rear .......... Depth _ 02,0.0."... ._. 10. Mire of Purchase .��..` P .: Naixs of Former ()timer ....A1, ...... .4.1 A) 11. •L(x)e or use district in wlridn premises are situated .."�0.m,-f .;t 6-C: ........................................... 12. Does Proix)sed constnx:L'ion violate any zoning; law, ordinance or regulation: ........................ 1:3. Wi 1 l 1 of he regraded .................... Will excess fill. he reitmed from Preni ses: YES 1*) Vi Nanes of Owner of prenises ........................... A(klress ..........................6... Ilxone No. .............. Mxiie of Architect ..•......................•.......... A(Uress .............................. I'lione No. ............r. Nine of Contractor A(klress ...............................i'1)one lb. .............. 1.5. Is this property within 300 feet of a tidal wetlarxl? * YIS ....... 1a) .. �.... *IF YES, SU111HD 1XX4N 'I111Si11(.S PERMIT MAY 193 W1AIIRIJI. I PLOT DIAGRAM lncat.e clearly and distinctly all lxnildi(igs, ul)ether existing or proposed, aril inxlicate all set-hack dimensions Fran property lines: Give -street arx] block ncnber or description according to (teed, and shun street r>innes.arxl irxlical'e Wl)ellver interior or corner lot. APPROVED AS DOTED ` rn c 4 it GATE: FEE: NOTIFY BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: x� �6 C` 1. FOUNDATION - TWO REQUIRED I FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FiNAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL coiNSTPUCTION SHALL MEET THE acrl iR"fJIEN'TS OF THL` N.Y. & ENERGY RESA,'10NSI8LE FOR Imo:pit l O's. CO4`,;ST F1,UCT1ON1' ERRORS `i I'A'lli (111 NIIJ Y(X?K Y} (XX)NIY (V .Ski �. .........................Ix;in dug [worn (le x)ses a(xl says r a b Y 1 ys ll .)L' he is; the appl.Icant: (Nate of i)xIi I(lual. signing; • tract) alive Ik: is, the ................ .9.... I) 4 Q f� .........!.C< _o� :........................................ ((kmtractor, agent, corgx)rate officer., etc:.) of: said (nnx-r or owil:rs, a(xl is duly aulhorized to 1mrfonn or have gxnrfonur>d Ille said work aixl to nrilm ;uxl file: this application; that n11. statements contaiix;d in this appl icarion are Lme to the Imfil: of his krxxaledg;e and Ixil.ief; a(xl Ihat. the work will he perfonmed in the m;miler. set forth in the application l'iled therewi.t.h. S4x)ro to before nn this CC�� ('t:.....da of ......19..L Notary Pnmblic .... .... ( iq;naku :of A I icant) JOYCE M.WILKINS Notary Public,State of New York No.4952246,Suffolk Coun Term Expires June 12,19 Urwidtodzad alteration or addition to 0"etxvoy to a*Wm of Section 7M of Ow Now York SMta EdtaoON Lbw. t.gtiaa atawl�not Giarinp I -; ,1 � k ��N•Ma tM bm-tea Wad Md or _ C atriaaeM•twN,tfieMnot ba ooralderad to be a veil rw-un. , i Ouraraeea kt�aMd Mraon rhal oun Ir-- ory to#w pw m br.W%n the @oval Z15 le aawM:&Won)ra ttatwlf Is" /4�Bf3`mod"L� /DO•QO a� tide oarpany,OowonnwrttN•apeBolend farNYip itawtraon Aetad n«rtm.nra A x -�:...-._..- to ha.aeelprwes-of the Wd"ktdlutfetta { =- =Jr QtwarMras are not rrabrabN I*addlio W inatlwtlom a vAoe4uW A ownsm O l y 6 A Af p s` I � 10 Q Y` COy Q N t:w Y K Z ti N of \ tmoJ 110 kv �✓a.�' /can- � �'uevEy.r-o.�•G'.C��•G0.21�'�'.C:9�Lc�' y `'�.CF .�is�T.�/Ort�✓!�S/,Lz`,w4rt/1�it�`✓� �avJc�r.�.�uCd v,�� .�G'cr�rrvr,•��/. �-% ,G.�✓O V�"Yt�,e Cx'.r� mac/ ��'O T�/GEE�s/�-•�,�- riivE�vT � ' �T�'�r�' ` 13f��5d�:�Eplfih�ye Zvi/��