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HomeMy WebLinkAbout23371-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. NP 23371 Z Permission is hereby granted to; / " �la ..�o ... . . .. . .. '©. ... .... # �(,�mlkls) .................................... . A .................................................................................................................................................................. ................ ............ at premises located at..............�..`...�.�.. !1 � ..........!e.r................................ ....................... ................................. �.�9- .................................................... ........... County Tax Map No. 1000 Section ......... Block.......... ......,... Lot No. ..................... pursuant to application dated ................. ..... , .. ...... .........1 19..... and approved by the Building inspect Fee$.. U ` Building Inspector Rev. 6/30/80 '~ BOARD OF HEALTH . . . . . . . (� FORM NO. 1 3 SETS OF PLANS v �' ;� TOWN OF SOUTHOLD SURVEY . . . . . _ _ . . . . . . . . . . . . I BUILDING DEPARTMENT CHECK i . . . . . . . . APR _ 9 TOWN HALL SEPTIC FORH _ . . . . . . . . . . . . . -' - ' SOUTHOLD, N.Y.01,971 TEL.: 765 1802 i;or FY ; -��',. 7?�• VBLD.&D— Inspec;i CAL L Examinehd- O_ MALL TO •4P0 - z? Approved / 11: Permit No.( . . . . . . . . . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . - - - . . . . . . . . . . . . (Building tor) P LICATION FOR BUILDING PERMIT Date . . . . . )qk. . . . .1 19 �/ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink acid 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 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 any purpose whatever,until a Certificate of Occupancy sliall 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, bre uil ing housing code, and regulations, and to admit authorized inspectors on premises and in bui.F6ling for,necessary insp ct* 11s. , ignature of applicant o name, if a corporation) !c. . .%�S".. 4 (Mailing address of applicant) State whether applicant is owner, lesse(gent, architect, engineer, general contractor, electrician, plumber or builder. i . . . . . . . . . . .I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . , . . . . . . . . . . . . . . . Name of owner of premises . . . . . . . . . . .ox,l'. . . . . . . . . . . . . . . . . . . . .. BG�, a ��. rR as on the tax roll or last deed) If pp is t is a co oration signature of duly authorized officer. � ... .. ` (Nall e and title of corporate officer) Builder's License No. Plumber's License No. Electrician's License No. Other Trade's License No. . . . . . . . . . . . . . . . . . . . 7 \ 1. Location of land on which proposed work will be done. . .-? �.S�. , ✓ 4 K-, , / A-J , � Ln , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . ... . : . . . . . . . . . . . . . Mouse Number Street Hamlet —moo County Tax Map No. 1000 Section .- 1 � Block Lot . . . . . . . . . . . . . . . . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . ... Filed Map No. Lot . . . . . . . . . . . . . . . (Name) 2.. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy °ter•'d. �'.x'' i Q:5�'f�•�a= �r v' E b. Intended use and occupancy . . . .S . .'??.+. . . . . . . . . ... . . . . yPsa a F i�$SxaR „ 6i ��°q•r�ltlr 51o'�q . . . . . . . . . . . . . . . . . . . . . -3. Nature of work (check which applicable): . . • • . `ef"ati n j - New Building Addition . . . �'.� ; =:, Alter Repair . . . . . . . . . . . . . . Removal Demolitipn " ' �' � ,ation •OtfierWork.r�.. 4. Estimated Cost . ��Q , �p a. (Description) / : . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . OP-_� . . . . . . . . . . . . (to be paid on.filin&this_application) S. If dwelling, number of dwelling units . .. . . . . . . . . . . . . , Number of dwelling units on,ea cl%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 . . Height Depth . . . . . . . . . . . . . . . . Number of Stories . . . Dimensions of same structure with alterations or additions: Front Depth . . . . . . . . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . Height : Number of Stories . • 8. Dimensions of entire new construction: Front . . . . . Rear Depth .Height . . . . . . . . . . . . . . . Number of Stories .. . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . . . Rear. .Depth . . . . . . . . . . . . : . . . . . . . . . . 10. Date of Purchase Name of Former Owner H. Zone or use district in which premises are situated . . . . . . ... . . . . . 12., Does proposed construction violate any zoning law, ordinance or regulation: ,ryv; 13. Will lot be regraded /u�1 . Will excess fill be removed from remises: Yes No 14. Name of Owner of premises l�Seo g-� A9AgCir,• . Address--?X neC®*; Y�07mKone No. 02-`FF-' Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . Address. . . Phone No. Name of Contractor . Address . Phone No. 15. Is this property within 300 feet of a tidal wetland? *Yes, . No A-- . , *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. cusaig wtoo J I15 lu _cam STATE OF NEW YAAK —'- COUNTY OF . C1'.sD . . . . . : S.S being duly sworn, deposes and says that lie is the applicant (Name of individual signing contract) above named. Heis the . . . . . . . . . . . . . . : . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 y f. Z� . . . . . . 19 � Notary Public, . . . . . . . . . °�unt l Roalr�T r— s Y NOTARY PUBII �r! No.4725089. �ff®11t�8t3 . . . . . . . . . . . . . . . ... . ... . . . . . . . . . . . . . . . . . . . . . �� Term Expires ay 3!•, (Signature of applicant) 25 zoo >_- d �� 'ti ��.n:• ,,�, N• o 1 c - m � - =o I{ qU" = ,$' �' ,+ �9- •` UNA{iTr6ORF7FC AP TFPATiOM OR AVOMO" TC T" SLRK-EY K- A YiOLATION OF 5 C71Q!i 7X0 OF THr NEW YC}7y�STATE - _ 4 5l Tt 1CN.;LAICC., LAW- 4� f f~ s R i.`4 �'�y � r<�•r• C4 ;..I- SUrYaT N-AP NOT ltEA,F,ir3C 4ti39 i1R 4'� Q Tom. !i v _ .•.v s:kL OR 2.0 S A �,- a._T &E CC)jrj <P,ED CiRrt 4 Yki.A .LH R F3f AYH-2W THET 3L:PYk1F f-., , -::. ti'S s' r.LF TO HE `,ga;;"*.13 py c �c�l��+C R }4 ; 'T� ;d- .'�� q..q.� Tr7:F �_piil U. vrIV.4-[f,�A: AUNCY AND J�d�Yie'rS i� #P FIL E�I}��iTs 60T�f"�Vi:. itr6T' me / cif t- C -t ION. AND o�s-�,'r ".,� `gF,sl,�ol-xf."�7 mrr of kG a � � Yt� TH; A55 GnLL� �x Tkf tEND0.+C er85rt• d tse fa 71JTPo'N GUAP ft TEES AFl- raoT 7aArt€ zA E .� s+ r� ,?3 f- -NO S4$� t To AUDMONAL rNSTiTt�7!Qj,*O,k SUBSLQ,,%T g o � i�_' -r• # ors'='`x � ti� -- �N . REVISVO YOU ^ \ ffi 400 0STRANDFR ,�4'=FvUE_ PIVERHEAD. NEW YC}RK - 023 L JULY 2, 1 973 apt ,4LE?E?ti! VV. YOU PdG _ FiOW'9RD W. YOUNG � JULY 23,1973 PF.OFESSi0MAL. E7JGPME£R AND LAMB SURVEYOR f SL�R!VEYC7R, N.Y-S. LIC- MO` !ZeAr5 74.Y-S. LLC. No- m3B93 l SURVEY F ! . INLAND LOT NO. 24,n LAUREL OUN 1 Rl Y E A� � sir `Q 1 /10 AT LAUREL SE UR 1 R TOWN OF rf �G SOUTHOLD c 15 95 By SUFFOLK CO., N-Y. SCALE. 40� ���> MAR.€2, i 73 ego. 73 —21S t1l 19000 I SssKG zw p 1 oo -n c) WC " ' rn OCm co o 1 \ys r # '. '� ` �^ �' •r,J9 \ - UNAUTN0 UM ALTEPATiON OR AOOr oo" 1 v .•_i a'� � TC rrls sut+rE► PIr A v1olAYlt?N OF SoC71QA 7XV OF THE NFW YORK STATE .i 15 'CN��AiLCN LAW- 5 CSrT;'r' S:1"Y'f7 N-PP MOT lEA6JNG 1w �✓ u O TI. Ea .ti•.D�:AI Olt 0 Q .r•B !.D S,A ,.•_` 1,-T BE COIGIDEP.ED 0 rA L. �' - $' I s _ 6rf � s_ A vA .e E:it tc av :!A A�-T'.-- -n-tAhz MF•KjN "KAu RUN _ 1r'a OMr 10 7H: r.. '. FJR WNW THE SURVEY, NOTE'' Pka.A- L, A . N'S i—*LF TO THE TIT:E COatl�,,. 4 VI kfN-,At AGLN-Cy AND U-r IVC n.5.:, ,1�„ L'SIIL Fi,FION. AND S`fJBletfVl !'lif MlrPFfLEDtIYrHFPfFIC£ kG ' ' TO M'' ASS-GK,GL NS LW TW LFNMC ITI, Of Ttfrx"Mow II CpUWTY ON t TJTI. P- N GUA ^ATEES A� NOT Jra W FFRA9LE JIME i's s970 AS FILEA00_5406. ti Q �fG 8��� TC ADD.7IONAL "STITLTIOIQ t,* SUiSiQUEMt Au REVISIONSYOUNG $ YOUNG IQ° r t _ APR.17, 1973 400 +JSTRAPtEFt }� Eh IIE. P.IYERNEAa. fYEW YORK �I'Z i'� JULY 2, 1973 ALDEN W. YOUNG HOWARD W. YOUNG JULY 23,1973 PPOFESSIONAL ENGINEER AND LAND SURVEYOR LANC SVRYEYOR, N.Y.S LiC. NO I2845 N.Y.S.I-LC. NO- 45e93 ? 1 ' sro yy Q 2? r k C>SURVEY FOR: F ��1L� � ANC HO�+lES,INC £y. � A I- LOT NO. 24,n LAUREL COUNTRY E At AT LAUREL G R NTE K €a SE UR Y T1 it Co. TOWN OF SOUTHOLD Gf 3 St1FFOLK CU., N_Y. BY,r� a SCALE: �'• _ 40' DATE MAR.t2, 197-3 �No. 73 -218