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HomeMy WebLinkAbout23813-z FORM NO. f 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) N® 2 3 8 Z Date ............ . �.................. 19Z 13 , Permission is hereby gr ed to: . . . . . .. . ;-Q 5.. . .....�.°�,. .. ... .... .............�� to . .. ................. :.1�. i�. :. . . , . .. ..... ............. ..... .. ........ a�at premises located at .........�...... .......................................................................................... ................................................................ .../.a :........... ......................................................................... .—.�.c�.............. .............................................................. County Tax Map No. 1000 Section .......... .. ..... Block .......... .... Lot No. .. ................ pursuant to application dated ................... .. ..........., 19Z.4� and approved by the Building Inspector. Fee 3 �............ .............. .............................................. ................ Building Inspector Rev. 6/30/80 DATU FO I It I D AT I( N s,-I- FOUNDAT I()N RID) 'X 111.11ri11 I MG, ------- -- -- I off PI;lt tj y f;TATF. CODIr --------------------- ------ F I HA I. -------------- =my------- ADOI.TIOUAl. . . - - - - - . _ - . : ,.-- . _� _ - - _ . ,.. _ Yr r� _._ .- -. -: _ _w - - cx+-c+..�" - - -: u - - :. . yr - -: .,. . - 5 yj'L7,7lTNb .raj ih7 ., ... . —{r, - _ �.��tTs`+�... - fir— ) �— r :J� rFCZ - - r y st a vrw��'� air s++++t " - _ - J 1 �l�_ i _ - — -� . �� -.v _ r L . -),r.E6 _. - - _ .. - - - _ _ _ -. _ y _- .; �u _ _ �.a - , :. 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TOWN OFSOUTHOLD CHECK � � • • • • - - _ BUILDING DEPARTMENT SEPTIC FORM ) 2 4 ( g TOWN HALL NOTIFY SOUTHOLD, N.Y. 11971 : : 1 il TEL.: 765-1802 CALL . = . : . . . . . . . . . � MAIL TO : Examined !J. • . • •: • .1 196C� • v I ' Approved . . . . . . ` ., 19��!Permit Noo.�O / Disapproved a/c . . . . . . . • . . . . J . . i . . . . . . I (Building Inspector). . A P ICA1'ION FOR BUILDING PERMIT Date INSTRUCTIONS i 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 areasi 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 ntil a ertificate of Occupancy shall have been granted by the Building Inspector: APPLICATION IS HEREBY MADE to the Building Department for the issuanc of a Builii'ing Permit pursuant to the Building`,Zone ,Ordinance of the Town of Southold, Suffolk County, New York, d o her applicable Lawsj Ordinances or Regulations, for.'the construction..of buildings, additions or alterations, or for re ov or emolition, as herein described. The applicant agrees to comply with all applicable laws; ordinances, building c de o g de, and.regulations, and to admit authorized inspectors on premises and in building for necessary inspectio i attire o plicant, or name, if a co ) a Flarf er Olsen, Esq. • .P,, .Q, .QQx iNQ, ;Mahn :Rd.:„ ,Cutchogue',i AY, il,1i9135 (Mailing address of applicant) State whether applicant is_owner, lessee; agent, architect, engineer, general contractor, electrician, plumber or builder. Attorney .• • • : • • • • • • i : i J • • • • • • • • : • • • • • • i • • • • • • • • • • J • • J n 1 : • 1 . • 1 1 1 J : : •'1 • • . 3 i • , i • : . 1 J • 1 Name of owner of premises' . .�y'hia .LogrQiQqdQ , : : , • , , . : • • „ : . : . . . . : . . . . . . . . . . . . . : . : : 1 : + . ..: ; , : (as on the tax roll or latest deed) If applicant is a corporation,signature of duly authorized officer;l ; (Name and title of corporate officer) ALL CONTRACTORS MUST BE SUFFOLK COUNTY LICENSED Builder's License No. . . . . • . : . . J : . . . . . . . . . • . . . . Plumber's License No. . + . . . . . . + . . . . . . . . . . . . . . . Electrician's License No. . . : . : : . . : . . . • • . '; . . . Other Trade's License No. . . . . . . . • . . . . . . 1. Location of land on which proposed work will be done, 950 Town Harbor Road:;:Southol d,, NY; , ; ; 950 • • . . . . 1 . , . . . . . . . . .T,awn. .Harbar. .R.d.. ' . , • • . . Sputnol d: , . . . . . . , a J . . / , . i . House Number Street Hamlet County Tax Map No. 1000 Section . . .64 . . • . • • •'. Block ? . . . . . . • . . . . . . + Lot. :6i "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 , ,Accessory, ,garage, ,as, ,�ui,l,t . :F: : • • • , • • : , : : • • + i it Accessory garage as built b. Intended use and occupancy . • • . : • .,, • >• . :J . • . . • . . • . . Accessory Garage as built 3 Nature of work (check which applicable);.New Building, X, , Addition . . . . . . . . . . Alteration . . . , . . . ' Demolition. . . . . . . . . . Other Work . , . . . • , , , , , , • .. Repair . , . . . , Removal . , . , • , , • • , , ,. . . (Description) Estimated Cost . , • . . . . , .. ,', , . Fee . , , , , , , , , , , , , , , , , , , , , • „ • , , , , , , , , , , , , • 4• . `• (to be paid on filing this application) 'S. if dwelling,number of dwelling units , , , ; , , , , , , Number of dwelling units on each floor , , , , , , , , , , , , , • . if garage,number of cars . . . . . . . . . . . . . . . . . . . . . . . . , , . . . , . . . , . , , . , , . , . : , . . , , . , , , , . , , , , , , , , , , , • , , , 6, If business, commercial or mitred occupancy, specify nature and extent of each type of use , , , , , , , , , , 7, Dimensions of existing structures,if any: Front . . . . , . , , . . , . , , , Rear , , . , . . , , , • , • Depth Height . . . . . . . . . . . . . . . NumberofStories . , . . . , . , , , . , , , , ; , ,', , . .`, ; , , , , , � , � . Dimensions'of same structure with alterations or-additions: Front , , , , , , , , , , , , , , , , , Rear . . . , , Depth , . Height . . . . . . . . . . , , . ♦ . , , , : . Numberof Stories , , , . , : . , r „ , , , , , , , � •8, Dimensions of entire new construction: Front . . . , • . Rear , , , , . , , , . . , , . . • Depth Heigh t Number of Stories . , , , , , , , , , , , , , , , , , , , , , . , , . . , , . , , . , , , , , , ••� � , , . , , . . , � , , , . . , . . 9, Size of lot; Front . . . . Depth . . Rear ; , , , , , , , , , , , , , , . , , , , . . , , , . , , , . , , , , • . , , , , , , 10. Date of Purchase ,, . , , , , , , , ;, , , , , , , , NameofFormerOwner , r , . . . . . , , . . . „ , , . � • + - . , „ 11, Zone or use district in which premises are situated , , , , , , , , , , , , , • „ • . . , • • , , , , Too , . . . . . . . , " " " ' ' 12. Does proposed construction Violate any zoning law, ordinance or regulation; , , , , , , , , , , , , , , • , + ° f + • + • + t ' + • ' ' 13, _!W41 lot be regraded . . . , .. , , • • , , • , • , , , , , • , . , , Will excess fill be removed from, premises: Yes No 141 Name of Owner of premises , , , , , , , , , , , , , , , , , , , Address Phone No. , , , . , • . , , , . , • , , Name of Architect . , . . . , , , , , , , , , , . T : • , , 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'reguired, .. 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. See attached survey PP"M �8 TOYED ..DATE: B.P# o� FEE° �r BY. NOTIFY: BUILDING OEPAFi T AT } • � . . . `fit 70E-1802 S AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: y� r (i €5 'I, FOUNDATION o TWO REQUIRED Ua � .x7 "•'� i�+� FOR POURED CONCRETE j t_ 6 4 L �x _ 2. ROUGH 9 FRAMING & PLUMBING € ,CAI 3. INSULATION 4. FINAL CONSTRUCTION MUST t't ace BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET €Et THE REQUIREMENT$ OF THE MY S EAT'E CONSTRUCTION & ENERGY. CODES. NOT RESPONSIBLE FOR DESIGN OR,CONSTRUCT'ION,.,ERRORS 'UNDERWRITERS CERTIFICATE` REQUIRED STATE OF N%� ORK, S.S COUNTY OF . . . . . . . . . . . . . . . . Gary •F1 anner •Olsen • • , . , • • • • • • , • • • • being duly sworn, deposes and says that he is the applicant . (Name of individual signing contract) above named. Attorney. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . , , • • . , • . . . . . . . , . , . , , . He is 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 h;e.aSnid belief;and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this � • W. . . . .day of. . . October • . • • • • • 19 96 Notary Publ'c, _ , , � �• . , , County LORRAINE KLOPFER , , . . • . • r , • • , . . • . . . . . . NN&4028373 Ye* ( gnature of applicant) QueRRed in Suffolk County Cmatieebn Emotes Nov.30,19917