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HomeMy WebLinkAbout23833-z FORK NO. 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) M23833 Z Date .. ' ..?: ..................................... Permission is hereby graAte to: ...�'9... ........ ... .. to ... .. ..: ... .: .. :.......... ....... ... ,............................................... .......... .............................................................................. 11 atpremises located of ..�.�'.�''....... ... .... ...` . ....`mil/ ..................................................... ................................................ .. .. .. ................................................................................... ................................................................................................................................................................. County Tax Map No. 1000 Section ......1:50$......... Block ........ ..... Lot No. ....: ...�.......... pursuant to application dated ............................... 19..2�.�, and approved by the Building Inspector. Fee ... ... .. �.. ....f ......�..... .Ing Inspector ............ Rev. 6/30/80 FORM NO. 1 ,,.3 SETS OF PLANS . . . . . . . . . . . . . . . TOWN OF SOUTHOLD '1111Si1RVEY I10V 1 2 l99i10- BUILDING DEPARTMENT �CiiECR . . . . . . . . . . . . . . . . . . . . . . . . . TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . . SOU HOLD, N.X. 1 197) zr ur'• _ a 'oD ><I, , TEL: 765-1 g02 NO'TIr t�b,) t".xanined .y8....... �?, 19. )) MAIL TO: . . . . . . . . . . . . . . . . . . Aplrrovecl.�� ....... 19..%( Permit No. Disapproved a/c .................................. ..................................... ...................................................... . �7pe •- 'z -� c APPLICATION FOR BUILDING PERMIT l Date. . . . . . . . . . . . . . . . . 19. . . . i INSTRUCTIONS a. 'Ibis application "list be catpl.etely .filled in by type-rr.iter or in ink aril suW'itted to the Wilding Inspector. wit. 3 setts of plans, accurate plot plan to scale. l.ee'accordingtto scheckrl.e. b. 1'I.ol plan slowing location of lot aril of: Ixrildings on premises, relationship to adjoining premises or public streets or areas, am] giving a detailed description of layout of property mast be'drmm on the diagram wlr.ich is part of this application- c. 71ie work covered by.this application may,pot be conmenced before issuance of Building Permit. (,. Upon approval:of. tl.�is''application, lhe'llui.lding inspector will`issue a'ikrilding Permit to the applicant. Such permit shall be kept an the premises available :for inspection th.rougllout the work. e. No Wilding, shiall.,•be occupied or used in whole or in part for any purpose whatever until a Certificate of (kcuparxy'slmil have been .granted by the Wilding.inspector. r APi.11,ICA'I'.LON IS IIEREi1X MAUE to the ikailding Department for the issuance of a Building Permit pursuant to the ihiilding 7bne 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 ti described. lbe applicant agrees to comply with all. akfl-icable laws, ordinances, building code, housing code, aril regulations, aril to admit authorized inspectors on premises and 1T1 building for necessary inspections. .... J�............................ (Signature of applicant, or nU~me, if a corlxn-ation) Hailinj ,S 9 Ni ckory s trees W 4e ...en >?ivooa�.G��: ,.yJ.� �e3a`:................. Mailing address of applicant) State wlredwr applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plurber or lxiilder. 0.w.nt=l.............................................................................................................. Nave of owner of premises ...Pifer.t;..�..*neL�e..D....C:Qrbin..................................................... (as on the tax roll or latest (teed) if: alrpl.i.cant is a corporation, signature of (July authorized officer. ....•-•- .. . (Name and title of corporate officer) ikailders License No. PWA,ers License No. ......................... Electricians License No. Other Trade's License No. .................... '�,'ll u Locatio" of ].and on •alridr proposed work will be done...l Q.Idl,2.fel ed9e..WQ 7'.............:................._... ........................... .....................---........._.....---..................5outhold4 tr4t/.yo��l ........ Wuse Wnber Street iLa�ilet /,,� ('cxn-y Tax Map No. 1000 Section ...... ....... 111 oxk .....�...... t o t ---.Y/..�l...... Sulxlivision ...................................... riled Map No. ............... Lot ............... (N<-me) 2. State existing use and occupar►cy of premises and intender] use arxl occupancy of proposed construction: a. existing use and occupancy ...&-54C►]Ce ............................................................... ir. lnt.emk-d usct and occupancy ...... LLI A,Alt d"A..'.Rha Ve.......................... .............•..... y. v 1i, if::•. .: I.:':r�, 5 �'E=SPw y'•.iy'�y .1. N•elure of work (dieck wlridi a1411i.calde): New Ikrilding; .......... Acklition .......... Alteration .. ...... .. Itcepuiir ............ Miloral ............. llow)]tLion ............ 00ler C•k)ric �,f]s�Q�l Spll:t.ral'1.�BnG�......_. (Clescrl pL ion) 4. Esc hwited Cost . �V..J.Q.-..'............. fee .....3.1-.............................. .... (to he paid on filing; phis application} 5. 11: Axel l ing, rxnLer of: chaell ing units ...........__ iknlrer-of, A,,el l ing twits on each floor ....:_.......... l f garage, ixnber of cars ... ............... . 6. If Ixisiness, cc.Yunercial or mixed Occupancy, specify nature aexl extent: of each type of use.......... ............ 1. llinwusicxls of existing st.rt►ctures, if t.iuy: Frolic..... ........... Real .. ............. Depth .. ........ .. ..... lk.,i&L ......................... Ukiber of SLor;ies ...............*. ....... Ilinensicos of sfnne stnxaure with alteraticxis or`.ixklitions: Front ..... ...........Rear ............... Depth .................... IleiglIt ................:"... M,iber of Stories It. llimeosions ol`. enLire rxew construction. FrooL ................ Rear .... ........... Depth .............. � t Ileigllet: ......................... Umber of Stories ..................... c). Size of log:: I3,1cxrt ..1.0. 0 M Clear -.1O.0..Q............ Depth 1.7.1-Q............ 10. hate of hirchae:c .. jp/1:/.9J?........ Hwvr of Fortier 04oer .491.-R, Puki....................... . 11. Mile or use disl:rict in tAiidi prcanises are siLuated .Aes.idt?Oiia.I............................................ .. 12. Ikos proposed c(xisl:rrxaion violate any zcoing lcn.,, ordinance or regulacion: .Wo................... H. Will lot: lie regrmled .....VO-........... Will excess frill. Ile renrrved from prani ses: YES l- " 14. N:nras of Owner of premises .Peter.k.�Andg.h..-CA 411 Acklress �9.�ic1�0ly.St<,..�h�/el`(/,Q���&Ifrorx 6��7-(�l�$ Name of Ardis test .................................... Mdress ...... ... ...................... Phone No. .............. 7W00 Rt, N8 hcanic Mine of Contractor .7AC .�I'erKe�...................... /vklress °?............_.......!........l�xxx 15. is this property within 3W feet of a tidal wetland? * YES .......... NO ..X...... *ll YES, SY11111"j) 'lam 'Iiwsllul s P1sliMC'1' MAY ills 11a)II1IIlsil. , PLOT DIAGRAM Imafe clearly anal distinctly all lxrildings, whether existing or progosecl, aexl hulicate all. seL-hack dimensions fixin prolxarty lines. Give street aixl block nnber or description according to deed,-and sltota street rinies and irxlicate Mrether interior or cornerAS See�vd+Fllched,Survey, .•� •" .,, . :;, . � k,�� ty �... p AP PE ,..e-._.�...... P...—_. TO E\776' U IFY BL.IK-DInC�%(��p a,;�lrl��.R�'i�€?EINT AT : Cr-6�i�r2 9 A101 �'sry PM FORTHE I-0 C.�..(,-?+:,`:411�'�_� 'n4AQ' REQUIRED FOR PM.lRED CONCRETE 2. PblUGH A ImRr",IWNG &, P Q UIASWIC :. II`3SU ��TiB�N 4. F-110NAL - CONSTRUCTION MUST GCE COMPLETE FOR C.O. ALL CONSTRUCTION RUCTION $11ALL. MDE HE REQUME ENTS OF THE N.114 ATE CONSTRUCTION & ENERGY OLES. NOT RESPONSIBLE FOR srnn: O I-A;W Y(Xw, DESlGI�OR CONSTRUCTION?ERI�CBR S 1,. SS (J(AINIY (Ji? .... tc � ......... .4 tva 0J)0S40J1C-4 .. ..Ixeing duly sworn, deloses aexl says that he is die appl icanl (Name of ii)(lividtial. signing contract) alx)ve gunned, Slk: is the ................... (Contractor, a1�'�corlx)rate officer, et.c.)...... ............................................ of said moer or owixars, inxl is duly auLhorized to lierfonn or have per('orurad the said work arxl to mike arxl file this application; Lhal: all. stateurenLs contaiwd in this appl icat ion are Lnie L'o the 1>es(: of his klxruledg;e aixl Nil ieH a1KI that Lhe work will Ile performed a numer set Forth in l.he application filed t.Irerewidr. :kxrrn to liefore Ora this . .......�Z-iti.....,lay of: ... . I 9.6... Notary Public .. �Zfr7CG�' � �C r .............. ROBERT I. SCOTT, (Sil;nature of Apo . cant.) NOTARY PUBLIC,St of N.Y. No.4725089,Su k Co u Term Expires May 31. 19 / P CZO P E[z ;YI*' 1, SURVEYEDJNT FG2 t Q0 -FE 0 Q/- 6 1 N "Tc 2 � ANME TTE 1 SOESTHO:LD Unauthorized altereflon oraddMon to this survey is a violation of TOWN 4 F -50 U T HO,D Section 7208 of the New York State 1 Education Law. i Copies of this survey map not bearing L� tm tae land surveyors inked seal or.� .��W �z O•E. V�J embossed seal shall not be considered to be a valid true copy. Guarantecs indicated hereon nin ' � yy r�� only to the person for whom t e sulrvey ©�/ U f1am PftO Ct/z1Pr a prepared,and on his behalf to the (Si r, (aa/ tdie company,governmental agency and 1 {` lending institution listed hereon and to the assignees of the lending insti- tution.Guarantees are not transferable 4 i to additional Institutions or subsequent 0—% Owners. - aN�-. 'aIZY - Ot 1- O o SCALE 4 �OU6� \ i a ! , o AQEA= !?500 S-F 1 \ Q•P1PE ` i 1 j sl OF N ` l ,, ----i W m t���Q'�cK V441 G a� CID fl:! { Ltd fr . �•, �G,�•�� � GUFF CA.TAx MAP rOW-088-5-53 lScn 25 JJ } :� - .' �• � �� � �� �_g1.33 J .��`�LAND s 100.*0 5t� k/A ERS E.D�►E. WAY GUArZANTEED TQ NC3PTH .FORK 8AN)G AND'' COMTMQ - Ei4LTH 4:AN0. TITLE I NSURAFJCE'CO, AS SUfzyeye D tZOU. Rr .VA�•1 TUYL-tP.C. } I:QT:NO'S.12EF'F TO MAP-':QF TER RY-WAM -FILED -'W 7 !: THE -GUFF. CO CLE12'K:S OFF C A A t - GREENPQR'tr NY . . 'ttc.LAiVO SUtt.VEYURS _