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HomeMy WebLinkAbout22960-z C d 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. .. N Z 22960 Permission Is hereby grant e t .� •• % .�. .. ? .............. ............�. ... t'' 0.. ............. .. Ato .... . ........ .. c,....... ........t ....... `-.......... �-f-/ � ..... ........ . . .. :............................. ......................................................................................../... .........../....................................................... at premises located at............. . de z�-�............ 1 �.. ? ...... -�'-................. .... .....................�"�r - - �/.4.......... L. �.......................... ............ County Tax Map No. 1000 Section ...........2 Y.... Block..........;1............ Lot No. .... AK......... pursuant to application dated ..........ef. .. .j............ 19..'y d approved by the Building Inspector. Fee$...... . .... ........................ ................... .: Building Inspector Rev. 6/30/80 BOARD OF HEALTH . . . . . . . . FORM NO. 1 3 SETS OF P.L,NNS . . . . . . . . TOWN OF SOUTHOLD SURVEY . . . . . _ _ _ . . . . . . . . . BUILDING DEPARTMENT CEIECK.. . . . . . . . . , . . . . . . . . TOWN HALL •0_ SE POT I:.0 F0R:I _ . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL.: 765-1802 t:OT I FY 7 CALL Examined . � , 19� MAIL T O : . . . . Approved . 66 7. 19�1 Permit No. G � . . . . . - - - • . . . . . . . . . � �• Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . ke I . . . . . . . (Building Inspector) r ICATION FOR BUILDING PERMIT r Date. l . . . . . . . . . . ., 199 . INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with _- sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Jocation of lot and of buildings on premises, relationship to adjoining premises or public street: 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 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 until'a'Certificate of 0ccupanc} shall have been granted by the Building Inspector. o . 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 'Nev✓ 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, building code, housin corm,-,and regulati fis.y. and to admit authorized inspectors on premises and in building for necessary in ections. . y, ...T . . . . . . . . . . . . . . -- (Sign'ature of applicant, or name, if a corporation)' (Mailin.g.addre.ss.af:,,applicant) State whether applicant is owner, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or builder. : . . . . . . . . E 'NOTE®.. . . . . . . . . . . Name of owner of premises ' ? Co�l�. ,�. DATE; 00 S,P.# � %o . (as on the tax roll or a' BY: If applicant is a corporation, signature of duly authorized officer. NOTIFY 6U ®ING DEPA - AT 765-1802 9. AM .TO-4 PM FOR THE. FOLLOWING INSPECTIONS: r T��I::(FOUNDATIONi TWO REQUIRED. (Name and title of corporate.,o.fficer)' 'r = POA P®URED'CONCRETE •' 2. i ClU a F f4 INN & PLUMBING Builder's'License No. . . . . : . . " . '"- • I� -- 4:. FINAL '- ``'CONSTRUCTION MUST . Plumber's License No. . . . . . . . . . . . . . BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET Electrician's License No. THE REQUIREMENTS F THE.,N.Y. O T - CONSTRUCTION-;&- ENgRGY Other Trade's License No. CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS 1. Location of land on which proposed work will be done. . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . ' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S ,l l . . . . . . . . . . . . . .S©c-co . . 1... . . . . . . . . . . . . . . . House Number Street �] Hamlet County Tax Map No. 1000 Section . . . : . . ... . . ..J. }. . . . Block . . . . . . . .l . . . . . . . . . . . ... . .. . . . . . . . Subdivision �P � �. 5. ��z�1.'. Filed Map No. ����. !.L . . . . . . Lot k9 (Name) ' ?: State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ' �. • •C -�,�`C}-1 . � 1e � b. Intended-use and occupancy, Me -' 1 4%44 / . !3. Nature of work (check which applicable): New Building ' ' ' ' ' ' • • • • Addition . . . . . . . . . . Alteration Repair . . . . . . . . . . .. . . . Removal . . . tt • • • • • . . . . . . . . . Demolition . . . .Other Work .F � 4. Estimated Cost . . . l � (Description) . . . . . l . . . . . . . . . . . . . . . . . . . . . . . . Fee • • " -(to be paid on film this . . . . . . S. If dwelling g is application) b, number of dwelling units . . . . . . . . • • . . .. Number of dwelling units on each floor . . . . . . . . . . . . . . . . _ If garage, number of cars 6. If business, commercial or mixed occupancy, specif ' ' ' • ' 7. Dimensions y nature and extent of.each type of use . of existing structures, if any: Front . Height . . . . . . . . . . . . . . . Number Rear . . . . . . . . . . . . Depth . . . . . . . . . . ,. . . . . of Stories • . . . Dimensions of same structure with alterations or additions: Front Depth . . . . .. ... . . . . . . . . . . . . . . . Height . . . . . . , ' Rear . . . . . ... . . . . . . . . . . . 8. . Dimensions of entire new coi�struc ' ' ' ' ' • • • • Number of Stories Rear . . . . . . . . tion: Front .Height . Number of Stories . . Depth . . . . . . . . . . . . . . . 9. Size of lot: Front. . . . . LCI� Fes' 10. Date . ... . . Rear. . . . . of Purchase . . . 1 .��q�l '32 f7-- Depth .* , :Vt-, • • • . . . . . Name of Former Owner IL Zone or use district°in which premises are situated . l•2: Does proposed construction violate any zoning law, ordinance or regulation:13. Will lot be regraded . Will excess fill be removed from premises: Yes 14. Name of Owner of premises . . . . . . . . . . Address rro . Name of Architect ' ' ' ' ' • ' • • • • • • • • • • . Phone No. . . • Name of Contractor . . ' ' ' ' ' ' ' ' • • • • • Address . . . . . . . . . . . . . . . . . Phone No. . . . . . 1 S. ' Is this property w ' ' ' ' • • • • • • Address . . . . . . . . . . . . . . . . . Phone o.P P y within 300 feet of a tidal wetland?� *Yes. " " ' *If yes,' Southold Town Trustees Permit may be required. No. . . . , , , . 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. L�sr•� � LssT- g k 0 R—r- '"`� N4�. -rfl � - zp c�,a�, o� mac►{.�T L.!� r�`•'C�.L�i� �, ((Q-�{Z O� =PATE OF NEW YORK; 0 UNTY'O'F (Name ofiindividual si nm contract being duly sworn.`, deposes and says that lie is the applicant 0ve named;,: > S? i ) isthe . . . . . . . ��P�►.�T . . . . . . . . . . . . . . . ..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) . said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this )lication; that all statements contained in this application are true to the best of his knowledge and belief; and that the .rk will be perfonned in the manner set forth in the application filed tl,iere.with. ; orn to before rrie this . . . . . . . . . . . .day of . . . . ... . . . 19 teary, Publi.c ,. .. � e r `• \. . . . . . Count �lotary LINPubD "1 COOPER . . . . . . . . . .. . . . . . . . . No.4822563.5u okCe of oun� ,6 (Signature of applicant) Term Expires December 31,1904.1 se ® i .. ._....� FE"�CE Al C1`tEcc 'A '+ mEc vthe �.: 5.6t 2- 30:_E. a 39sa:o2 m to 2 i. ,� i 56. � 7>� Itt 6, Gur ony Isp; title AC LWELL. m `� troth, f0 r'— o • tuvo, to ad .e tCTQF GAle-i -- \ 111 � o� i .i.J M> p 1 FI. pQ-0 P. RTY _ Sl—jRVE`i'Et. F`Otz NOTE 1 LTI_" 1. �_ - --- ----- — _ >t_ - REEF.aN.THE. c— CD: CLEE2�'E ��.Mr���' ''.l f,� 5 � OUTHOLt✓ G.UA2At iTEED TO V-E _EORP. MG2TGAGE,1; TI l.0 I N;U RANC E CO.-M, f 1 9 CCUNT Y r�•B 'R��C4 I+T©.-�_TV, LrECr:� Iti�• SUFF Ca,T" MH.F DA7r4 i O 77 _-' 23