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HomeMy WebLinkAbout17205-Z FORM NO. 2 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) N0 017205 Z Date .....Z./.. -....................................... 19 �_ Permission is hereby �y ranted to: ..... ....... ..... .e.... .......... .... ......... .... .. . ..... ... to . . ... .... ...... .... .. ..... . ...... ... .......... .. ..... Y ..X..................................................................f.................................... ; ............... ................. ct premises located at .............�G� � -� . . . ... . . ... . . . .................................... ............................................... ......... ...>. ... ..t. ...... ....................................................................................................................................................Q............ County Tax Map No. 1000 Section ...........� . Block ........10141—.... Lot No. ..........�. .0......... pursuant to application dated .........1711..................................... 19.4Feand approved by the Building Inspector. Fee $... Buildi nspector' ................ Rev. 6/30/80 OF SOUT�o� /�►��OS * # TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 INSPECTION [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] .INSULATION/CAULKING [ ] FRAMING/STRAPPING [ ] .FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION'- ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) CODE VIOLATION [ ] PRE C/O: [ ] ,RENTAL REMARKS: DATE o 15a > INSPECTOR SU:� �ID ,,i:. �I SCi:'TMNTS m � 3 FA FOUNDATION ( 1st) FOUNDATION ( 2nd ) _ _ r (1 2. z c v\ ROUGH FRAME & O •PLUMBING y 3 =\ r� C INSULATION PER N . Y. y STATE ENERGY CODE r 4 . FI14AL .\ ADDITIONAL COMMENTS : �.� x v H • 9 H O ' 2 C*] r�H CZ] "D ►-3 �-�� BOARD OF HEALTH . . . . . . . . . . . . ( �VJ 3 SETS OF PLANS . . . . . . . . . . . . FORM NO. 1 SURVEY . . . . . . . . . . . . . . . . . . . . . ,� iopp TOWN OF SOUTHOLD CHECK . . . . . . . . . . . . . . . . . . . . . . A k�aw BUILDING DEPARTMENT SEPTIC FORM . . . . . . . . . . . . . . . . TOWN HALL BLDG. DEPT. SOUTHOLD, N.Y. 11971 NOTIFY / Q TOWN OF SOUTHOLD t� TEL.: 765-1802 CALL Examined . . . . .�—:. . . . . . . . .. 19 .�U MAIL TO . Approved ro ed . . .. ti . . . . . . ., 194�Perinit No. !. /.,�Ioj- Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . uild' I spector) APP ASNffEO APPLICATION FOR BUILDING PERMIT QATE: /11 B.P.# air Date . . .. . . . . . . . . . . . . . . .. 19 . . . NOn",-OUILOVIG DEPANTWNT AT INSTRUCTIONS 765-1802 9 AM TO 4 PM OR THE a.F�lI},iO�ppp� completely filled in by typewriter or in ink and submitted to,the Building Inspector, with 3 sets of1PllCU"Nplot 1 ee according to schedule. b. P in of lot and of buildings on premises, relationship to adjoining premises or public streets or are2.,ROfthi2TRAM1I*&c&c {N®of layout of property must be drawn on the diagram which is part of this appli- cationg. INSULATION c.4:rhNAlork.coCONSTRUlr4CMAUSton may not be commenced before issuance of Building Permit. d. Lftg© 'F fM6,Opplication, the Building Inspector will issued a Building Permit to the applicant. Such permit shall bAlklepCONMLC=D;s iWI nspection throughout the work. e.TOO NOMMONEM WculM Mised in whole or in part for any purpose whatever until a Certificate of Occupancy shall hSTA'MeCONSTRUCIM 1l]luiRMBYpector. A`DL :_.MIW)rTitranfeRlowAnftf FOR p the Building Department for the issuance of a Building Permit pursuant to the Building on o t 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, building,code, h sin.- code, and regulations, and to admit authorized inspectors on premises and in building for necessary ' spect ons. ./..... .... . . . . ... . . . . . . . . . .. . . . (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . . . . c .Ctiv,?,o .1.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . . . . . ®CCUPA Cv OR (Name and title of corporate officer) Builder's License No. . . ... . . . . . �/3 . . . . . . . . . USE 15"' UNLAWFUL Plumber's License No. . . . . . . . . . . . . . WITHOUT CERTIFICATE Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . OF OCCUPANCY Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. House Numbcr Street, Hamlet County Tax I'vfap No. 1000 Section . . . .� ,/. . .,. . . . : Block . . j� , , , , , Lot . . . , . , Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . Lot . . . . . . . . . . . . . . . Manic) State e\istinr, use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy �/ /�i Cd !4.�`'�. . . . .Gt! ; �%� . �r1, AZd, 714-S, b. Intende / , , 1:d d use and occupancy ' . , , , _ . �"� l U d �j .r 3. Nature of work (check which applicable): New Building . . . . . • ' Repair • • • • Addition . . . Alteration . . . . . . . . . Removal . . . . . . Demolition Othc&Yor . . . . . . . . ff 4. Estimated Cost . b,` 75 (°13fcription) . . . . . . . . . . . . . . . Fee . . F. . . . . . . . . . . . . . . . . . . . . . . (to be paid on'filiii&this application) 5. If dwelling,number of dwelling units . . . . . . . . . . . . . . . Number of dwelling units on each floor . . . : . . . If gara;e, number of cars . . • • • . . . . . 6. If business, commercial or mixed occupancy, specify nature and e, • • • • ' ' ' ' ' ' ' ' 7. Dimensions of existing structures, if any: Front .42 extent of each type of use . . , • • Height . . . Rear .r:� . . . . Depth . .�®� ,ey-. . • • • • • • . Number of Stories . . Dimensions of same structure with alterations or additions: Front • • • • • • ' ' • ' ' ' • Depth Height . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . 8. Dimensions of ' ' ' ' • • Num�c�of Stories . . . . . . �ire new construction: Front .lc}---• • Rear �-- • Height . . . .CU . . . . . . . . Number of Stories • • • • • • • Depth''. . �.i „ • • • • • . 9. Size of lot: Front . . • , • • . • ' • " " . . . . . . • • • • . . 10. Date of Purchase ���/l . . . . . . . . . Rear . .70��. . . . . . . . . . . . -.Depth. r• . . . . . . • • . . • . . 11.. Zone or u • • • • • • • • • . Name of Former Owner ' 1r� ,Leif c��c Pj,:� se district in which premises are situated . � 12. Does Proposed . . . . . . . . . . . . . . . . . . . . ,,�v • •, :� � �� .�'�r� p posed construction violate any zoning law, ordinance or regulation: ! *' 13. Will lot be regraded .Aid r. . •R<s ...�,v..... ...'??=- . . Will excess fill be'tem.ov d from a ises:: 14. Name of Owner of premi�s� ✓�,� Yes.�,,"- N Address Name of Architect/ r./'�;�/tom U�0o r., �oti!• Address 1rv� Name of ContractorJ�. , ' ia�s�' < ��: , �..jpr�c. !c1 d �: i✓ � " *-s r. `Gpo zee No � 15 .Is this property located• • �' • • Address r /. ; ¢fF,.?i?r � ,N� P� b;No`J�A!`:� 5. y within feet of a tidA4 ?.. * 4.y����0_►�% ' *If yes , Southold Town Trustees Permit may be required" *jr,,j+pti PLOT DIAGRAM , Locate clearly and distinctlyall buildings, whether existing or � � .� . s'+ln3ii.. g proposed;nand indeae algl„set-bacdnnensions from property lines. Give street and block number or description according to deed, and sli'o;sfret4nairies and;iridca.tse whether interior or corner lot. t ;=y ;,,, ,;i v 31 ------------ -7777 �'���� /�-' l 9�Gv �- 4�E'� -,�"•Ire', '��' it Sr;�I;a•'�°9�i .i�s': Sy�,�,:5•�va'cSy� g� �`c�i`';"�:Do`5•yEyj��'Ecg•Iv_ 'r r:r'�n•e ' _ !��t.�4'1 4 j.4$'.nt°Y•�4..P.T 4li@� 'I C.�A�k a.r.�t�,�.i�.l h\^v STATE O F Stw Yb RI` COUNTY OF". . +'. s S:S a ., . . . . . . . . . .: .' . r • • • • being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. lie 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 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 . . . . . . . . . . . . .�. . . . .day of. . . . . //. . . . . . . . . . ., 19 Notary Public, . • • , `. . ,L lJ! . . . . . . . County HELEN K.DE YOE . . . . . . `�. . NOTARY PUBLIC,State of New Yak • • . . . . . . . . . . . . No.4707878,Suffolk County Term Expires March 30,19. (Signature of applicant)