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HomeMy WebLinkAbout19493-Z FORM NO. S 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° 1 9 4 9r Z Date ......................................... 19p Permission is hereby granted to: . .....�1.c... .. . .... .......................... ( .............. .� ...7.,7 ......................................... ..... . ... �V .:.. ..,.... ................ ' to J ..... IC.. ....... . ..... ... - �-�......................................................................................................... at premises located at ......1� ..� ...., . .... ...... .....................................................;?" ......................................................................................... ................................................................................................................................................................. County Tax Map No. 1000 Section ......... Block .?........... Lot No. , .. pursuant to application dated ....... ..2 .................... 19.,&, and approved by the Building Inspector. Fee r .... . ......... . '.t.. ..... ........ .................... Bu' mg I or Rev. 6/30/80 DBOARD OF HEALTH FORM NO. 1 SURVEY OF PLANS r E 7 r TOWN OF SOU HOLDK ' ' �:� T CHECK . . . . . .`fly . BUILDING DEPARTMENT SEPTIC FORMBLDG ' ' ' ' • ' TOia.. ''r I OF E.r;::7!,,-.; i DEPT TOWN HALL . . . . . . SOUTHCIL)_LILY_1IE171 NaT i PY 66 TEL.: :."l 765.1802 CALL . �' `�;x a .• . :. Examined .�� .�. . . . 19�� .. .. . . MAIL TO: L{.� ,_Q j S-/ • . . Approved :. . ./l . . . . . ., 19/'.Permit No. .`� �- . . . . . . . . . . . . . . . . . . . . . . . . Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " AP ROVED.AS NOTE �,. . - '!-.� . �/' ' . . . . . . . . FEE: /o, BY: . . . . . . . , �,. NC►FIFY BUILDING DEPA LENT AT (But in nspector) ' 765-1802 9 AM TO 4 PM FOR THE FOLI_01"ViiNGi INSPECTIONS: APPLICATION FOR BUILDING PERMIT t, FOU, RATIO,i -. TVV0 REQUIRED F02 TOURED CONCRETE Date . . . D 'aa 2. R,0"C'H - rF's,a.N"IMIQ & PLUMBING .. I9 3. II\I`y..,�. . 's! 4 INSTRUCTIONS �I`lus applica'tpn'.W0t be completely filled in.by typewriter or in ink and submitted to the Building sets of g Inspector,with ; lsns;?ccttrattr plppl��� to ca Fee sc�ardin^ t z OP, r .: i WON �< :�J �jta e' b o schedule. I . Plot' "lan sliowm loap o of and of buildings on premises, relationshi to adjoining or ai s, and'`biW a'a'detaile des r� tt n of la out of Property P premises or public street- cati `'" """`` '�C ' PL"s �`' � '9� y P P y must be drawn on the diagram which is part of.tWs a li u. '.:,;s. -;=,orgy SIF3t.F �=�P PP ��ETte work`covered; y this pp ication may not be commenced before issuance of Building Permit. . won a rlaav rint s Y pproval of't us apOication, the Building Inspector will issued a Building shall be kept on the premises available for inspection throughout the work, o Per to the applicant. Such permit e. No building shall be occupied or used in whole or in part for any Certificate of Occupancy shall have been granted by the Building Inspector. purpose whatever until a 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, building code, housing code, and regulations, --.d to admit authorized inspectors on premises and in building for necessary ins etions. (S'gnature applicant, or na , if a corporation)• - (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premise . . . :q!�/� . . . . . . . . . . . . . . . . . . . . ... .. . .. . . . . (as on the tax roll or latest. . . . . ' ' . . ' ' ' . ' ' If applicant is a corporation,signature of duly authorized officer. deed). . . . . . . . . . . . • ' ' ' ' ' (Name and title of corporate officer)' ' ' . . . . Builder's License No. .... . .... ...... . .. . . . . . . . . Plumber's License No. . . . . . . . . ... . . . . . . . . . . . . . . Electrician's License No. Other Trades License No. . . . . . . . . .. . . . . . . . . . 1. Location of land on which proposed work will be done; 1`� , . (louse Number . . . . . . . ...C/EAI7' . . . . . Street, • • • • . . . . , � Hamlet ' ' ' ' - County Tax ,11ap No. !000 Section . . . . .'?,f!. . . .� . /�. . . . . . . . Blbek . . . . . Lot . T Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . Filed (Namej . . . . . . . . . . . . . . flap No. ' ' . ' . . . ' . • . . . . • ' ' .Lot . _ State existing use and occupancy of premises and intended use and occu • . ' ' . , - pancY of proposed construction: A. Existing use and occupancy. . . . . . . . . �.�2G�1 �9i: •� B. Intended use and occupancy. . . . .Sa:'• r. . . .`J . . , , tt.}sl/. . . . . . . . . . . . . . . 3, Nature of work (check which applicable): New Building . . . . . . . . . ,Ad�d't. Alteration . ... . .. . . . . Y:''+ Repair .. . . : . :i. , Removal . . . : . ..: , , . , , Demolition �G . . . . .Swi:iiiling =poo1: . ... . Tennis•Court ... . . . . Accessory Building. . . . . . . . . . Fence . . . . . . .Other Work: . ,•,•,•,•,•, , , ••, 4. Estimated Cost . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fee . lU . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4tn be paid on filing this aeplication1 S. If dwelling,number of dwelling units . . . . . . . . .'. . . . . . Number of dwelling units-on each floor. . . . . . . ... . . . . ... . .. Ifgara-e, 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 . ... . . . . . . . . . . . Depth . .. . . . Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . Dimensions of same structure with alterations or additions: Front . . . . . . • • . . • • . . . Rear . . .. . Depth . . . . . . . . . . . . . . . . . . . . . . 1Ieight . . . . . . . . . . . . . . . . . . . . . . Number. of Stories . . . . . . . . . . . . . . .. .. . . . . 8. Dimensions of entire new constntction: Front .... . . . . . . . . . . . . . Rear . . . . .: . Depth • • . • • • • . Height • . . . . . . .Number of Stories . . . . . . . . . ' . . . . . 9. Size of lot: Fiont .. . . . . . . ... . Rea: .. . . . . . . . . . . . . .. . . Depth .. . .. . . . . . . . . . ,. . . . . . , 10. Date of Purchase . . . . .Name of Former Owner . . . ... . . . . . . . . . ..... . . . ... • • • 11. Zone or use district in which premises are situated.. . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded . __ _... , ., • :• , . ,.., , . ., , ,Will excess fill be removed from premises: Yes .... No . 14. Name of Owner of remises .. p ...... ... ..........Address ........._.... . . ....Phone No. ....... . .. .. , Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . .Address . . . . . . . . . . . . . . . . . . .Phone No. . . :. ... .... .. Name of Contractor . . . . . . . . . . . . . . . . : . .. ..Address . .. . .... .Phone No. .. . . . . . . ... , z . 15._Ls this. property located within* 300 feet of a tidal wetland? —YES. . . .NO. _ *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 streei names and indicate whether interior or comer lot. nJsT__SU ..Rao� CP Ldi A. 1 4-n STATE OF NEW YORE, COUNTY OF .Set f f!f.K r , , , S.S C • . . . . QO K(•4�S. . . . . . . . . . . . • • . being dul sworn deposes and says that he t o Y P Y is the applicant (1`am6 oCindividuall'ci.Jnitigcontra=tI above named: He is the.. . . . . .oa_,.c ZK,.. . . . . . . . . . . . . . . . . . • (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 tlli 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 m this . . . . . . . . . . . . . . . . . . . . . .day of. . . . . . . . . 19 9v Notary Public, . . . . . . . • • . . . . . . County MARY ANN BOU.MAN N mV Public Sutu of NW Na• ( azure of applicant q PP 6mmiss Expk�s Fsbrwry SLA