HomeMy WebLinkAbout23344-Z FORM NO.3 O
V
TOWN OF SOUTHOLD BUILDINOGW DEPARTMENT q1D
SOUTHOLD,N.Y. 0
U �
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Date...................... `'ram........................, 19.. ...
N2 23344 Z
Permission Is hereby granted to;
.. .............. i�7.....................
.............................................
� ``... ........... ... ! . �� .........10.01 ...................... .................
..................................................................................................................................................................
..................................................................................................................................................................
...........................................................................0.1 01 ...............................................................
at premises located at...................... T���........ .(....... ..................................................
...................................................................l.'/.. / .. ..........................................................
County Tax Map No. 1000 Section .....la"........ Block......®l........... Lot No. ............ ................
pursuant to application dated ......./"!C//.... ................ 19..... j�.�.., and approved by the
Building Inspector.
Fee$.........................
............ ...... ..............................
B ding Inspector
Rev. 6/30/80
(Oil 101,11011T D ATI;
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FUL111DAT 1011 (211
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BOARD OF IUinl..'.11 . . . . . . . . . . . . . . .
FORM NO- I :✓3 SETS OF PLANS
TOWN OF SOUTIiOTA) SURVEY . . . . . . . . . . . . . . . . . . . . . . . .
.BU1..D..NG DEPARTMENT -/CiiFCK . . . . . . . . . . . . . . . . . . . . . . . . .
TOWN ilALL SEPTIC FORM . . . . . . . . . . . . . . . . . . .
SOl1Ta0LD, N.Y. 11971
TEL: 765-1802 NOTIFY:
CALL . 2R� -. .L 0
Examined----- (/T (/..., 19_. MALL TO: . C.Q . �Jv •1I_��'.�. . .
Approved........T//X... 19 9 Permit No. .. 33 I <.�V�l......Z..
Disapproved a/c .................................. ....................
......................................................
Z/4�c tor)
{a > •
APPLICATION FOR BUILDING PERMIT
.r-. Date.`. ! Z . . . . . . . . . , I9 "I V
INSTRUCTIONS
a. 'Ibis application mist he corrq�Ietel.y fil.l.ed in by typewriter or in ink and submitted to the Tkli.l.ding Inspector wit'
3 sets of plans, accurate plot plan to scale. Fee accordinp- to schedule.
b. Plot plan showing .location of lot and of lxiildings on premises, relationship to adjoining premises or public
streets or areas, W giving a detailed description of: l.aycxit of property must be drawn on the diagram wliieli is part of
this appl.icatio n-
c. 11e work covered by this application My oxrt be camvenced before issuance of ikii1ding Permit.
d. Upon approval of this application, t1e iuilding Inspector will issue a Building Permit to the applicant. Such
permit- shall be kept on the premises available for inspection throughout the work.
r. e. No building sliall. be occupied or used in whole or in part for any purpose whatever until a Certificate of
Occupancy shall have been granted by the Building Inspector.
APPLICATION IS IiCREiTY MADE to the iBuil.ding Department for the issuance of a Building Permit pursuant to the
.Building 7,ane Ordinance of tlne Town of Southold, Suffolk Canty, Nev; York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or. alterations, or for removal or denoliti.on, as herein
described. 'Ibe applicant agrees to comply with all applicable laws, ordinances, building-code, housing Cale, and
regulations, and to admit authorized inspectors on premises and in iuil.ding for necessary inspections.
.....................................................
(Signature of applicant, or nave, if a corporation)
.. f�x..1 s39:.Wa 0-',-Lc k.'.iv`�. ....
(Mailing address of. applicant) I
9tate Aiether applicant is owner, lessee, agent, architect, engineer, general cantractor, electrician, plurber or builder
( >✓17 Y ............................................. . ... ......... ...... ............- .......................
Nave of owner of premisesY� '..., Svn�':.�° '..�JYGtCI (Pc� ...........
(as on the tax roll or l.atest•deed) '
If applicant is a corporation, signature of: duly authorized officer.
.........................................................
and title of corporate officer)
(Builders License No. ....!�A................
Plumbers License No. ... .................
Electricians license No. .....................
Other Trade's License No. ... ..............
1. lmation of land on which proposed work will be clone..............................................................
ly�Z7...._.. ............. .....:... . !...I? .........._...li `�! - .(:! -:...................
Blouse Nuri)er Street Hamlet
Cavity Tax Map No. IOU) Section ...I .� ........ Block .......I........ Lot Z....... .._
Sulxllvistun .(Y�a ht�(C - :i=- .S +eo Filed Map No. :t U. ..... Lot .`G...........
(am)
2. State existing use and occupancy of: premises and intended use 1a d occupancy of proposed constriction: ��((,,�
a. Existing use aril ox cuparxy --S 1 r � ... ��-1 �� ..I:l�. e:.(.C.Qn S }-ft�l C:��."...+�.. .�S:�l`g!" �
( � S�yo n
1). intended ded use and occupancy -_SaB :.._..`.. P �+..:S ...�*`�^.S �.................
7. N•Uure of: %mik (clwck %A►iffi all)licable); Nuw lk►ildlnll ...... Acklitioo .......... Alteral:ion ..........
Itepmir ............ Reuoval Denit)IiLio►► ............ Other 1•k)rk ..................................
� (Ik�sc:rilnl:inn)
4. Lstiniated Cost Pee ..............................................
(fo Ix! lurid on filing this application)
5. If thwellinll, ►xidrer of (haellicy; units ...1......_. I&III)er of ckaelling r►nifs on each floor ................
If garal;e, ►xnber of cars .. NA................................
:n. If Ix►shvess, ainnercial or mixed ocetipancy, specify nature a►xl extent of each type of use....
rJ ..............
1. Dimensions of existing structures, if any: Front.. .. .�......... hear ............... Depth ................
t
lkigl►L ._I�..................... Umber of Stories r\.A7 ,,I
Milieus ions of sane stn►ctZrre with alterations or axkl i t ions: Front ..(Y........:. hear ...............
Iktl►lln Ileig�►L .................... Mnlrer of Stories ...............
11. Dimensions of entire new construction: Front ..
!_..t.......... [tear ... . ........ Depth `...............
►Ilei(;l►t __ (P..................... M,►lner of Sl:ories ...o r`tl-.............
9. Size of lot: Front ... S O ►............ Rear ....�S��.......... Depth 2 J O ►
10. Ib►fe of hir-chase Z 1 S I �............. N,711: of Former Otimer .��4►�le/J...Ce h'. .......
If. Zcx►e or use district in thich prenises are situated _. 4 U......................................................
12. Poes prolx)sed coostn►ction violate any zoning law, ordinance or regulation: ,
I:). [dill lot be regraded .)'`0............... Will excess fill lie renoved frail premises;
YES
14. Maws of 0n►er of preuises + lr•)I L ( )retdf
, e(,I No.2Rk 2C,I
Acklress � t3�x ttk4e � l�+�cCIG I1►one
Name of ArcI►icecl .N... Arklress ......... ..................... 1'1►ot No. ..............
M-mike of Contractor ..N...t ............................ Aciclress ...............................flume No. ...............
IS- is Ihis property within 300 feet of a tidal caetlami? * YES ....... NO ✓.........
*IF YES, SwIlvill, lam '111t151L'FS lcumn. 11AY IM-L W. A111119).
PLOT DTAGIIAH
Locate clearly and distinctly all Imildings, xAnether existing or proposed, aril i►xlicate all see-back dimensions
frciii proix:rfy lines. Give street aril block niidner or description according to deed, and Alm; street Hanes arxl irxlicafe
tAiether inferior or corner lot, �l(L 1/le
APPROVED AS DOTED
DATE:
1 B.P.# �S3
3f Z.
®C�e 1 NOTIFY BUILDING DEPARTMENT AT
ta V 1 ®-`a v"� OA' 765-1802 9 AM TO 4 PM FOR THE
U4Z� �� UNLAWFUL�UL FOLLOWING INSPECTIONS:
U 1, FOUNDATION - TWO REQUIRED
WITHOUT CERTIFICATE FOR POURED CONCRETE
OF OCCUP'As"CY 2, ROUGH - FRAMING & PLUMBING
3. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION & ENERGY
,. CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
iXx1NIY (A' ......................
—tieing duly sworn de xnses vxl says that he is Lhe ►►Licant
..'�_......... - (� Y l � Y' III
(Naw of i►xlividwil. signing contracts)
Axwe iunr:cl,
(CoutracLor, agent, corlxrrate officer, etc.)
of said cxnx r or cxn►c:rs, a►xI is,duly aulhoriz-A Lo ix!rforu► or have lxnrfor wd the raid work acxl to make: a►xl file Ihis:
appl icaLion; Will: all. statenents contained in LI►is appl ical ion are Lrue, Lo the best of: his k►owledl;e a►xl lxil.ief; mill
Ih.it. die wofk will be performed in l.he u►;anxir set: fort.l► in the application f.ile(l therewil.l►.
:14xnrn to Ix.ferf: nr_ this
_..__._ �. .clay of
R*ary 1'ul lie
CLAIRE L.GLEW S nal:ure of Applicant)
Notary Public,State of New York
No.4879505
Qualified in Suffolk County /
Commission Expires December 8,19�`'
�o-1 _ TOWN OF SOUTHOLD PROPERTY RECORD CARD
OWNER STREET VILLAGE DIST. SUB. LOT
i
- 1e M I �oa� M c� �'�c c c I� 9 M Q-t h+Q cK C cep Fs1-o�es
ACR. n REMARKS •'
`�
TYPE OF BLD.
- coosi. c)nc•�arn 's 1 bwell; "a w/�ara5C '.
PROP. CLASSI
s-- L i 7s4 5va - Co 1jj 4v ,- qq,om
LAND IMP. TOTAL DATE
Zoo Q 2Do 2
1 C)oo ?e�
bOc� 1 aoo zoo z a c - --
FRONTAGE ON WATER TILLABLE
FRONTAGE ON ROAD WOODLAND
DEPTH MEADOWLAND
BULKHEAD HOUSE/LOT (qbd
TOTAL
i
COLOR
i.
. r
TRIM
M. Bldg. Foundation PC .
C. Bath Dinette
FULL
Extension Basement CRAWL Floors Kit.
SLAB
Extension Ext. Walls Interior Finish L.R.
Extension Fire Place Heat D.R.
Patio Woodstove BR.
Porch Dormer Fin. B.
Deck Attic
Breezeway Rooms 1st,Floor
Garage Driveway Rooms 2nd Floor
O.B.
Pool
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Of
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7V fie OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE _.,
OF OCCUPANCY
i S7 r' � g�db ��
' s ,
TM= OFssm (Olt moqgwm
�PEg� HEREON ►"A T•1E smcm s To THE NOTE: THIS PROPERTY DESIGNATED p/srr/cr i000� �-
PIROPE,RI V AM FORA CsHC IUR,OSE AW VA 00 Tt CR¢OM AM LOT N_
>~oT rrTE " TO OUHOE THE ERECTION OF FENCES. RCTA I M X&U- r POOL% ,rE c r/ON /0 7, 8[.0 a x- /�.G T o . Z. s
7 ON THE LAND AND TAX is7ieP off"
PArjM RMfT*4 APMk% MMM014 TO VAXSOCS NO ANY OTHER C NSTWXT1 K MAP OF THE COUNTY OF s
uFFo c-,Y. /WATT/TvGA
jYOTE:EGEv,4TioNS spowN ARF TAKE/Y FRo/+�1 � H`sT�T�s
,SWEET /.r s. 45'6 3¢, To/0 MAP O� T
Ts/C FivE EiOSrE.4.- ToCAl^'Sl suFFocK
Go uN1 �, EG6✓ATioN Sf o [.+ioS f/E�L> 0 �/rV e/�
4r //j/LATER-"Fc7/or✓ OF M/ce eoAO � .e>
/AND REEvE ^T•�D �s SNa�.+� a.v .rP�o ivsf+O"
.suFFo�,.� ca v.,'Ty �.•>,'c w ):o/,'�
a� suFFo GK co u/Y ry tic E N!•: 920-�
L �K O ✓O I•/N G• BRRACb L C'V
OQ /.?EN T
E SoW TA.Y/S -QRADG Ey
�/G 8¢) . ��' sp o• t,, sc.>. I.C. , /f�YC.
�G•R // f�F f ^• Q R✓RAG ECONOr+?IG AND
6 '�� Con.sM1JN/ / D�rEGoPME/yT
LV �Ro�EcT. N� 9S-o/-z7'
/3" /99S
�� 6j 9 r- �'.'�i f!•� ° m ` FOur•JL>,47 it Sr,14 OVT j7EC. /�o, 1995"
bE f F�Ps• 73 1� FouHp.or/or✓ Goct4no" • Jf4r4• /7, /99co
t f3° rr o v"\ L%WTHORIM ALTERATION OR ADO(T10M TO
- 7T�� an THIS SURWY 13 A WOLATION Of SECTION 7:09
Of THE MiEW YOW STATE EDUCATIKA LAW
¢ N COPIES Of TM SUWvTY 4M NOT BEAJ&40
THE LAMO SLR1•EYOWS 00= SEAL OR
EL�D SM SKM.L NOT BE CommoER£D
54° C rn TO K A VALM TRUE COPY
I
CERT*FCGTICHS INCOCATED HEREON.SM►il RUN
�°✓� 5' ' t F,} 9 ONLY TO THE PERSON "-YFHpy THE SURVEY
o O IS PREPARED MHO ON HIS 801A F TO THE
� °f TITLE CpIPANY, 0047tNUENTAL AGENCY ANO
o �,a D O �_ �,.5 LEMDWC •+SRTUTIoN USTED HERE-CH MHO
' TO THE ASS4NEES OF THE LEM0t4 WSTTTUTION.
(� CFJtT'*IGT)ONS ARE NOT TR4HSFEltA8LE To
ADO(notAL NSMVnOMS OR SUBSEQUENT OWNERS.
ri
p N' c) t7 Pf o T 1 ►HEREBY CEFTIFv THAT A AY A PROFESSIONAL LAND
SURNI YOR LKXI, FD TO"PRACTICE IN THE STA,j>T Of
E 5$• \ MEIY YOM AMO THAT THIS PLAN IS BASED OY AM
0 0 ACTUAL FIELD SURVEY UN00t NY W AWEDIATE
rT SUPUMSION. 1 F>NrrR7t OECUML. TO THE BEST
Of WY PROFES:SIOIiAL KNOWLED,E-AHD BE LjEF,
v` �o THAT THeS tLJW IS A CORRECT AMACCURATE
E / RfPRESQ(TnTION O COMOMONS CrtSTsp4 AS
or THIS DATE HMO".
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a � °o A' O
toA7M. �
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/REivE TSOrd i4K/S-BR�p�Ey
TEsr .�-�o�E .ate. sox isa8
OArA T�KE/�/ F/NOM i+�oo of rr,rcrC^; /rl y. /9st DONALD G. DEKENI PP
n,orr/r✓cK CaEEK Frr.orEs Ar �-�"� z98 -z°/' LAND SURVEYOR
- ^.f,a rr it✓c.Y ,• su.�A=ocK aoun,ry
F'c6 /v° 9z`-;. F/c•Ev zs"/99Z r �^� FiQM/GiA',q W/TN TNF .STi�+NO�f7DS FOR AOPROt//1 L
Sc9 MAp 'oft TEST /aoLE A/nSrPO osCONSTYR,f✓GTiv/rOSN o.f ,s/�esu �F n�s/ ���SsE T�,J��o�RE=T N 354 GARDEN STREET
W. I S LI PR N.Y 11795
. FOND rr'/GG �B iOF d TSJE CO!'rOrY/O .
" rNE.eE,.-r �,ro or3 r.✓� PERM/T ro GoNSTR✓GT• 516 - 32 I - 1.653 •
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