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Home My WebLink About24649-z 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 .....El B;WWARY........4........................... 19...9.Q.... 24649 Z Permission Is hereby granted to; DOIVO.�D...E...fUTFiI�L.............................. 3�5R... .4. . ;qj�A.I!...0y. ............................'............ ........5 Q.4!T.H QL P.e.N.Y....11.97.1........................................ to .....ERRQT...O...b.:.H.T.GH..FRNQF-...T.N...THE-R.-OR...YOR,P...O.$...0P.P1-.I.FD...F..QR....................... .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. ..................................................... ..........................I........................................................................I...... at premises located at................;W .4.....P.Q.T55.ERU...(W.E.........................:.........S.QUTH.QI .V........... ................................................................................................................................................................ County Tax Map No. .,,,473eEI9...... Section ...05.5............. Block .....0006........ Lot No. .0.08............... pursuant to application dated .....!ANYA.R .. ... ................. ..9 19...... ... and approved by the ...... . Building Inspector. Fee$........35.00..... ................. B ding Inspector Rev. 6/30/80 BOARD OF HEALTH . . . . . . . . . . . . . . . FORM NO. 1 3 SETS OF PLANS - - - - - - - - - - - - - - - TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . . TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL: 765-1802 NOTIFY: / CALL 19 Approved.... .... 19 � Permi t No. ........ .�. W.. ... Disapproved / .................................. y ..... f a c �- iAN ��1998 3 ,. BLDG.DEPT. ..... ......... .. ... T WN F S UTHOLD (Building Ins tor) APPLICATION FOR BUILDING PERMIT Date- 19.�� INSTRUCTIONS a. 'This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of Ciis application. c. 1he work covered by this application may not be coamneed before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue 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 Occupancy shall have been granted by the Building Inspector. APPLICAfI(v IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building pone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Iaws, 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, and to admit authorized inspectors on premises and in building for necessary inspections. .� .. .�?�'St.-•� •'@ �:. A•-f`. q.:: .. M •_ .»r._.- }..,r'•.t'3....:--.,.�.�..n. - a........... •(Signature `or.,applicanC or nane;'.'i't a°cor*ration) 31-5-6 8015SEfv sovrllea, (Mailing address of applicant) �f State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plufier or builder. .....�.... ...................................................................................................... ®ONhLD �E, `3 L 401F)VA• F, TT T-1114 au D.nsHOTED. Nameof owner of premises ............................................................ .. (as on the tax roll or latest deed) DA , r G B P# - If applicant is a corporation, signature of duly authorized officer. FEE r (7 NOTIFY BUILDING DE P ME AT ......................................................... 765-1802 8 AM TO 4 PM FO THE (Name and title of corporate officer) FOLLOWING INSPECTIONS' 1 FOUNDATION - TWO REQUIRED FOR POURED CONCRETE Builders License No. ......................... 2. ROUGH • FRAMING 4k PLUMBING Plumbers License No. ......................... 4. INSULATION 4. FINAL - CONSTRUCTION MUST Electricians License No. ..................... BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET Other Trade's License No. .................... THE REQUIREMENTS OF THE N.Y. 1. Location of land on which proposed work will be done....................... STATE CONSTRUCTION & 'ENERGY �CO O RESPONSIBLE FOR . .. .............8Dl SS �4 U .../ . �, ... ........... Sd .SIiI� tNSTRUCTION ERRORS... . House Number ....Street ... Hamlet County Tax Map No. 1000 Section .....ice ..... Block ................ Lot ................ Subdivision ...................................... Filed Map No. ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy - !' .. rC 5�...�C� ................................................... b. Intended use and occupancy ..� / r . ................................................................... 3. Nature of work (clw& w1iic► applicable): New Iluilding .......... Addition ' Alteration . Repair ............ Removal ............. Danol it ion ............ Other Ubrk (Description) 4. Estimated Cost ......................... fee .............................................. (to be paid on filing; this application) 5. If ckrelling, nuliher of dwelling units ............ HLiriher of (ko-alling units on each floor ................ 1...g5uaP,e ..aamherfar .................................... 6. If Ix,sine cx r`he�rCial Ji.ixed occupancy, specify nature and extent of each type of use..................... 7. Dimensions of exist ing.sphtictures, if any: Front.............. Rear ............... Depth ................. height .}'.......r..... t,. °1 ..._ Nuiber of Stories ...................... Dimensions„of s��T�e_ hctue with alterations or additions: Front Rear Depth .. :::i: :...`jllei ht .................... Umber of'S ....... ............... ryt�e. ir;olr 3T � tt � forges ............... B. Diiiiensions of entire new constructiou: Front ................ Rear ............... Depth .............. ileioht ......................... Number of Stories ............. ...... 9_ Size of lot: Front .................... Rear ..................... Depth .................... 10. Date of Purdiase ..................... N�um of Fonmr. Owner ......................................... 11. Zone or use district in whidh premises are situated .......�.� T?....,,Ave ,,,,,-,,,, ,•„_,,,,-.„••. 12. Does proposed construction violate any zoning law, ordinance or.regulation: _/!�,.................... 13. Will lot be regraded .................... Will excess fill be removed from YES 'I premises: � NO 14. Names of Owner of premises .................�� ......,.... 1 ress �` �,��%S• U.. �� Pltione No. .. .- `. Nameof Arduitect .................................... Address ............................ Phone No. .......�:.___. N-me of Contractor ................................... Acklress :.....................:........Phhone No. .............. 15. is this property within 300 feet of a tidal wetland? * YES .......... NO ...,. *IF YES, SOLM"D IU4N 'IRIISITLS PERMIT MAY BE REQUIRED. PLOT DIAGRAM Locate clearly and distinctly all buildings, wlhether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block nuniher or description according to deed, and show street names and indicate hwdhether interior or corner log'. Woewe F-P)Ver 440c-47-AF.D Av Rn e v xmpv y �Nc� CL. 95r -re s'v v 7"f r G./N,,A:- 9T 4 eN G. C 3411.113 Owl - "Mw7 wi it f srn n, cx� wway.q%,� (jute -� M,,al • ----• ••.••••0.0 MM 1" e X) .......................being; duly sworn, deposes and says.Lhat be is the applicant ant alxh3e:4k�3>L�cY; ?h C E1'l.fii z 3HT Ileliiq�11('..Iex': ti'.�1.. f f :i` 3 e ............................ ..... ilgehM- orporaL'e officer., etc..) of said owner or owners, and is duly authorized to per.fonn or have performed the said work and to make and file this appl icaticm; that all statements contained in this application are tnhe to the hest of his kixywl.edge and b(Aief; awl tiiaL Lhe work will be perforned in the iminner set forth in the application filed therewith. Sworn to before me Lhis '2 clay of 19J.. Notary Public .. .�'...... .................................. HELENE D. HORNEE (Signature of Applicant) Not.,,y PLiblic,Stale of N®iN Votk No-49ra13S4 Qualified in SusffoN County CU:;Irr3issiOn EXPires rfty 22, '192f p v !! ars:tion or ed:1 :ioR tip Is a Y nl tali ` tv nY J r�,�c.�;i•,R•Lsw. hj 0 +:: -gat`/ Covi=�c"•rhis.1jrvsv rn*2e n ati a�nnnq j cz the l,,id>Urvc•lar'�ln'R.^i 5:; ��'` Q/ i'.�7f� ern-'ox'+'d S33i 5"'!^a:tis C.1t151. i to v_iid?rum ar:P9• J�o r0n'r1iiS ino`ii;J:d�h•..'+f, ,Jnl ni.. in_;;tatir,n e r u; I.:n';• to�,3 3si{ires 2S,re no.t+..,r;;•.,r i a �tI 4,' _ , J I toj��_ti;;ana1 tutions or suv a4 . LL ay Si i ft' fit! QCyA7 k 0� QI (9 i II �fi�G \ice t l 1 1 ti 'II r LEI 1 .s LOT H GHP—i;N f '-f Acoads + �.IlC r. �1 t 1 i I GUAL�ANT �D TO. HOME TITLE, OIV- 1 �661 - --- ISIO_N CHICAGO _TITLE INSOIZZANCE f MAP OF PQQt��R�'Y CO. _ _ _•- 0 i i AND T Z?'T'�iE SU i MOf.D. AYI i\tG::> F.3F1h1K SURVEYED i=0 ASR`tY�D _ DE't.l`1; a C�fot .CFI . . .YUTI�!�L VAN lv . . _ SON ' OWN OF wQUNOLD NY Ct7.T N' AMERIDED-OCT.i ! 1-90: SUFI • -- -.A4%( ,AP DATAo 1000.05c-6•..8, Art�is0 ev Amusj 8 t _� �M`Y <n�