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Home My WebLink About23841-z FORK NO. 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° 23841 Z Date .............. . . .��...................... 19.2 Permission is hereby granted to: , ...... ............ ........................ ................. ......... . �...c. ... ............... .... ............. ..... ... .. .�` ...Q .... . . ........... .. .. ..�- . atpremises located at ......... ...... . . .... ... ..................................................................... .................................................................... .... .. . .... . .. ..................................... ........................................................................... .. .........................:.................................................... County Tax Map No. 1000 Section .2 ..... Block .......... Lot No. . ........... . ....... . ................... Q pursuant to application dated ......................... .............�` ........., 19 ., and approved by the Building Inspector. . Fee $........................ .... ... ....... ....... .... ...... .... ........ Building Inspector Rev. 6/30/80 Q BOARD OF IIIiA1.111 . . . . . . . . . . . . . . . FORM NO. 1 3 SrTS Of PLANS . . . . . . . . . . . . . . . .TOWN OF SOII'T1101,I) ,,-SlJRVRY . . . . . . . . . . . . . . . . . . . . . . . . 1 n BUILDING DrPARTMrNT ClIECK . . . . . . . . . . . . . . . . . . . . . . . . . J!t I 1�i��b ,.. .2 ,,,.,�� TOWN HALL FORM . . . . . . . . . . . . . . . . . . . SOUTiIOLD, N.X. 11971 TFL: 7 6 5—1 1102 NOTIFY GALL . . . .'� 1x;mi.rx,d.. ..!..., 19. � MAIi. f0 . . . . . . . . . . . . . . . . . . . . AI>[rnavrd_. .., I'9� {'orrnil No. r� .... ........................... . ... . Disalalaroved a/c .................................... ......................................?AT inspector) AR iIiII1.1)1NC PI IkMiT INSTRUCTIONS !• n. 'ibis application rnrrst be co"pletely filled in by typoIriter or in ink aril submitted to the Ikrilding insle.ctor wit 3 sets of: plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan sliowing location of lot and of: buildings on premises, relationship to adjoining premises or lxrUl is streets or areas, arxl giving a detailed description,Of layout of property nrrast be clrmgn on the diagram which is part of this nppl.icatiOn. c. 'Ilre work covered by this aplil.i ca t:i cm rely not be com?renced before issuance of Ika i 1 d i ng Permit. d. lllxna approval of this application, the ibii.lding 1nShector will issue a ikail.ding Permit to the aplil.icant. Suclr permit shall be kept on the premises available for inspection throup)iorat the work. v. No Inrildin>,. shal.l. be cxcupied or used in whole or in pert for any lxrrlxise whatever until. a Certificate of: lk.cuparx-y slml.l- have lx>en granted Iry the Ikr.iIsling Inspector. APPLICATION IS 1111,011Y tIAIE to the Wilding i>epartment for the issuance of a Ikailding Permit lxarsnant to the 11uilding Zone, Ordinance of the Texan of Scxttlrold, Suffolk Ccxinty, New York, aril other appl.icabl.e i:aws, Ordinances or 14-gul.at:icnrs, for. the construction of Imil.dings, ackIlLicns or alterations, or for muva.l or ckinolil:ion, as herein descrilx'tl. 'Ilre applicant agrees to cel"ply with al1. alrpl icable 1-aws, ordinances, Ixi.ilding code, housing code, arxl regulations, arxl to admit acadaoriml inspectors mi premises acxl in Imildi.ng for recessary inspecticnrs. ......... .......A....,7 d ............. (S.igmiture of applicant, or name, if a corporatirna) (Mil..ing address of applicant) State whether applicant is caner, lessee, agent, architect, engineer, general contractor, electrician, plumber. or Inail.der _W!::'I.:......................................................................•...........................-- Nt-wne of owner of premises ..... �. .. .. u .. ......•... (as on dae tax roll or latest deed �Ap"RKIUASNOTED.OATS: S.P# if al>,il.icant' is a corporation, szpr,ature of chrl.y acatliori.zecl officer. [sue FEE: �� By- ......................................................... NOTIFY BUILDING D4 VAIME-- AT (Nam awl title of corporate officer) 765-1802 S AMTO 4OR THE FOLLOWING INSPECTIONS: 'I. FOUNDATION - TWO REQUIRED Builders License No. ......................... FOR POURED CONCRETE 2. ROUGH m FRAMING &. 1'LI.MBING Pl.uriaers License No. ......................... 3. INSULATION Electricians License No. ..................... 4. FINAL - CONSTRUCTION MUST RE COMPLETE FOR C.O. Other 'Trwle's License No. .................... ALL CONS T RIXTION SHALL MEET I. Location of l.arxl on which THE REQUIREMENTS OF THE N.Y, Fruixa� work will be ckne................. ..�. aATE'-l:OIrlST'RUCTIOI�t-&-EVEsR GY---•----- NGOUNUST RESPONSIBLE FOR RU-13TION ERRORS......... lknrse treet Il.-irilet (:exam:y 'i:ax Map No. JOOn Section .... TO ....._.- ill ock ..... ......... Lot .......... Sulxli.visionr ...................................... Filed Wip No. ............... hot ............... (Name) State existing use and occ-capacxy of Premises aril interxlecl use aril oc:cuplucy of: proposed construction! a_ Existing rise and occupancy ...... �Y/Ll` i.......................................................... b. i.nterxled use and occupancy ..... ....................................... .............. 1..Y!! �a I. R-lfill-L of w(k (dieck %kith a14)licahle). New IkAldinj. .......... AM i L i ofi Alteration .. .. .... .. ltiqw i i. ............ Resioval ............. Dai-jol i L ion ..... ....... Other I,k)ri( .................... .. .. .......... (bescr i pt ion) 4. W0 4 Esc isivired Cosf: p L....0 1............... fee .95r4n................................ ...... (to be paid oil filing t.11is applicatioil) 5. If: AA!Iling, iltsiber of: &elling tilkits ............ tkjli)er of jh&-Iling units oft each floor .......... ...... 'It garage, titsiber of cara .......... ........... ................ If 1xishiess, cA.-gawreial or mixed m:c-tipancy, specify nature mKI extent of each Lype of use........ .. ............ 1. Dinknifilions of existing iii-rilCLures, if aily: Front:.......... .. .... Hear .. ............. Depth ............ ..... ....... .................. thstiwr of Stories ...................... Mitiensicmis of sane stnicture with alterations or ad(lit:iotis: Front. ...... ..... .... .Mar ............... Ikpll, ..................... neit'jit: ............... .... Usiber of SCories ............... I 1 11 1 LK' If. 'Cioil: ...X..J�6 . I�X 1W14 CO(ISMSC . F1 oil L .............X� .. I ill . Ileif)II: ......................... Uxilwm of Scories .................... .. 9. Size of lot.': Ftcxit: .................... Rear .................. .. De.1)L I I .................... 10. Dare of Purchatic ..................... liaw- of I-oriiw-,r Owiler ..... ...... ............................ . If. ZA)(k-, or use district: in %Addi premises are sjLjjaj:ed ..... ........................................... ..... ... . 12. We-. propose(I cemsirtmLjoil violate ally zollirig law, ortlilvilice or regillacioil H. Will lot: be regrwied ........f N-0........ Will excess fill, be reinoved froin pranises; Yr,s (�:Ili D fit Wit" of Owner of premises .......... Aikiresis CP(WtIll.. . . ......... 1110fle No. J_Tnfl o Nate of Ardiitecf: ................................ .... AikIress ... ... ... .......<-(............. Phone No. .. ............ Nxiva of: (YAiUracl'or ................................... Aikiress .. .......................... ...I'llotle No. . .... .... ..... 15. is this I)n)lx.-rLy within W) feet of a tidal j"etlaiwl? * YI:Q1j .......... NO *11; us, sarlim 'I"'N '11-disime-s 11--.1urr HAY IE WPIRED. PLOT DYAGRAH Itx:ate clearly and distinctly all Wildings, %,Aiedier existing or proposed, al-A indicate all. set-back dimensions fi-c-mi property lhles. Give street: aril block rAm6er or'destript:ion according Co ileed.-a► l. filwm street wknefi and irlilicare %Aiellter interior or corner lot. 6so lor 66 J 64T[,- lot M,/Vil'l or IIEW Y(mq< MINH (m,. ......... .... .... ...... ... i ...A ....H.� ........ ... . ..... . . ....being duly dellosei nd says that he i,i the applicant (Hisix! of ilKlividilal 1jignillf., contract) ;Ilxjve lumicil, lk! k 11w ....... ...... ........... ......... .......... ........ ................................ .. .. (Gmt.rac(or, agent, corporate officer, et(:.) of: said (jwocr or owners, and is duly authorized Lo IA!rfomk or have performed the said work aril to make aikl file 1his ilppliCaLi011; Illill! all. Stlateill2tits conLaiiied in this application are nue to the lxtal: of hi:; luxuledile and belief. ald that. Live work will be perfolilled in OW lisalliler set Forth in Lhe appl.ical:ion filed therewit-ii. ,kAml to kJore Ine 11lis ... .... ... ...lay of .... ... ... 1( a Yl q() A o p i icon JR SCOTT State of N. T I�IC�ffolk Cou f Notary INIblic ....... .............. .. OBERTI.SCOTT.JR. (Sil.,i V't1A'jl_e*of Al.q.)I .. ... ............. a PUBLIC. of N. N ARY PUBLIC.State N NO 508 Ik Cou o.4725089;Suffolk 19 Term Expires May 31@ 19 _ ..._...... C*L)r-1-01.I< Co. HE AI_rH c+E'PT � r STATEMENT OF INTENT I' THE WATER SUPPLY AND SEWAGE DISPOSAL. � — " SYSTEMS FOR THIS RESIDENCE WILL ' ' CONFORM TO THE STANDARDS OF l-FIE � SUFFOLK CO. DEPT. OF HEALTH SERVICES, I 4 l�) i APPLICANT ' ! SUFFOLK COUNTY DEPT. OF HEALTH ' ` } SERVICES -- FOR APPROVAL OF ! CONSTRUCTION ONLY DATE: H. S. REF. NO,; APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. FLOCK PCL.. OWNERS ADDRESS: 2100 PAf<k A&11'. .. . . DEED: L. P. TEST HOLE, STAMP + n� �?r;}tl79 P�3'r!\•4i'�C :1'rc;a Law. mm k !c:<!sur,ayor's inked sim;o. ` Gr1;'- ca soal shall not bo nsid•3r:.;+ 1..�1 i J.I....+r� ;a:x,a rrs-lld truo copy, ' iri i.- !�,i•. a ;;y'.i. `:;y.. ..._......._. .... _ _.... r+•tothaperssontior'od Iwh,)ntltosur.+t, ' i.. ::os,ersd.andcn his!:.;isl tr;t`:e t3oucrnmant'sl n2.1my&.-.d 4 . L' .... I I:. •! .ap ,..:. 1... +:.��4.��+rr31 i".ilfl9n Iisiii;J 11,yrccn t.;'d of the lai.dina it ,:;:,L•.n,i3�arartsas ore not transi5rsshie • \ Su.D..:a:ia:tai imtuitions er suPjst4uonl SEAL �_..--•'—'----- _. �''h; c_ir"i}C._ E�.f-""�•;f';'�f�.i.'•1t 1'til�:, �i ;�.I''`ii'.,1:.'i'�,f:.,�,,} �-la RODrERICK VAN TUYL, P.0 LICENSED LAND SURV ORS GRE_EPIPORT, NEW YORK `.`iS.�:�S 25'5''� 1 , ' L A V1E:!..f.. c{i ��?j•� :aG=1;r.p. 4.eZ1.t,._ •'`) "} .. , U►i 65- ' ' ' U • f `O. N. � O Lti i 4 .• tiI 11 1 ! PrsOf. 11 1 rJ ! 27 1 , Aj VACANT