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Home My WebLink About23434-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 COMPLE11ON OF THE WORK AUTHORIZED) Date................. .... ....................................... 19..,✓� W 23434 Z Permission Is hereby granted to: ..... .. J... ,� ....................... �� ... ... � ....!� ,�=............ to .. ..: J. � ......... ......... x....../max-%'�-................... ../ �� r. �!�'....../7 ....... ......... .. .........��✓...... °��,, ...... .................... .................................................................................................................................................................. .................................................................................................................................................................. ..................................................................... ............... ......................................... at premises located at............. ,211 ....................... ................................. . �`j .............................................,............. County Tax Map No. 1000 Section ...A .............. Block....... ............ Lot No. ... �................. q pursuant to application dated ........ ........e/ ............... 19.. ..�o.... and approved by the Building Inspector. Fee$...`....`..�....r..... ... .. .. ... . Building Inspector Rev. 6/30/80 ie. Esl.iavlted (ost ._. ._ ' - /�-Dn 'Z -C`7h>, X�� 1.�.a..... . . ........ fee . s........ ...._.. ....._._... ......._.. .._... (Io be, pai(I cxl filing, this npplicatirxr) :i. If rhJc!I I iogl, rxni>er of (1well iof; unil:s . .. .... ... .• tA nl>er of (h4!1 I in1; Wails (wI enclt floor 1 f garage, Ixnlxlr of (:arrt ... Ci. If lAliiioess, C13imercial or nrixerl tx:cug><tr)ry, ,pe(:ify nature alxl exteol: of each type of use...... ... . . 7. I)in,ensiolis of existiog structures, if ;toy: I%r(x11... .. ......... ... Rear . ... . .... . .... . Ik!plh _.. .. . .i:�_..._.. Ik!igl ......................... Phr,lx!r of Stories p I ......... . . .. . I)inx!rlsi(x1s of st■ne strivaure wi lh al feral:icxis or :xl(I i L ions: IFronf. _,•-, , , ,•- • , _,_ Itenr .... . .. lk!p111 lk!i1;J,t .. .... . .......... . .. t1r,llLr Of n)torir;l 1(NIL T pIN13 of EI1.I1f! I( J .... ............ heal. .. .. . .. ........ Depth (1) N Cray .... . o Cm Ik!ig;lit ..................... ... . Illnlx!r of Morien ..... . . 'o - 9. Size of lot: Frrxit Item lkp(ll ............1c7 n:hmm N:rrx! of F (ao111mr ile.r IO. I11L'e of 111 I I. Z(x)e or use district in i,ri)ich preiiises are situ ale d N. I)ocs progx-)sed ccx,slrix:Lion violate any z(x,ing; 1:xJ, ordilkux:e or reg;IrlaLioo: ........................ I'). hill lot be reg)rixled .............. .. .... Will excess fill he rEmwed from prenises: YES Ix) I�r. 'L.111es of ()ccr,er- of prellir;es . ..................... ..... tviciress ... ... ['fxxx Pk�. . ......... A ... .. .. .. .. 11■rr! of Architect: ............... ... ........... ....... Acl(Iresrt 11,o1r Net. ... . . . .. .. .... .... . .......... . . .... Mvix! of Contrael'or ..•............... .......... ....... 1l(klress Is this prx)lx!rl.y wilhin 3(X) Fee(: of a OcIal wel:lalxl7 * YI?.S .. .. .. .... *11� YI%.S, cxxfilKxj) 'IixJN my I)I? I(I%.(i1111ta). PLOT 1)TAGRMI Icx:ale clearly atilt distitx.t:ly all lxlildi 1.�lelher existing or ptogx)sr_d, mwl iix)i<:at:e all set-back diux!nsions Ir(rn propel-(y likes. Give strrc!t: atxl hl(x:k txui>er or ripti<x1 accoldi ( e<et—T, tirx(rlic�w street: nstines alxg irxlirafe i�llclhcr interior ( corlx!r Ot. t- c 2- 0 2, Seci-L 1-15 (1T P I r 13 =� L01 I- +0.I (x- l•F-14 Y(xlK, .I^ (AAIWIY (x L I� .. .. . ........ .being dugY tr ) n (IeIx)ses mill sly!;; [hat he is the applicant (Plnix! of ilxl'vidu:rl nil.'ni111; coal vacl ) aix)ve turned, �r � f .. .... . . . . ... . .. . .. Ike i:, live .. J �(knllra(:Cor, agent, (:orgx)rit(! officer, etc.) of said mitier or owilerr, :axe is (filly aulhorizcxl to gxlr-form or hnve perforim?d (.he said work a(xl Lo mike mill fill! Ihia appl iCntioo; Lh:II: of I. contained in this application are (rile Lo the I»rl: of his kilotAedg;e aril) 1>(il.ief; Ilxl lhat the ")rk Will lie 1>erfomy--d in the avtrnxer set: fOrIII in the applic:1l:iun filed t(rerewi(h. ... BOARD OF 11f Ai:rn . . . . . . . . . . . . . . . FORM N0. 1 3 SETS OF PLANS'TOWN OF SOUTH OLD Sl1RVf(X . . . . . . . . . . . . . . . . . . . . . . . . j� BUILDING DEPAR' HII,NT i CIIECR . . . . . . . . . . . . . . . . . . . . . . . . . _,' TOWN iIA1,1. SEP'1'LC FORM . . . . . . . . . . . . . . . . . . . APR 2 9 SOIITIIOLD, N.Y. 11971 TEL: 7 6 5-1 110 2 NOTIFY: BLD G DEPT. j TOWN OF S UTHOLD /1 CAiI. . . . . . . . . . . . . . . . . . . xirrinecl...... ....., 19 MAIi. '1'0: . . . . . . . . . . . . . . Alpumed...... . . ...., 19.lc 0 Permit No. i.?�J T.. .................................... Disapproveda/c .................................. .................................... ...................................................... i 0 ,i7 nsluector) am 6Z ddd =, APPi.'iCA'1'ION FOR RUJIMING PiiRMiT t y? Date. . . � �- - . . . . . . . 19.9�Ln INSTRUCTIONS a. 'Ibis application mrrrst be ccripletely filled .in by typewriter or in ink aril scrlinitted to the Wilding Inspector with 3 sets of plans, accurate plot plan to scale. Fee accordinl; to schedule. b. Plot plan showing locatim of lot aril of. WiIdings on premises, relationship to uxi.joining premises or lxubl.ic streets or areas, aril givit1g' a detailed rlescr.iptirnu of layout of property nxust be clump on the diagram which is part of this application. c; 'ihe work covered Iry this alrlil i ca t i(xi r><ry riot be ccxmrerx.ed before i ss(kunce of Building Permit. cl. llpm approval of this application, the Njilding Inspector will issue a Wildhig Permit to the applicant. Such permit shall be kept- on Lire premises available for inspectim thrcxrgliout the work. e. No 1x1iIding shall be occupied or used in viliote or in part for any purpose whatever until a Certificate of (kxxrlhmrxy shall have been P,ranted iry the ikri.lding Insluecl:or. AM.i ..NFION IS iIEREIIY MATA's to Lire lkuilding Depirtment for the issuance of: a ikuilding Pennit pursuant to the lkrilding 7cxre Ordin.nme of Lire Towi of: Southold, Suffolk Oxunty, New York, and other applicable 1nws, Or'dinarx'es or ltegulatims, for the construction of buildings, a(kliticmS or. alterations, or for. rerxrval. or demolition, as herein described. 'ihe applicant .agrees to canply with all. aplil icable Laws, ordir mites, Imildi.ng code, imsing code, arxl regulations, and to a(lmtit auLirorized inspectors (-At premises and in lxiildi.ng for necessary inspections. ....................... I (Signature of applicant, or r><-mr, if a corporatirnu) ................................................... (1.4-riIing cx.klress of: alypl.icant): State whether applicant is owner, lessee, agent, architect, engineer, general c_ontraclor,•electrician, coilu pler or I-Ad Wer. ........ APB OVED AS DOTED Nine of saner of prmises •` (as cxu thr latest deed) NO ' e tax roll. o • NOTIFY BUILDING DEPARTMENT AT Ifalrlulican ho t is a corratiar, Signature of duly a111-110rize(1 officer_ 765-1802 9 AM TO 4 PM FOR THEFOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED ............................................. FOR POURED CONCRETE . Krne aril title of corporate officer) 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST iku i lders License No. ......................... BE COMPLETE FOR C.O. 11mbers license No. _ __ __ ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. Btectricians i,icense No. ..................... STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR OLirer h axle's i.icense No. ........._. DESIGN OR CONSTRUCTION ERRORS I. location of land on which prolx)sed work wil.l lue ckme�.�5._Lee .4-6La -dL ................................ ............................................................... a' ` �?i�� ' n 1.1.�5.z-......................_ Ikxrse Rummer ` / Street runlet Section .... IIIock ..........�/.. lo ('�cxunty Tax Kip No. I(XX) � ,�� ..... SulA ivision ...................................... Filed Map No. ............... Lot ............... (Nine) 2. State existing use aril occ•(rparx-y of premises aril infemled use aril occupamy of proposed construction: a. Existing use and oc(xuparx-y �PS�cI � y ........................................ 1). 7nterxled use aril occuparx-y �!!-w c: �1-Q 1.$�.. �Gl.✓V t P/ 4" ). Milure of 011( (dieck t.Aticai nl,)liccihle): R_,%j Iktildinl; . .. .. .._ . . Atklilion E. .. ..... Alteration ... ... Itc!lrr i r V..._..... Iluiiotra I .......... .. . Beitiol i L i on .. . . ........ ()I he r 1461 It to. Est.in4i[e<I (bsl: ._.. .1 5� ...... ......... Fee .... .... .............. Z� rns3 �?tS (to be paid oil filing Lhis nppl.ication) :i. If ck4ul I ing, oUlAwr of Ak ell irlg rini(:s ....... ____. Rxiber of: owel I ing units cxt each floor 1f gnrnl;e, ixnher of cars ........... . ... . .... .. . ... ......... . ... 6. If lxishless, cuivilercial or mixed occupancy, si,eci fy nature nix] extent of each Lype.of use............ .. . ..... . . 7. Uinlensicxls of exist.iog sLrtir_[atres, if noy: I?r0411:.. . . ... ... ... ... Renr . .._..___.. ..... IlepLh _ .. ... . . .. _. .. _ Ikliglit Mrdler of Stories . . . ... . ........ .. . . .. . I)iioensions of sane stritclure with alterat:icxts or rxklitions: Prom: Bear ..... ..... ..... IklptJt ............... ..... .. ............ .... .. Mnl,er of Stories 8. I)Inrinsions of ent.i re t",, r..00sVF%xa.lcxr: Proot. .... ........ .... Itc>rrr . .. . ... .. .. . ... I)epLf► ... ......._.__ Iklii;liC .. ..., tktrdxlr of fi(:ories ... . ... . . .... .. ... .. . 9. Size of IoL: Pron: ......... ........... Itenr 1)ep111 _. .. . .......... ....." IO. I►:ite of hirchnse ..................... N:rne of Fotnulr Owiler _. . . .. . .. . ........ ............. .......... If. Mile or use district in rd►ich premises are s.ituatecl ........ .................... ....... 12. ]k,es proposed coost.mcLion violate any zcxr]nl, l.xa, ordinance or regulaHoo: I:). Will lot Ix! regrcxled ............... ..... Will exceris fill Ix! renrnved from preini ses: YfS tx) Ill. IA:rnes of Mlrer of pram ses . .......................... .:.:...:. lficxte No. ..... .. .. ... N;rcr! of Architect: .................. ..... . ..... . ...... Acklress ... ...... .. Ilinixl .No., Plant! of Cootrac:for ................................... Mkhess ... ... .. . .. ..... ..... ...........1licaxe HO. . ... .. . .. . . 15. is this pmIlerl.y Within YX) feet: of a Lidal wetlaixl7 * YIS .... .. .... IV ...�.... *IP YES, S(1lllll('Nl) 'ITIM •11t)ISIIai1, lTltfll•I• MAY III; RP,(�)IMU). PLOT I)TAGRAM Icx:nte clearly aixl (list..itx:I:ly all lxrildings, t.Alether existing or i>roix>sed, nix] irxlicat:e all seL-back dimensions ftun prolx:rly Hiles. Give street: aixl block trailer or cklscripticxr nccordti%—h e< , tux r rl— c reel' n�n1e aixl irxlicate %Aie(her ]n[erior c corr>er.__p i r I � 3 I I'. M tF.W YMKOX11,117 IF , lyidwfl. .._. .._.bein 1 (htl 'nwt,rii de xu;es atxl sa s tha ' li b a , ! Y 1 y l e tr• l e .i I,Ileant. (PLne of itxl r-igi'rii,q, contract) nlx,ve ((FniCrni l'cir, ngent, curix►r ite of ricer, et.c.) Of raid cxrtxlr or cnnler,, ntKl is duly nnlhorizc'd to ixlrfonn or have lrerfornled the said work atxl Lo rmllce nix] file This nppl icalion; Lhnl: al I. sl:ntenents contaioed in this :,pill icatior, are trtx- Lo the ber:1: of his klxxalecll;e atKI Ixil.ief; mxl Ihat the uutk will. be perfonirNl in (lie nvirnxlr net: forth iu the nppl.ir..il:ioo filed tlte.reaiUt. !kX)rll to IK-Jor-! ne Lhis Notary Nbl CLA]RE L.CLEW: (0 gn;toi a of Apt l icnnl.) Notary Public,.-State of,Now York ,'Fff&14879505 �,.:O ti6lified'in Suffolk County -Comrrtission-Expires December 8,1�..,,