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Home My WebLink About23455-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 COMPLET10N OF THE WORK AUTHORIZED) Date...............5117.................................. 19..l.. E 23455 Z Permission Is hereby granted to; ` ... ......... ,,s`'/rir/��9Gffir:—................................... . .... lS................................... , o �.... ze�e;V7........... q .f'........�.r/................ to ......... ........................ ....... . � `........... � ............./ ...........? ...... -��.2............. ........... .��.�'.................. ....... . ................................................................................I........................... .................................................................................................................................................................. ........................•....I..........................I............ ', . • ..................................................... at premises located at.......... ,..V�.. ,.c�i�..... �•••• .................................................... ,�� ••••�• •••••• ....................... ...................................�{.•.•.i��•••...",,,"•/.. .......I.........................................I............. /'o CountyTaxMapNo. 1000 Section .,...��......•.• Block.......... ............... Lot No. ..... pursuant to application dated .... ....••• ••••••••••••••••••••••....... 19.. •••• � •. and approved by the Building Inspector. PiM Fee$... ....... ....... ... ..:ti ... ............................... Building Inspector Rev. 6/30/80 zco 00 T 1 4 �a/c ire f t G p mQo o LL �. rn co �re:--ole , eI / / -ice i < <• _ r I i 111 AY Hr•Ft.tdsd .la•4.:11 c, :IS?98j�t�ftf r9 `Y�� " '�i •�i - S,:IRV�YEL' .Fir? _ . . - alOv. zo. 9si�; r,�c.;!7, Z4.--- - -- - Lei' I7 �N R�' �/ENE G!<E 1��. -_ F�ri•';xr�-.4� :'ty.1;'fro�d:1Yvrrrgs Prsrrlc cux�± ;r-c -/c:l ' N. "Y �S S:�rJ��cty OCR 1•'r, [',;8Z p 1ST. /boo SST 9-7 3aewc G G o'r" ��`tG�-t16,4�:�Lc1:L�:'.lrtr!%eYAr•S; t RR _ HOARD OF HEALTH . . . . . . . . . . . . . . . l5 U FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . . . TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . . . . . . MAY 6 BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . .. . . . "6 - 1996 TOWN HALL SEPTIC FORM �_;- SOUTHOLD, N.Y. 11971 BLDG.DEPT. TEL: 765-1002 NOTIFY: TOWN OF SOUTHOLD 77 CALL . . 7.3:�-Gsf/. . . Examined.....g.�l!.._.., 19 ..... MAIL TO. . . . . . . . . . . . . . . . . . . . . Approved....... .. ......., 19 ..�1 Permit No. /.. .................................... Disapproveda/c .................................. .................................... ...................................................... (Builclingtor) APPLICATION FOR BUILDING PERMIT / TNSTRUCTi.ONS a. 11iis application must be completely filled in by typewriter or in ink mwl submitted to the Building Inspector with 3vsets 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 pr6perty must be drawn on the diagram wdsich is part of this application. c- The work covered by this application rviy not be c(-rmmnced before issu roue 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 wlx)le or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building inspector. ; APPLiCNrION IS IF.RM- M iE to the B uilding Department for the issuance of. a Building Permit pursuant to UP-- Building Zone Ordinance of the 'ram of: Soatusold, Suffolk County, Ness York, and other applicable Taws, 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 buildi or essa inspections. •(Signatuure of applicant,.or.mve,.if•a•corporation) /.s G v re�.. ... .. .... ......... . ...... . . ....... (Mailing address of applicant). State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....._.._OwN� ..................................................................APP 0911D.AS NOTED....... 40� DATE• B.P.#Name of owner of premises ..... �.`.P.��.� :.............. .. 3 . .. ... (as on the tax roll or Latest deed) ��FEE: �B NOTIFY BUILDING DE ARTME T AT If applicant is a corporation, signature of: duly authorized officer. 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED •(N •aril.title.of.corporate.off:icer)... •. ...••.'• FOR POURED CONCRETE ame 2. ROUGH - FRAMING & PLUMBING. 3. INSULATION Builders License Ido.. 4. FINAL - CONSTRUCTION! MUST ......................... BE'COMPLETE FOR C.O. Pl.umi)ers License No. ALL' CONSTRUCTION SHALL MiE�T• T14E REQUIREMLNTS OF THE. N-`'. Electricians License No. STATE CONSTRUCTION' & E�JFPG Other Trade's License No. CODES. NOT RESFONSHR.E f :•,; DESIGN OR CONSTRUCTIOi� ERF:O; ti, 1. Location of land on which sed work will be done.................................................:............ .. ..S? ... . !....!z?oZ �/i-ti... ...................... ..........v............ ............. lknase Nmi)er Street haml /et County Tax Map No. 1000 Section ......�.J.7....... Block .......�....... Lot ...../ ....... i Subdivision ...................................... Filed Map No. ............. Lot (PI¢me) 2. State existing use mA occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...7P- ...7�-xF i D ........................................ i to. Intended use and occupancy .........S'A" . E....LJ..rµ.._ 7-Ui\1 .. ..................... viiiiju aI?,,lip? `;s�.^.;F>.014 c I11 ,. . :OIL VCI ecililp, mE3i 3. N•rture of work (clieck wlridr applicable): Now Ikrildingl .......... AckliLiou .......... AIl'erti1:i0II .......... Italia i r ............ Itarhova l ............. D611 l i L i on ............ Other l•krh k (1)escripl'icxr)�� viNl� 1i Eslimrrrt'ed Cost ...�� .:............ fee ............................ (to be paid on filing; this•appl:icdi.cin) ,, • 5. I f ((,sel ling," hxidrer' 'of (Lell inn tali Ls ............ Bober of ih el I ing run is on each Floor ................ Ifgarage, hxnber of cars ..............2...................... 6. •If business, ctirmercial or mixed ocLupancy, specify nature arxl extent of each type of use.....................:.. 7. Dimensions of exist g structures, if any: Front....P..y..//..... Itear ... Z....... Depth ....Z.......... Ik:igllrl' .......t!�.............. Ma►dier of Stories .......[.......- t / Dimeusi(xhs of srm�te structure with alterations or ackliLions: !'rant �.�..... !tear .... �'...... DUJAlh .......2% ........... lleijJ, .L ._..._ �........ ......I........ .l�. Mnlx�r. of Stories li. Dimensiochs of entire rw construction: Front _ !tear ....X' .... Depth �d lieiglrt .........//............... Muber of Stories ....!v)A— .... .. 9. Size of lot: Front ...1. .,....... hear ......L: ........ Ik:pth ......U �..I... 10. Mile of t'urchase .... �`.!L �. Mime of Former Owh►er ...�.('Dl?111�... •...� 1 �........ 11. 7<xre or use district in wlhidh premises are situated s'?E:' '!1. :.....................................•...... 12. Does progrosed construction IIviolate any miring gnu, ordinwice or regulation: ...��?................ y 13. Will lot be regracled .... /o/ .......... Will excess fill be rermaved fran promises: YES No M. Manes of Owner of premises ��,u .jz.!...'�� -. AcklressG�D...... k'c"�Hrcx�e No.� `�-(..... Mi a of Architect .................................... Mdress Phone No. M<rme of Contractor ........ .................... Acklress ...............................Ilion do ............ i 15. Is this property within 300 feet of a tidal wetland? * YES .......... a) ..d...... *1F YES, RX111DID 'Il7M '11711SRLS MMI'1' MAY Mr, I".pilum. no'r DIAGRAM Ux:aLe clearly and distinctly all buildings, whel her existing or proposed, ahxl irxlicate all set-back dimensions fiau progxtrty lines. Give street and block rawher or description according to (geed, and slow street runes and inlicaLe rAretlrer interior or corner lot. ! i i i `i ln'IE (A. wv Y(MtK, (XA1tJlY (A' ... c . 1 ° rUy . --•--� •..• ( .•..lG .................lx!ing duly sworn, delxrses arxl says that he is the applicant. (N:11r9 of irxlividual. signing contract) i alxrve immed, l; Ik-� 'i:; the ............................ YV�? ..................................................._......._ i (Contractor, agent, corlxhrate officer, etc.) of said owner or owners, aril is duly authorized to perform or have IKrforned [.be said work and to nail(e aril file this appl icaL ion; that all sLaUemenLs contaimA in this ahpl icat:ion are tnx= to the best of his khx)wl (lge and Ix'HeN MKI that. the work will be Irerforrrhed in the rionner set forth in the application filed therewith. ;sw)rn to llx:fore an this Q, `^........clay of 19...L�.. Notary frrbl is .. f . + ROBERT 1.-SC ;JR: r, (S i g;nature of Appl i cant-) - " NOTARY PUBU ,State of N.Y. j No.4725089�j uffolk Courm Term Expi 5 May 3t.19p