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Home My WebLink About23458-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 ............... ............................ 19... R 23458 Z Permission Is hereby granted to; .6....VA'�. to ...� .. / . .. ....... .......... �- / e ................ ...............��....... ...... ...... ../�:e...................................................... .................................................................................................................................................................. ...............I............................... ............................... ........................... @lf... ...... �ti.............. ............................... ..... 1.� ............................ atpremises located at..... .............................'.. ............................................................ ....................... •........................a .. .... ......................................................I............. County Tax Map No. 1000 Section ..1..1 . .......... Block.... ........ Lot No. ...® ......... pursuant to application dated ......�j ......... 19.. .... ..., and approved by the Building Inspector. Fee$. c.1.`..` �....... ............. ..................................... Building Inspector Rev. 6/30/80 ilOARD OF iIEALTII . . . . . . . . . . . . . . . FORM NO. 1 3 SETS of PLANS TOWN-OF SOUTHOLD SUi1VEY . . . . . . . . . . . . . . . . . . . . . . . . ISU:II,DING Ui?E'AR1111ENT CIIFCR . . . . . . . . . . . . . . . . . . . . . . . . . TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . SOIITHOLD, N.Y. 11971 TEL.: 765-1802 NOTIFY: CALL . . . _ . �� lswrynined....._ ..., 19. � MAIL TO: . . . . . . . . . . . . . . . . . . . . Alilirovecl_..... v._., 19-S� fermit No. '.. ............................... Disapproveda/c .................................. .................................... ...................................................... (1Stii ld'nl, insltecLor) APPLICATION FOR IMILDING PI-LIMIT / ))ate�f4n- �. . . , 1995? . INSTRUCTIONS a. 'Ibis application must be coritpletely frilled .in by typewriter or in ink and submitted'to Lite Wilding Inspector with 3 sets of: plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of lxrildings on premises, relationship to adjoining premises or public streets or. areas, arxl giving a detailed description of layout of property must be dr -7n on the diagram wlticIt is part of Lhis application. c. 1he work covered Iry this application vny not be comnenwed Before issuance of Building Permit. d.. Upon approval of Lhis application, Lite lbjilding inspector will issue a iktilding Permit to the applicant. Such permit shall be kept on Cite premises available for inspection lhrcxrgltout Lite work. e. NO Wilding shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy sliall have been granted Iq Lite 111ilding Inspector. APPi.ICNIJCN IS IL-,tTIIY tWE to the iuilding Department for Lite issuance of a Wilding Permit pursuant to Lite Building Zone Ordinance of Cite T%ni of. Soutliold, Stiff-olk Canty, New York, and other applicable Laws, Ordin.-rnces or Regulations, for Cite consLruetiat of Inildings, additions or alteraLicns, or for removal. or demolition, as herein described. 'the applicant agrees to comply with all. applicable laws, ordinances, Building code, housing code, and reIgulations, and to admit atiLhorized inspectors on premises and in building for necessary inspections. nfoRT, FoR K COWNTRY-..�8.............. (Signature of appl.icanL, or name, if a corporation) P Q:.kQX.. 'T�S' C U-r6j-)nG:y E..!Y.Y...J.1�� (t4ti ling acklress of: aliplicanL) SLaLe whether applicant is owner, lessee, agent, architect, engineer, general conLractor�,�pli i i�i r or hid)der. Otn1n1G�Z........................................................ . DATE: fl-a- :# s n./o H..FQKK.. Q4 /r�Y c�UB FEEq �� BY:Nano of owner of premises .. .. ._.. ._._ (as on Lite tax roll.or latest deed) NOTjF N1'a Y*el)(CO1 •OEPAR EYtiT'AT'' 765-1802 9 AM TO 4 PM FOR THE If appl.icanL is a corporation, signature.of duly auLltoritzec[-officer. •:'FOLLOWING INSPECTIONS: i 1. FOUNDATION TWO REQUIRED ��e y•••• • ,)••... ......... FOR POURED CONCRETE (Nano aril title orporate officer) 2. ROUGH - FRAMING & PLUMBING 3. INSULATION ` 4. FINAL - CONSTRUCTION MUST IWIders License No. ................. BE COVAPLETE,FOR C.O. 'ALL. CONSTRUCTION .SHALL MEET PluTiteTs License No_ THE QEQUIREMcNTS OF THE N.Y. STATE 'CONSTRUCTION & ENERGY Electricians License No. CODES. NOT RESPONSIBLE FOR OLher Trade's License a). .................... DESIGN OR CONSTRUCTION ERRORS 1. ImaLion of land on wlticli proposed work will be cone.................................................. . .......... ....a53,aD................ . . _Ikx+r@ Nutter Streetq hamlet QxmLy Tax Map No. 1000 Section jQ.F*��.... Blcxk ...Q;3±QQ.... Lot �� •.�d.._. YLibdivision ...................................... Filed Kip No. Lot ............... (iJame) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Cxisting use and occupancy ...�-!vo..q! y......................................................... b. Intended use and occupancy ...LAN.0...UN.Ly...!N� Fr✓NCC .... r / (6/7 ...................... 1. h•►Iure of axnk ((J►eck a. ddi allAicahle); R---w Ikailding . ......... A(klition ... Altera ion .... .. Itepair ............ Rew vaI ............. lemliLioil ............ Other Wo►k ci GT.,t( NC6..._........ (Description) It. Es(:iiviLecl (:casl: ......................... fee ................................. ............. (to lie iaai(I on filial; this application) 5. If AA-I l ing, rxni►er of ooell ing ur(iUs ............ Rnlaer of dael I ing uni Ls cxi each floor ................ If garage, ►xid)er of Gars ........ .......... ..... ........... .... 6. If'lxisi►►ess, cciniercial or mixed occul)aocy, specify ruiture nixl extent of each type of use......... ............. 7. Din*-nsious of existing strax:U►res, if my:' Frm(.................. Rear .. ...... .. ..... DepLh ................. Ik!•igl►L .......................... UeRier of SLories.. ... .................... 1)inr;nc�icx►s of sane sLrlxaure'wi-th alLeraHms or sxklitions: Front hear ............... Dept11 .................... Hei14iL ............... ... Rxdx:r of Storie:i ............... (l. 1)inxansicx►s of: enLire r►ew cor►sLrax:l:oit: Frcx►t ................ Itear .... ... ......:.. Depl.h . .. ........... Ileigl►L Mni)er of Stories ................. .... ////// 0 4L.1�//� ` 9. Size of loL: Front ....`7`LP ............ Rear ...../.. ............ De .................... 10. Dal:e of lNirchase E ...l.'Z.r. R:1.�.. Nrxne of Furnx.r O naer .. 2En/S I'� / �}�LQn/SK, ) -11. Zcar►e or use disLrict ir► uA►iell pre(►ises are situated ................................................ .......... ..... 12. lkaes prol►oued c(x►sl.r(xaicx► violate any 7-ming law, ordinai►ce or regulation: ...!".d.... ........ , I:l. Will- lot ae•rel;rale(, r Vi l l' e)(CeS9 fill Ire rellMed fran iM01ti Rei : YES N) R � QY yr . 3� . Nnrcs of 14raer of prenises � 6/xklress 91/J 4 7J3�. Merin of Archiiec:L .................................... Arklress ... . ..... ..... I1106e No. .. .... . N n►e of Contractor .. A(klieps ... ............................1'fione No. ....... .... 15. is this prx)I)erl:y within 3M feel: of a Li(kil weLlarxl? * YI`i ......... . NC) .. .x.... *IF YES, fi(XlllK)II) •IT1M '1)t11SI1Ji:i lf?Itk11'I' MY Ill: Itl"sgillEU. PLOT DIAGRAM Icx:ate clearly aril disLincl:ly all IndIdings, x.A►ether existing,or. I)roiiosed,,-.a(xI i►xlicate all set-back din►ensigns frcxn property lilies. Give streeL a►xl block rxr►iaer or (kesr_ription according I:i� (teed, and Mimi sLreel: nines aixl irxlicate %Aielher interior or corner lot. ! d S1'A'll�. M. I'V114 Y( tK, X NIY (A' � r-,CCL)C SS C� �. ..�.�. �x!►nf, duly sworn, (lelxa^,eS arxl says that lie is the appl icanL (N:nr. ► , '( i ideal. r,i �ning al►lracC) alxave i r(I, I et- ZN- Ik! if; Ole ..._ ��i7'1 ........... ......... ........... ................... ..._........................ (Ccx►Lrnctor, ager►C, corlxrrnl.e officer, etc:.) of: said miner or ("xirs, n(xl in duly (uiLhorized Lo Ix!rfmin or have rx.rfor►ned I.he said work arxl Lo nial(e aixl file this npplicaLiou; Lhnl: all. r,Laterx_nLn conLained in l:his npplicaLion sire Lnxi Lo the bell: of his krxawledge mxl bxal.ief; nIxl IhaL the w(►rk will. Ile per.fonned W the naun►er seL ford► in ll►e nplAicatAmL11.1.,eith. ;i x)rn Lo before nr_ dais " -y Milli aJ� .....(lay of: ..... !e:� .. .� .......... LINDA F.KOWALSKI (5 fill It r e if App l i cant.) Notary Public,State of NewYor_k No.62-4524771 Qualified In Suffolk County Commission Expires Nov.30,1 0-2� !A v c�1 1"`a � 'MQc� . . '•: - - . . . : �;. _ �'� . • . . • .. . :ice• ~y-^ •V.y!'�`.. _ ��..^ _ _ - '.v- (, %.r. Vim;' _ Z' .. - - .. ... r.' .'. irat �•`�7 �` y Y•` ��• _ may.-� � wY v Z.. •'h.- ).� _ :� "r•ac .S' - � .�.. -.�_ Fes, 1 •t' - -' N F E I y - r a I- i _ Q t NiZ J r _ 0.7 j4-i 1 'I C cx �ThY.'iAfTt lam_ - 1" .._ - � ". - -tea t-'-r �. _ _ �•.i - _ _ .. -'r•:'p„S'-'^CY..77arr TaR STLfe<- -i• I� ar.Tw i - - •- - - _•_.. - - ... ..- .'• _. � r - :�%• _ . . =:rase yr rwriat sne�be,4: .. - .r: _ •� - _ �` ... .. ,' •. ." _ .. ».�+aa aw sees,: �. .��T- `7' .:Y._- •' -� -t _ - ',-s. -• _1°r'at`M6raM area t :•` .-r - ,-- -.y_ - -.ter•• .. ,. s,mne nnean for.w�alwneae�.. 4 �,f.}��_'�t�'� ��]•{�.}�[( VtCf:-'J �irtJ .�.,1 V.--•. - - - - •I ri--r,...atrL+c+x:.: !'7 L: �. ). t � `< .. - •- � � _ - � - a�.��rp-"�.�y�rw� r.. _•� _ _- ,•. '.s- _.. _:rs^_ :.:1:1.��._ may. .. is V. - {t �, .l. , _ -� '_ a�.�L.l�a.r�[y f,�A�.".... - .��•.�_sa:�t[re 0.:�t�_._;:' °• Li Via/ JT'_;a :C,L.•c �. .._,-ASSW-VEYB?"... _. - 1