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Home My WebLink About24630-zFORM NO.3 TOWN OF SOUTHOLO BUiLDiNG D£PARTMENT TOWN HAIL SOUTHOLD, N.Y. 24630 Z BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETiON OF THE WORK AUTHORIZED) Permission Is hereby granted to: ........ ~,P,~h~...l~g ~.~1~ ......................................................... ........ ~.~.~. 2.~ ,..~;L~.T.,. ~.T.B.g F~7. ........................................ ....... .E B.g I~.lff...bl l~.~ .0.~}1¢.~., .iN .Y... ,1.,,1, ;~,6,5. ........................... to ....... .I~I~.N~.~ B.IJI$.~.. ~..F..I~I~:~...F.O.LIB...E~I~.T....~.N...~ ~.~ W.~...~ N..%~..~DN %...~ ~.. ~S. ..... ......... I~ .P.P..L ~ ~D...E.OB., ............................................................................................................................ at premises located at ................ ~,~.0..,0.,,,., ~.~,U.,,N,..D.W.:~..E, ~.,, ~.V.,.E. ................................ J~e.T..T..~..T.U.C~ ........ CountyTax Map No.....~7.,.3..~.?. .....Section ....0..?.~ ............. Block ......q.O...O.~ ........ Lot No..~.0.~ ............... pursuant to application dated.....N./..~ ............................................... 19 ................ and approved by the Building Inspector. Fee $ ........ ~,,5, ,;, ,0,,0. ..... ......... ...................... Rev, 6/30/80 FORH NO. TOWN OF SOUTtlOLD BUILDING DE PAR'II4E lqT TO~/N IIALL SOUTItOLD, N.Y. 1197 I TEl,: 765-1802 Disapproved a/c .................................. BOARD OF HEALTH ............... 3 SETS OF PLANS ............... SURVEY ........................ CIIECK ......................... SEPTIC FORH ................... (tMildiag Insl~ctor) APPLICATION FOR BUILDING PERHIT INSTRUCTIONS a. 'lhis application nnst be conpletely filled in by typ~4riter or in irk and suhsitted to the Ikdldiag lnspecLor witl 3 ~ts OF plans, at.rate plot plan to ~ale. F~ acco~i~ to sd~te. b. Plot plan ~i~ l~ti~ of lot ~ of hnld~s ~ ~ ~s, ~latlon~lip to ~joiniag pr~i~s or ~bllc struts or areas, a~ givi~ a ~tail~ ~rlptlon of layer of pro~rty mst ~ dr~ ~ tim dla~an ~dd~ is Imrt of this appli~tia~. c. 'lhe ~rk c~r~ ~ fl~is a~lication my ntt I~ c~l ~fore isle of ~ildi~ Pemit. d. O~ a~al of fl~is appllcati~, the l~ildi~ Ins~ctor will is~ a ~ildiag Pemlt to the applicant. ~ch pomit ~mll ~ ~pt ~ tim ~s avail~le for ins~ti~ th~mt tim x~rk. e. ~ ~ildi~ ~all ~ ~i~ or ~ in ~le or in i~r~ for ~ ~ ~mt~er ~til a ~r~iHcate of ~qncy Mtall h~e l~n grant~ by tim lkdldi.g Ins~tor. ~I~'fl~ IS IE~ ~ to tim l~ildi~ ~r~nr for ~e la--me o[ a I~ilding Pe~t poramnr to the I~fildiag 7~ O~i~e o[ ~ T~ o[ ~ttmld, ~[folk ~n~, ~ York, a~ otlmr a~licable l~a. ~di:~es or ~datims, for tim ~t~tlm o[ hildi~s, a~itims or Mterations, or for r~al or ~lirion, as herein doscril~. ~ appllmt ~s to ca~ly with all a~licable l~a, ordlmmes, Imildlag c~e, h~Mag c~e, a~ re.latins, md to ~it ~ri~ in~tors on ~mims ~in ~ilding f~--~~4 ins~ ~ "'2 ....... ~"lY --~ ........ ~'"~; ......... · - (Sag~tureMf a~li~nt, or ~. afa co.rationS/ State ~hettmr applicant is ~var, lessee, agent, architect, engineer, getmral contractor, electrician, pltvaber or I~ihter. (~ m the t~ x~ll or latest d~) If applicant is a corporation, aignakure of duly antborized officer. (Nane and title of corporate officer) I~dlders License No .......................... Ph~nbers License lto .......................... Electricians License No ...................... ..................... I. Ix~.~ation of land on ~hich proposed ~ork will be done .............. Ilouse IXimi~r Street H~nlet ..... .?.q ...... .... ........ .... ..Z... ........ Subdivision ...................................... Filed Hap No ................ Lot ............... (Nam) 2. State exist~ag use and occupancy of premises~vanq, i, ntended use and occupar~zy of proposed ctamtructlon: a. ~iatlag ,~ ~ oc~y ............ -.%-ff--~--:.-)~e-q~. X-~--'~ ............................. I0, II, 12. t3, 14. 15, l~x:ate clearly and distinctly propert7 lines. Give street a~d interior or corner lot. I~ittnre of ~rk (d~eck ~hich al~licable): ~ l~lihling .......... ~ition .......... Alteratioa .......... Est n~atal ~st ................ i ......... f~ .............................................. IE ~ara~e~ m~i~r of cars ..... ~ ................................. If Ixminess, ~rcial or mi~l ~i~y, s~ci~ ~t'ure a~l ~ten~ of ead~ ty~ .o~ u~ ...................... lli~n~ima o~ ~m ~tn~t~ro width a'lrerati~8 or ~itions: Front ............... ~ar ............... ~pth .................... I~i~t .................... l~d~r o[ Stories ............... Din~nsl~m of entire ~ ~st~ti~u F~t ................ l~nr ............... l~pfl~ .............. Si~ o[ ]ot~ ~r ........... ~ ......... ~ar .................... ~pth .................... l~l'e o[ h~rdm~ .............. ~ ....... ~ o[ Fon~er ~r ........................................ ~ or u~ di~trlct in ~dd~ p[~8 am ~itmt~ .............................................................. ~ o[ C~trae~or ................................... ~klress ............................... ~m~ ~ ............... PI,OT DIAGRA~ bl~k ~imr or i~scriptlt~ acco~llng to I~, a~ ~ streeL ~a and i~licate ..... ,. .... ~ ................................ I~i~q~ duly ~rn, delx)~s atxl ~ays tirol he ~s the a~)licant ((b~tractar, at&eat, ~orlx)rate officer, etc.) og ~aid ~mr or ~rs, and i~ duEy ~Lhorl~ ~o imrfonu or h~e [mrfon~ the ~id ~k and to n~ke taxi ~ile this that the ~rk ~i1.1 I~ ImrEon~l ia ll~ ~mner ~C forth in th~ aRdieation filal tl~r~id~. ~ta~ B]blic . . ~o, 49513G4 ' C,m~h~sion Fx~i,~es May 22, 1 ~ ~