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Home My WebLink About24649-zFORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 24649 BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permlsslon Is hereby granted to: ....... .~,Q.I~ 8~,D... ~:... T..U .T.~,I .~, k, .............................. , ............ ........ ~ ~,.5..q... i~.~! ~; .~ ~.~ 8.U...~t .V.~ ........................................ ........ ~ Q.~J .T..Iff (~ D. ,. ~.Y....~ ,t.?. Z.~ ........................................ to ...,.~E:.C,T.,,~,,,~,%H,I.~W.. ~.E:~.,.I.N....TWB:...I~8...Y,~ P,,.~.~.. ~e~,~,~,. ~ ....................... at premises located at ................ .~,~,~,O,,,,,,~,~),I.~.I~8,U,,,(I,V,B ................................... ~.OIJ. T~Ok.]~ ........... Counly TaxMap No, ,....4..,7,,~, ,8,,.8.~, ..... Section ....0..5...5. ............. Block ...,,0...0,0.,6., ........ Lot No, ..0..0.,.8. ............... pursuant to application dated ,] ANUARY 9 19,,,,,.,9..,8. ..... and approved by the Building Inspector. Fee $ ........ ~,,5,,;.,0,,0, ..... Rev. 6/30/80 588'5T30~. HAP OF PROPERTY ,~OCLYEYED F-OR E. ? L02~,~. E.TU'E/q, ILL 5OUT~0LD HAP BATA¢ [000'055'6'.8, GMA~'..A~'T'EI~D TO, NOl,ilE TITI...F., DN- FORN NO. I TOI{N OF SOUTIlOLD BUILDING DEPAR'EHENT TOVIH HALL SOHTItOLD, N.¥. 1197 I TEl.: 765-1802 Di~ a/c . · · ~ ' ' '"~l~ildi~ Ins~ APPLICATION FOR BUILHING PEI~IT INSTRUCTIONS BOARD OF HEALTH ............... 3 SETS OF PLANS ............... SURVEY ........................ CIIECK ......................... SEPTIC FORt4 ................... NOTIFY: CALL ................. · t<.~ ' 70 1 _ a. 'fhis applieatian nust be coRaletely filled in by t~riter or in ink and submitted to the I~dlding Inspector will' 3 sets of plans, eceurate plot plan to scale. Fee according to sd,edule. , b. Plot plan sho~ing location of lot and of buildings on praises, relationship to adjoining pronlses or public si'reels or areas, and giving a detailed description of layont of property ~ast be drama on the diagram ~hich is part of lids appl.i, cat ion. e. lira ~ork covered by ti,is application my oat be coavenced before issuance of Building Permit. d. UlX~n approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept an tim premises available for inspection thronghont the work. e. lxb building slmll be occupied or used in ~vole or in port for any purpose ~atever untll a Certificate of Occupancy shall have been granted by flue lhilding Inspector. APPLICATI(Iq IS I~REBY ~ifiDE to tim Building DeporOrent for the issuance of a Buildlng Permit porsamnt to the Building Zone Ordinance of the Tawn of Southold, Snffolk County, New York, and other applicable l,aws, Orditu~aees or Regulations~ for the construction of h~ildings, mldltions or alteratlons~ or for ren~val or doTolltion, as Imreln desorlbed. ~m applicant agrees to co0ply with all applicable laws, ordlannees, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ,.? · State ~hetlmr applicant is o~a~er, lessee, agent, arddtect, engineer, general contractor, electrician, phmber or buihler. · ............................................................... Dok'ALi) E, LP/iW/k F. Narc of owner of pr~nises .............. (as an the tax roll or latest deed) If aplflicont is a corporation, signature of duly autt~rized officer. NOTIFY BUILDING DEPAiRTMEN~T AT 766-1802 S AM TO 4 PM FOR' THE 1 FOUNDATION - TWO REOUlRED FOit IKXJIm) GONCnETE 2. nOUON. ImaMll~ & FLUMmNG $. INSU~ 4. FINAL - CONITIIUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUClION SHALL MEET THE REOUIREMENTS OF THE N.Y. STATE CONST.UCrION & ENERGY l~,ilders License kb .......................... Plmtmrs License Ro ................... .. .. . .. Electricians License kb ...................... otlmr Trade's License No ..................... I. Ix~catlon of land on vddth proposed x~rk will be done ........................ ~{~;'~{~' '~'~[~{~$~1[~' '~0]~'" Ilotme lxlumber Street lt~flet CoonOj Tax }lap kb. I000 Section ............. . . . Block ............. Subdivision ...................................... Filed t~ap kb ................ Lot ............... 2. State exist~ag use and occupancy of premises and intended use and occupancy of proposed constroction: a. ~xlstlng ~me aed occupon~ ..... ;~ 5d £ .. b. Inteeded use and occuponc~ ......... , ................................................................. I¢l. II. 12. 13. 14. 15. ~ pro[~rty li~s. gi~ et~t and ~d~tl~r interior or co~r lot, ~atture nf ~rk (d~k ~lddt applicable): I~ Ihdlding .......... Nklition ....... i/)' Alteration .......... i ~rip~i~) DI.ena~m o~ entire ~ ~at~t:~. l~t ................ ~ar ............... ~pth .............. lhte of ~rdm~ ...... [ ~ of Fonmr ~r l~ or u~ district in dfids pr~i~a am ai~t~ ............................................................. ~s propel ~mt~ti~ violate any ~dng 1~, o~ilm~me or regulaci~: ........................ Ts t la p~rty within ~ f~t o[ a till ~etl~l? ~ W3 ~ .~ lq.OT ~AGRAH bl~k ~mr or (~scripti~ acco~ing to ~, a~ ~ strut ~s and i~licace ................. being duly ~n~, (le|x),ses a~xl mays that he ie the appl icnnt ,%xm~ t.o Imf~re .e this ~ I HELENE D. HOR~E Not~y Pu~lic, S~ate of NewYo~k No. 49513~4 i ~ Qualified in Suffo k ~bunw ~ ber~mission Expires f, Aev 22 19 / / (Sig[mture nf ^pplicnnL) said (~r or ~rs, m~l i~ du~y )~LI)or)~ ~o ~rEo~n o~ ha~ [~rfo~ the ~kl m~k thaL tl~e ~)rk will I~ I~rfon~l itt th:e iwn.~r ~c Forth in Lhe al~l. icat:ion fJJ.~ tl~r~[U~.