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Home My WebLink About24457-zFORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENt TOWN HALL SOUTHOLD, N.Y. 24457 Z BUILDING PERMIT [THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted to: ......... ,w,.,z. ~.~z,~,, ~,,. &N.N... C.R~.M~,~. s. ............................ ......... ~5.9. o.... s.,o. U.~, P~!.~,.. AY, ~, ...................................... ......... ,Y~..T.~. Z..~. ~.C. ~.,. N.'4...Z..Z,9. 5.2. .................................... to ....... ]~..R.~..c..%...A,..~:.N.C..~..A.~.....5.~.~.~;..~.p...~..o.~.. ................................................................................. at premises located at .................... .5...9..0........s..o..~.~.v...z.~...&v..~ ................................ .~.~..z.T.~.c..~ ....... CountyTax Map No ....... ~..?,,3. 8..8...9... .. Section ..... ~..0.0. ........... Block ...... 0...0.0.$ ....... Lot No. ,...0..2...8. .............. pursuant to application dated ..... .~ .~...]].~....2..5. ....................... 19 ....... ..9..?....., and approved by the Building Inspector. s .......... .3.,5..:..o...o.... Building Inspect6¢ Rev. 6/30/80 FORH NO. 1 TOI4N OF SOUTHOLD BUILDING DEPARTt4ENT TOWN HALL SOUTIIOLD, N.Y. [ 197 I TEL: 765- 1802 Oisepproved a/c .................................. BOARD OF NEAL~31 3 SETS OF PLANS ............... SURVEY ........................ CUECK ......................... SEPTIC FORH ................... NOTIFY: CALL .................. HAIL TO: .................... APPLICATION FOR BUILDING PEP&lIT INSTRUCTIONS a. lhis application ntmL be completely filled in Iry typem'iter or in ink and ani~nitted to the Ikfilding Inspector w B sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan sho~ing location of lot and o1~ beildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed deseription of layo?t of property rmst be drawn on the diagrem ~ieh is I~rt of this application. e. 11~ ~ork covered by this al~P] ication may ~ot be cc,rrmneed before issuance of Building Permit. d. Upon approval of this application, tt~e Building Inspector will issue a Buildlng Permit to the applicant. Soch pamit stroll be kept m the premises available for inspection throngtmt the ~rk. e. No Imilding stroll be occupied or used in vl~ole or in part for arry purpose *Ynatever until a Certificate off Ocoupaocy shall Ihave been granted by the Building Inspector. APPLICATIC~I IS IlrttF2lY ~IPllE to the Building Departnent for the. ism~nme of a Building Permit paranant to the Building Zone Ordinance of the To~n of Southold, Suffolk County, Ne~ York, and other applicable l,aws, Ordimmees or r~gulations, for tbe eoc~struction og buildings, additions or alterations, or for removal or dca~lition, as herein described, lhe applicant ag~es to c~aply with all applicable laws, ordinances, building code, l}onslng code, and regulatians, and to a~nit authorlz~l inspectors o~ premises and in build~ for seecas~eticas. , ............................................. , ' (Signature of app a corporation) (Hailing address of applicant) State ~tmther allulicant is omar, lessee, agent, architect, engineer, general contractor,~~ or Imild~ .................. .................................................. (as If a~licant is a m~ratim, si~tm (~e aM LiLle of co.rate offi~r) 4. ~l~Ak - ~ON~RU~O8 MUST ~ ~ ~R C.O. ~il~rs l.ice~ ~ .......................... ~LL CON~RD~IO~ ~ MEET Plm~rs Liee~ ~ .......................... ~ R~OUIR~M~T~ O~ THE N.Y. 8TA~ CONSTRUCTION · ~NERGY El~triei~s Liee~ ~ ...................... CODES. N~ RESPONSIBLE FOR Otter ~s Li~n~ I. l~ati~ of 1~ ~ ~,id~ ~ ~ will ~ ~ .............................................................. .... ............. ..... .................. ................... l~m ~r St~t t~let ~ty T~p ~. I~ ~tim .... ~ ..... m~ ...... .~ ....... ~t .... ~. ..... ~ivlsi~ ...................................... FiI~ ~p ~ ................ l~t ............... (~) 2. State ~isti~ ~ ~ ~my of proni~s ~ inre~ t~ mxl ~ of ~ cmst~tim: a. ~isti~ ~ ~ m~ .........~ ~~(~.~~ ...... ~m ......... : ................... 11. 12. 13. 15. N;dttte of ~)tk (d~eck M~id; apI)licable): l,k.~a I~fihling .......... ~Mici~ .......... AlteratiCn~ .......... ......................... o~,~ ~,~ ~....~.. I~?l~i r I~at I~1 iLi~ ............ EaLimtc~l {~st ..~..' ............. fee .............................................. (Io I~ ~id ~z filing this al~licati~0 gnra~% t:~t~r of cars ~ .... I~miz~ss, ~rcial or mi~l ~c~, sl~eif~ lmture ~z~l extent off ends ty~ of'use ...................... IH.ensi~m of ~isting stn~ture., iff nny: ~t ................ ~ar ............... ~pth ................. l~i~st ......................... Kzd~r of Storie~ ...................... IH.~nsi~m of sine stricture with nlterati~m or ~li~ions: Front ............... ~ar ............... I~plh .................... I~ip~:t .................... K:d~r off Stories ............... Di.~msi~ d~ entlze ~ ~t~ti~: lrrtmt ................ ~ar ............... ~pt.ls .............. I~i[~t .......................... K~t~r of $torie~ ..................... ,~,,~ ,,~ ,~,~,:,.~ ..... ffff.~.~ .... ~ o~ ,,o.~ ~ ........................................ ~ ,,~ ,,~ ,~i~.~ i. ~,i~, .,.~i~ ~ ~i~ ........ ~= ~ ........... · ............................. ~s prol~l c~mt~t~ti~ vi01nt'e any r~H'~ 1~, onlh~s<e or regulat:i~: ..... ~ ......... ~ill lot I~ regr~hl .... ~ ............ ~ill e~:ess fill le r~l this p~rt:y withis ~1 f~t of a tkhl x~tlmal? ~ ~q .......... 1)I,OT I) IA(;RAId l~x:ate clearly m~l distinctly all IxHhlh~s. -M~elher existing or prol~l, mgl h~licate all set-I~k di.~nai~m prol~rty lt~s. (;i~ strut ar~l bl~k s~d~r or (~serq~t'cs~ flceordmg I:o ~1, nt~ ~ street ~u~s fltgl ~sllcnte interior or eo~r lot. I~ is the .................................................................................................. (Czstt ractor, nBent, corlx)rnt:e o[fi c:er, etc. ) of ~;ald (~r or (m~rs, mxl is tJtlJy m)lhorir~l to larfmm or hme I~rforn~l the mid ~)rk a~KI to rake n~l File nl~l lent:ion; Lhnt nil stnm~nts c,~aalm~l in Lhls nlq~licati~ m'n t.n~ to the I~t off hia k~l~lge IhnL lhe ~sk ~itl tm l~rFon~l in I,h~ n~m~r ~t forth in the applic~tk~ fil~ tl~r~iO~. K~tnry Ihll)l lc . , / ,- ~ ................. : ................