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Home My WebLink About24288-z24288 Z FORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE 'W~RK AUTHORIZED] Permission Is hereby granted to: DOUGLAS ~1R ROGERS PO BOX 2&5 ....... ~.s.Z..~ ~.g..N....~.~....Z..Z.~.~ ~ ............................... to.....5~.~g.T...,~..,,~.~.~.~...~....~?~¼ ~.~.~....Eq~. .................................................................................... at premises located at .................. ~.~.O.,......q~.,D.,...q~.,C,.H..~.,D....,~.~ .............................. ~.~.~....~. ~,~,.~..~, ,N. .... County Tax Map No...,.~ ,~..~...~.?. ...... Section ...,O,~.} .............. Block .....o,..O..O.,~ ......... Lot No..O.~ ................ pursuant to application dated ,..~ .U.,L...Y. ............... ~.~ ......................... 19.....?.~ ......and approved bythe Building Inspector, 55.00 Fee $ ......................... /_,,,Building Inspectdf Rev. 6/80/80 sc,a/e. 8'0%/~ '-I FOR~ NO. 1 TO~4N OF soIrrHoLB BUILDING DEPARTPIgNT TONN BALL SOUTBOLD, N.Y. 1197 I TEL: 765- 1802 Ois~pp~ eyed a/c .................................. BOARD OF HEM.TH ............... 3 SETS OF PLANS ............... SURVEY ........................ CBECK ......................... SEPTIC FeRN ................... NOTIFY: N~IL TO: ................... APPLICATION FOR BUILDING PERNIT INSTRUCTIONS a. 2his application must he .=c~pletely filled in by type~iter or in ink and anlnitted to the Building Inspector 3 sets of plans, accurate plot plan Co scale. Fee according to schedule. b. Plot plan shoaing leeation o~ lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of p~v~erty mast he dra~ on the dlagrm ~ahich is part oJ this application. c. 2he ~ork covered by this application v~7 not he CC~T~eseed before ism of Building Permit. d. Ulxm approval of this application, the Building Inspector will issue a Building Permit to the applicant. SUd permit shall be kept on the premises available for inspection throngbont the work. e. No building shall he occupied or used in ~ole or in part for any Perpase -shatever ontll a Certificate of Occupancy shall have been r_~a~,ted by the Building Inspector. APPLICATIGN 1S ~e.~s¥ 15AGE to the Building Pepartnent for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the TcTan of Sonthold, Suffolk County, Ne~ York, and other applicable La~s, Ordinances or Regulations, for the construction o£ buildings, additions or alterations, or for ren~val or denolition, as herein described. The applicant agrees to comply with all applicable la~s, ordlr~ces, building code, housing code, and regulations, and to ackalt authorised inspectors on premises and in building for nsee~.~ry inspections. .......... (Signatu~ of' applicant, or m ~ a corperatlm) (Hailing address of applicant) State dae'ther appliomt is c~er, lessee, agent, architect, englseer, general contractor, electrician, plumber or bull, ...C~.~.~ ...................................................................................................... ,,,~,-~ ,-~,..~ ~. ~ c'*~r.~,~cc. A..,FP/I~EDJAPP EDgeD (~ t~ t~%ll or latest ~) 9~~ .... ~ 7~ // If ~Hc~r is a ~ati~, ~i~ of ~ly ~r~ri~ otfi~r. N~I~ BUILDING D~M~ AT 765-~2 9 A~ ~ 4 ~ ~ ~E (~ ~ title of ~te o~i~t) Builders License No ........................... Plmbers License Re ........................... Electricians License No ...................... Other Trade's License NO ..................... FOLLOWING I FOUNDATION FOR ffCXJR~D ~ONCIWtl S. 4. FINAL - CONSVRUCTION MUST BE COMPL.e:I I: FOR C.O. ALL CONSTRUCTION SHALL MEET THE REOUIREMENT~ O~ THE N.Y. STATE CONSTRUCTIOI~i£& ENERGY RESPON$11LE · ' '1 CODE8 NOT FOR I. Lseat~on of land on ~h]sh Inx~°sed ~a°rk w~ I he done ........................ f~E~.~T.;.~.~.'...t..'..:.~. ..........~:.----- :.- - - .... D ........... rr ............................. ................... ~ ~ St~t ......... ........... .......... ~iv~s~ ...................................... F~I~ a. ~sti~ ~ ~ ~j ..................... 3. I~mtre (ff vrotk (c{~k Milch al~licable): blc-a l~dldi~; .......... ~kliti~ .......... .~ ~.Alterati°n .......... ,,. ...... ........... ........... ........... ' ............... (to ~ l~id on filing this a~licati~) 5. If ~lling, ~t~r of ~Ili~ tudts ............ ~Md~r of (~lling traits ~ e~t fl~r ................ I[ gaCa~e~ ~tm{~r of cars 6. If l~miocss~ ~rcia] or mi~ ~o]~, s~cify ~ture a~t ~CenC of ead~ ty~ o~ u~ ...................... 7. l)in~nsi~s of ~isci~ strict:utes, if a~y: Fret ................ ~ar ............... ~pth ................. I~i~c ......................... ~d~r of Stories Dimensi~m of sam st~mmre with alterati(~s or ~icions~ Front ............... ~ar ............... l~pth .................... IkdO~c .................... ~ler of Stories ............... 8. Oime~i~ entire [~ ~C~ti~: Fret ................ that ............... ~pth IhiO~t ......................... ~=d~r of Stories 9. Sie~ of lot: l~t .................... ~ar .................... ~pth .................... I I. ~ or ~ discricc in d~id~ pr~i~s a~ s~t~t~ .............................................................. 12. ~s propel e~mc~ti~ violate any ~i~ 1~, ordi~e or regulati~: 13. ~ill lot I~ ~gr~ .................... ~ill ~ess fill' I~ r~ fr~ pr~i~s: ~ ~ of ~ddt~C .................................... ~ress .............................. ~ 15. Is this p~rty within ~ f~C of a ti~[ ~tl~]? * ~ .......... ~ .......... PI.OT BI AGRAH l~cate dearly ~ diatioctly all L~aildings, ~Imtlver existing or proposed, atv3 indicate all set-I~c& dimensions property lines. Give str~el: and block r~nL~er or description according to deed, and sho~ street na~s and i~dica~:e ~ether interior or corner lot. ...................................................................... (~tractor, age.t, corlx)rate officer, etc.) ~id ~r or ~rs, at~t is duly ~thori~ to l~rfonn or ha~ l~rl'o~.~ tl~ ~id ~rk a~l to ~ke m~l file this atRflication; that all stat~nts contait~xl in Ibis al~*licati~m are tn~ to fl~e trust of his k~l~ a~ l~lleQ a~l the ~rk ~itt I~ l~rfon~l in Ihe ~o~mr ~t forth in the applieati~ fil~ d~ily .~orn, delx~.,~es ai*l .~ys that lie is the oppl (~ig~ature of ^ppi i¢- ~L) ~?