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Home My WebLink About24235-z ~0~1~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HAtA. SOUTHOLD, N. Y. BUILDING PERMIT N.o (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~35 z ~o,, ....... ...~....Y... ................. . County Tax Mop No. 1000 Section ...~....~....~.. ...... Block ...................... t N ...................... · /...~. 19.?. ~ and a roved b the pursuant to application dated ........ ~ .............................. , ...... , pp y Fee $... }?....'T .......... ~ .......... '6~,ii~~ ........ / Rev. 6~30/80 lull IH; I'UIV f lJ6'l ~' SUFFOLK cOUNI¥ DEFT. OF HEALTH GE:RVH3E8 FOR APP7 ,)'¢AL OF CON~ -F ONLY APPROVED BY · C'T 1 '¢.~V^'dO~ '~g. ,'V~"'*C.J,- ,d,'~,~ SUB-St ~I:/XC[: .:,, RL.,.rURES, WHERE NOT VISIBt_E 02 RLifi)ILY APPARANT, WILL HOT · BE SI.tt?,,%I /*~iiil) ]'Hi:IR LOCA-flON AND [.x ~,~T WILL NOT CERTIFIED. CERTIFIED ONLY TO: By DESTIN G. GRAF LAND SURVEYOR 73 WOODLAWN ROAD DESTIN G, GRAF N.Y.S. LIC No. 50067 TAX I.D. No, SUFFOLK COUNIY DEPT. OF HEALTH SERVICES FOR APP,'!OV,'",t. OF CONSI: ONLY Df~'E FI.8. F,,-F. NO. APPROVED BY ,q4 SUB-St. VISIBLE (';E F2.?',.!')iI 7/\I:~PARANT, WILL NOT BE SHOWN &'JD I'HEiR LOCATION AND EXTEN7: WILL NOT BE CERI'IFIED. CERTIFIED ONLY TO: By DESTIN G. GRAF N.Y,S, LIC 50067 SURVEY OF: ~-~"' /u%4- ~' otc DATE: DESTIN G. G~ ~ SUR~YOR 73 WOODLAWN ROAD ROCKY POINT, NEW YORK 11778 PHONE {516) 821-3442 FORM NO. 1 TONN OF SOUTHOLD BUILDING DEPARTI~ENT TOI~N HALL SOUTHOLD, N.Y. 1197 ] TEL: 765- 1802 INSTRUCTIONS BOARD OF HEALTH ............... 3 SETS OF PLANS ............... URVEY ..................... · · RECK ................. .. ' · . SEPTIC FOPaXt ............ NOTIFY: CALl ................... HAIL TO: .................... a. ~his application must be conpletely filled in by typewriter or in ink and ml~itted to the Pafilding Inspector with 3 sets of plass, accurate plot plan to seale. Fee according to sdaedule. b. Plot plan sl~rlng location of lot and of buildings on premises, relationship to adjoining praises or peblic streets or areas, and giving a detailed description of laymt of property mist be dr~n on the diagram ~hich is pert of this al~plication. c. 2be work covered by this al~plieation may ant be ccrxaeoced before issaanco of Building Permit. d. Uixm appreval of this application, the Building Inspector Yrill issue a I~ilding Pennlt to the applicant. Soch permit shall be kept on the premises available for iuspection throug~/ont tile work. e. NO building .shall he occupied or used in */aole or in pert for any purpose ~aatever antil a Certificate of Occupancy shall have been granted by the Building Inspector. APPLI~ IS I~Y ~ to the Building Departn~nt for the isamnce of a Building Permit poranant to the Boilding Zone Ordinance of the T~ran of goutbuld, ~ffolk Cotmty~ l~v York, and other applicable La~s, Ordinances or Pegulatlons, for the constroction of buildings, additions or alterations, or for removal or damolition, as herein described. The applicant agrees to ex,ply with all applicable laws, ordinances, lmildiog code, hausing code, and regulations, and to ad, it authorized inspectors on premises and in building for necessary inspections. (Signatt~e of applicant, or na~, if a corporate) (Flailing address of applicant) State vahether applicaut is c~mer, lessee, agent, arehiteet, engineer, g~neral contractor, eleetriciau, pltnber or builder. Name of c~er of premises . .~ ......................................................................................... (as on the tax roll or la,est deed) If applieaut is a corporation, signature of duly authorized officer. (N~e and title of corporate officer) Builders License No ......................... . Pl~nbers License No ........ Electriclaus Lic~ 1~o .... Other Trade's License No .......... 1. Location of land on ~ahich proposed work will be done ...... .Z?...7~....~...3.3. ............ .~..V..~.~?. ?.r.' .a..~.~..1~). ......... Boase Nmf~r Street Itmtlet c ty Tax} 000 s t on ...... .L°..? ..... .... ....... ..... Subdlvi~ion .~ /~ FA£m~' ............ Lot ................................... ilnd .... ...... 2. State ~sti~ ~ ~ ~ of g~s ~ inte~ ~ ~ ~ of ~ cmst~tim: b. Int~ ~ ~~ ........................................... · · ~-~ ....................... ? .... 3. Fzflure of ~ork (cl~ck sdfich ~plflicable): ~ l~dlding .......... ~iti~] .......... Alteration .......... I~ir ............ I~al .[ ............ l~x~liti~l Olher ~ 4. Est in~t~l ~sr .............. ] ........... f~ ......... . .................................... ! (to ~ ~id a~ filing this a~licati~s) 5. If ~lllng, ~tmr of ~lli~ nnits ............ tild~r of (~lllng ~mits ~ end~ H~r ................ If gnrage~ la.imf of cars ...i fi. If I~mitmss. ~mrcial or mi~ ~oqm~y~ s~ci~ ~l.ure a~l ~tent of ead~ t~ of u~ ...................... 7. I)i.epsiam of ~isting strictures, if soy: l~t .... ~ar ..... =..' ....... l~pth ................. Bln~nal~s.'~,~ a~hamre ~tth alteratims or a~itions: Front .... ~ar .... I~p~.: ............. ~ ..... Ib:iJ~t .................... K~d~r of Stories ............... fi. l)i,~ ~f'enelre a adt~tia,: Frail .~.C ...... I~ar ..~.t. ....... ~pU, .7t ~t .............. '.. K~t~r of Stories ..................... I 1. ?a~ or u~ district in ~ id~] prmi~s am si~t~ ~ - fid 12. ~s propelcamL~:t' ~' ~iblate any za~ng' 1~, ordis~e or regularly: .... ~ ................ 13. ~ill lot I~ regr~ ...~. ........... ~ilt ~e~ss fill I~ r~t~al fr~ ~'~d~s: ~S ~n of Arddteet .................................... ~lress .............................. H~ ~ ............. · ~m of C~tractor .................................... ~klress ................... H~ ~ .... 15. Is this p~mrty within ~ ~t of a ti{~l x~tla~l? * W~ .......... ~ ...~ ..... PI.OT 1}IAGRAH l~ate clearly a~ disti~tly[ all ~ildi~s. ~mttmr existi~ or pro~, n~ itxlicnte all ~t-I~ di~nslo~s ~ pro~rty li~s. Oi~ st~t n~ bl~k a~i~r or ~seripti~ according to ~, a~ ~ strut ~a taxi l~hcate APPROVED ~S NOTED OA~:~R~~~ NOTI~ BUI~INe ~PA~ OOC~PA~CY0~ 76s-~802 9 AM ~ 4 PM FOR THE ~ ~, ~= FOLLOWING INSPE~ONS: "~ ~ ~'-' '~" FOR POURED CONCRETE W~ .~d~ CErTifiCATE z ROU~H- FRAM,NG & PLUMm.G 0F 0CCUPA~Cy ~. ~. ~mA~ CO.ST.UCT, O. UUST BE COMPLETE FOR C.O, ALL CONSTRUCTION SHALL THE REQUIREMENTS OF THE N.~ STATE CONSTRUCTION & ENERGY CODES, NOT RESPONSIBLE FOR DESIGN O8 CONSTRUCTION ERRORS ...... ~ ...... ;~ .... ~&--~.~l).~s.~ ...'. I~(lulyg ~ ~ ~ ' ~ ~//~ ~rn, delx~s atxl says that he ia tim applicant (~a~ of i~ivld~l ~igni.8 contract) / ~ (C~trnctor, ngent,~ corl~rate officer, etc.) of said c~mr or ~rs, a~l is dul~ nuthoriz~ to l~rfnnu or h~e [~rfor.~ the ~id ~rk at~l to ~ke a~ file appllcati~; that ntt state.nra c¢~Itai~ in Lids nl~)l ieation nrc tn~ to the Imat: of hin k~l~ sift Imlief~ at~l that the ~)tk will I~ i~rFon~l in I]1~ t[~l[ll~F ~ forth in the app[icatlon filed ~)rn to I~fore nn this ....... ~Z~ ...... d~y o~ ...~.~ ...... ............ ~ ~ (si~.,,.,,,~ ~ ~,,p~ ) / Quolifled In SUFFOLK COUN~ My Comminlon Explr~ ~EB 28.~ ~ [