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Home My WebLink About24279-z24279 Z FORM NO.$ TOW~ OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD~ N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission Is hereby granted to: ....... ~;,fflCC,.S,,T,.E.,R,..,~.,,~.~,~,.~,,Y, ........................................... ....... ;?2,.~...I~.~I~..P..P....P. ~,~.~.~. .............................................. ....... ~ ~J~ N~ ~J~ .T....N.Y....~. ~,.~.~.~ ~ .................................... to.....E;~I:;.T... ,~,, .~,E~E;F..,, ~...~P,,P,I.. I E.I:)., .EQL~ .................................................................................... at premises Io¢¢ted at .................. ~,?,5,.....I~,~E/.P...P..L. ............................................. ~.I~,F.,~h~.PjO. B.T. ......... Count/Tax Map No. ,,.,,~,7..~;,1~.1~.9. ...... Seotion ..~;~.,4 .............. Block ....O,O.Q2; ......... Lot No. C)J.~ ................ pursuant to application dated ...Q.LIL.Y. ............... ~...4. ......................... 19.....~.7. ...... and approved by the Building Inspector. Fee $ ....... ~ 5,,.~,0, ..... ~a~ng ~nspec~r Rev. 6/30/80 ,FORH NO. ! TOWN OF SOUTHOLD BUILDING DEPARTE~ENT TOWN BALL SOUTHOLD ~ N.Y. 1197l TEL: 765-1802 Disal~ved a/c .... BOARD OF HEALTH ............... 3 SETS OF PLANS ............... SIIR'-~¥ ............... CHECK ......................... SEPTIC FORH.... ............. . - APPLICATION FOR BUILDING PEP, HIT INSTRUCTIONS a. Ibis application mast be ca~letely filled in ~ ~iter or in ink ~ ~ttM to the ~ildi~ In~tor ~ 3 ~ts of plus, ~ate plot pl~ to ~le. F~ ~i~ to ~le. b. Plot pl~ ~i~ l~ti~ of lot ~ of ~ildi~s ~ ~s, relati~ip to ~joini~ ~s or ~blic struts or geas, ~ givi~ a ~tail~ &aripti~ of l~t of ~r~ ~st ~ dr~ ~ the dia~ ~i~ is ~rt of ~is ~li~ti~. c. ~ ~ m~ ~ ~is ~li~ti~ ~ mt ~ ~ ~fo~ is~ of ~ildi~ ~t. d. ~ ~al of ~is ~li~tim, ~ ~ildi~ In,erg ~11 is~ a ~ildi~ Pe~t to t~ ~licat. ~t ~1 ~ ~pt ~ ~ ~s ~ailable for in--tim theft ~e ~rk. e. ~ ~ildi~ ~all ~ ~i~ ~ ~ in ~le ~ in ~ for ~ ~ ~at~r mtil a ~rtificate of ~I~ I5 ~ ~ to t~ ~ildi~ ~mt for ~ isle of a ~ildi~ Pe~t ~t to the ~ildi~ ~ ~i~ of ~ T~ of ~t~ld, ~ffolk ~, ~ Y~, ~ o~r ~li~le ~s, ~i~es ~ ~la~i~s, f~ t~ mt~ti~ of ~ildi~s, ~iti~s ~ alterati~s, ~ for ~al or ~liti~, as ~rein &ari~. ~ ~li~t ~s to c~ly ~th ~1 ~llcable 1~, ordi~es, ~ilding c~, ~i~ ~, ~ ;..~...~e~...z ....... %:.~... P~ ..... (~ili~ ~ss of a~he~t~ -- State ~aether ~plicent is o~er, lessee, a~ent, architect, engineer, ~neral o ~o~e_~-_~ ...................... Naue of ~r of premises . .' .......... : .... ; (as on the tax mi1 or latest ~ ~ If applicant is a corporation, sil~ature of duly authorized officer. or b~ilder. (N~ne and title of corporate officer) Builders License No .......................... Plt~bers License Ro ......... Electriciass License No ...................... Other Tra~e's License No ............ THE REOUIREMENT~ OF ,THE #.Y, ITATE CON~TR~ION & ENERGY NOT RESFON~BLE FOR OR C~ISTR ,t~T~ ERRORS Location of land on qaich l~oposed ~ork will be done ..................... : ........................................ . . ....... .... .......................... ...... .............. ] ... ....... ........ Bense Nanber -- Street \ f:o- }~ -- llanler q~/~ ~Y Lot J ~'~ ...... ~.~ Tax ~ No. _~.~ ~t,~ ....... .~. ...... Ei~ ....................... Sut~llvlsfco ............................... ....... Filed Nap No ..... Lot ......... State ~st~n~ use and ~:cupancy o~ pi~n~se$ and ~ntended use ~ tJ~ 3. t~;~ture iff ~ork (cl~:k ~d~ich applicable); lice Bliilding ...... .... a~kl~t~on'" .......... Alteration Repair ............ llem~val ............. l I~nolition ............ Ocher l~}rk ..~..~}.C.~ ............. 6. Esti,~]ted C~ost ... fac .............................................. (ro be paid cm filing ti]is appticaticm) 5. If d~elling, va~i~r of d~lli~g nsits ..... ~ t~i~er of d~alling ~mits ~) end] floor If ~arsge, zms~l~r of cars .... { ..... { .................... 6. If Ixmi[~ess, ¢~nercial or mixed octampancy, specify trot:ute ar~l e-xtent of ead~ type of uae ...................... 7. l)haensic~s of e_xis~in§ sttect'u~es, if arty: Frost ................ Rear ............... Depth ................. I)imassioas of sa~ st'n~ct~mte with al~ers~i~)s or additions: Front ............... Rear ............... l~pth ................ 2... Ileip~at .................... Ntmdxar of $~orles ............... 8. Dht~nsi~.dt~ entire ne~ cooatlamtl~]: Fra)t ................ Rear ............... Depth Ileitis; ....................... ~. llxnber of Stories ..................... 9. Size of lot: Frtm~ ~ Rear llepch I I. ;k~ae or use district is ~d~id~ ~r~iaes ate situated .............................................................. ]2. Ikms propa~] c~t~titm vlolat:e any z~-min§ 1~, ordinance or regular:ion: ........................ 13. l~lill lot Im regrnded ......... '~ .......... ~/ill excess fill be removed ftem premises: ~ NO 14. ~'~s of O~er o1~ premises ~ .......... Axklress .............................. lahca~e No ........ l~a of Ardli£e~t ............ ~ ....................... K4dreae .............................. H~ae Ho ............... ~rae off Cm~rsctor ........... , ....................... /kk]tess ............................... Hlon~ lis ............... 15. Is this property witllin 300 feet of a tidal wetland? * I'IL~ .......... NO .......... PLOT DIAGRAH la:ate clearly and distinctly &Il Daildi~Igs, ~dmther existing or propasc~l, and indicate all ~t-I~k dt~nMons pmpart:y li~a. gi~ sC~C a~ bilk ~dmr or ~acripti~ acco~ing to ~, a~ d~ sttee~ ~s and indicate ~dmtlmr interior or co~r lot. ~ ............ lining duly .q~)rn, ¢lel×)aes and says that he is the spplicasi. lie is the .............................................................................................. [ (C~tractor, agent, ~orparate officer, eke.) o1:, i~id (mcr nr Cm~ra, and is dt,ly (It]thoriz~l to I~rfo~nt or have Imrlbr,~l the ma[d ~k mgl to u~ke and file Ipl)l cakl()ll) thai: all stata~nts c~mtat~l in :his al~l mation are cue Lo the {~st: of his k,~l~e a,~l Ixilieri a~xl ihak the ~rk w&l, 1 i~ ~rFon~tl~ a~s.~r ~t Forth in the aih~l icat:i/.~ fil~ ~rn to I~fnre ne this / / /A - .... -/ // / (Sig,~at,,re of Applicant) ~ / ~ 01S~7 ,