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Home My WebLink About23643-z "Ru NO. S TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 2-Z- ........... .. >,9..9..� Dote .. N9 23643 Z .. Permission is hereby granted to: ...... ..... . ...... .... .... . ... ...... ...&44. ............ . .... ......... 4z g .4 ............. ................. ...........�. .. ... to, . ..... . ... ... .... ..... . . ......... , ,� " ............. atpremises located at .................... .................. ............................................ ... .......... ..... ... ............ .................. .......... .................................................................................... ............................................................................. 4' - ............ County Tax Mop No. 1000 Section ...........70...... Block ........ ........... Lot No and opPr0v0d by the qy ............ pursuant to application doted ................ Gy, �`.. Building inspector. Fee $26............. ....•.. .. ............ ............. .. ....... Building Inspector BOARD OF 11HA1311 . . . . . . . . . . . . . . . FORM NO. 1 3 SI-TS OF PLANS . . . . . . . . . . . . . . . TOWN OF SOUT1101.1) SURVEY . . . . . . . . . . . . . . . . . . . . . . . . BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . . TOWN HALL SIPTIC FORM . . . . . . . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL: 765-1802 NOTIFY: .. . .... .. 19. MAIL. TO: . . . . . . . . . . . . . . . . . . . . AMnowNi. .................................... Disapproveda/c .............................. . . .................................... ........................................... .... ..... 11ldiT)g Inspector) M T 1996 AP CATION FOR 111111.1)ING P1,11MIT BLDG.DEPT Date. . . . . . . . . . . . . . . . . 19 TOWN OF-SOUTHOLD INSTRUCTIONS a. 'Ibis application mist be cuipletely filled io lyy typewriter or in ink aril suixiiiLted to the Tkoildiog bistrctor wills 3 sets of plans, accurate plot plan to scale. Fee according to schethile. 1). Plot: plan sliowirig location of lot arxi of Wildings ori premises, relaLiotiship to adjoiriing, premises or pilblic streets or areas, and giving a detailed dercriptiovi of layotjL of lyropeuty mist be drm-ni on the diagram which is part of this application. c. 1he work covered ljy this allAicatioil uny ixR be comiroced before isstiance of Building Permit. d. Alix)ii approval of this application, the Building Inspector trill issue a Building Permit to the n0f;iienilt. Stich J)eilllil- stall be kept (ov Lite premises available for ivispec-Limi throtij),i(xit the work. e. No Wilding, shall be occupied or used in uiliole or in part for airy purpose whatever initil. a Certificate of -Ocullpalicy sliall have leen granted by 11W Rlildinly, hisoector. APPIACNI'loN IS 11i"RE.15Y MAIJto the 1%jildilig Departilielit for the iSR11aoCe Of a Building PeriniL pursivint to the lkjil(liiq,, 7Axie O"litinoc of the 'lVxAi of Sotitliold, Suffolk Cwtity, New York, aryl other. applicable laws, Ordinances or -e Regulations, for the cotisLnicHoo of Wildiogs, zwklitions or alterations, or for removal or demolition, as herein I described. TIw- applicant agrees to coryply with all, applicable laws, orditumces, b0ilding code, Imsing code, awl repilaHoos, awl to whit authorized insliecuors cAi premises aixi in lxjildirj, for necessary inspections. .... . .................... '11 -e of mie, if a corporatloii) (Signature or n, ................. (Mailing wklress of applicant) • State %AwLber applicant is owner, lessee, agent, archiLect,-Auigineer, general contractor, electrician, pluTber or Wilder. h4-v14— .. . .. ..... .. ... ... ................ ......... Naine of owner of premises ....Y6....p ............... . ............................................. (as ovi the tax roll or latest, deed) If al4flicant is a corporation, H i gria L-tire of duly aiitlKwi7ed officer. ..................d............................... (Nanie.qixl title of corporate officer) License No. ......................... I'lulix-Ts License No. ......................... Electricians I.Jcense No. ..................... Other Tvxle's I.icetise. No. .................... ImaLion of land on which proposed work wi 11. lx-- (kwie... ..... .................. ........................................ ........................................ .....f(0.................................. CotinLy Tax Map No. IWO Sect ion 111 ock IkAise Amber Street Ilaitilet. 'N............. .... 6 .............. ............ Int .. SAJIXI iV i S i0o ......................... ............. Ni led Kip ?b. ............... lot ............... (Nanle) 7. !,Late existing use awl occtipaywy of premises 01K1 inLeoded use nixi occtirkincy of proliosed coqisLTuction: a. U xisLitig use aril occiipai-icy ........................................................ 1). Iii(emled use aryl occiii-witwy .... .........................................I...................... ). K►lute of (x,(k ((lieck whicl► al,pltcahle): W-AJ Iklildt'nll .... .... .. AcklitiooIteration Rept i r ............ ltcerroval ............. IkNlr)I it!i0(1 ......... ... Other lka ....... . .. k ..... .... .. .......... . fbesc:riptim) 4. I.:;t illial ed Cost l,.. Ob.......... ... . fee ....... ..... ......... ............ . ...... .. ... . (Lo he paid on filiol; lhia application) (kAA 1 int;, omber of (kJell il% units . ........... tkoi,er of ck,,el I iog un[Is ()i► earl► floor .... ...... garalge, rrnl,er of care 6. If IxElloCJ9, (anuiercial or a►isred oc:rupclrxy, specify lulture e1x1 extent of each type of use......... . ...... 7. Uisralsicna of existing str(►c:Lures, if any: F►(nt.. ... .... . . ..... Rear Ik:ig)11: ......................... Usil,er of Stories .. ..... ..... ... . 1)inreosioos of sign structure with alteraticxls or (kklilions: FrOoL ...... . . .. . .... Itear Depth ...... .............. Ik:il;l►c tisiber of Stories . ... . .. ... .............. .... .. it. I)ilmmsioi(s of ela ile rxew coost"MA io(r: Fr(1(lL . . ....... ... .... Itear Ikptl► .... , ........ Ik:ig1►I: ........... .......... .... Mnl,er of Storiea . . ......... . ..... .... 9. f;iz.(e of lot.: Fr(x1t ..... .. .... Itear ...`1J►"R ... . Depth Wo I0. Dile of 111rchase ............. rJnX of Ionrrc:r (kn,er ..!C �1 .........4`.S✓........ ......... . 11. 'l(xre or use dial rict in %Adcl► prel11ises are s'ifuatecl ................... . . ....... .. .. ... ................... . .. . .. .. 12. Ikxs prolr(lsed cox►surocl i(x( violate a1►y uxling law, ordinance or reg(llat.ion: ....... ............ . .. ....... Will excess file rarrave l be fran pi&Ikisea: YES NO 17. Will lot 11e rebra(le(I ........ ..... > 14. MarK:s of (X-mer ofpre�nisess, �.!..C4WAIRDy..... Acklress4if.0 �4L�>�Y / L N►ax No.�r�9.'.•�3��!... Nary. of Architect .............. . ................. .... A(klress 11(orle N). .. . .. .. .. ... . Mille of Co(ltractor .................. ................. Acklress Ilxxle 1Ju. 1'i. is this prr,lx:rty within 3(X) feel: of a tidal c,rellarkll * YGS .. .., NO *IF YES, RUnr>1n '1CXJN '1141S11?ES 11:14-11'1' IjAY 141: Itl.pIl(lq). ITOT 11IAGIIAH Locate clearly arm) distinctly all Inilclings, %Arether existing or prol-iosed, nrxl hulicate all set-back (Iiarensioils I-r(ra property litres. Give street ani block rnd,er or (lescripticxl according to tleeclr at sl xa street nares alxl irxlicate %Aielher interior or coater lot. /� i sTe,�&AA �� 3( �. ` ROVED AS NOTED 4� 7 � �' 71� d FEE. BY: NOTIFY BUILDING DEWFOR 1 765.1802 8 AM 70 4 _ _ 3 FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED x FOR POURED CONCRETE )4.4 e° 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 444. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET ,6�" THE REQUIREMENTS OF THE N.Y. /STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR W a4!r1L DESIGN OR CONSTRtJC M WOMB ( ss 0XIMY W ..... . . . . J �.... fu • ... !^. .. . ..Ixtinlq du y c.x,rn, delk,ses 111X1 says Ihat Ire is the appl icaol. (Narre of irxlividual signinl; contract) ;dx,ve ruxrrxl, Ik! is lire .... ..... .... ... . . .. ..,......... . .. ... ....... . .... ..... . ................ .... (Cc)1rlracLor, ai;ent, corlxrrate officer, etc.) of said ow(►er or owrrc:rs, 1111d is duly 1n1thorized to IxQrfor►a or have 1x!rforllKtd the said work 111X1 to 11Krlce 1110 file Mia shpt kation; (hill: till. sLat(-31x1 l:s contained in 1.1jis ,ppl icat iorr are tioe to the heal: of his krx,(,Ledge 111X1 lxel ief; ilod that: Lhe- wcnlc will be performed io (lie IIFa11rer sets I-olt.11 in lire applical:iun filed therewith. ,)worn to II7 fore nr_ (his �-- .. .......(.. ...day of .... . t,lotary 13T)oic azA— ............ . CLAIRE L.GLEW ... ........... Notary Public,State of Now York (Signa(:ore of Applicant) No.4878505 Qualified in Suffolk County Commission Expires December 8.15 t I � ov 0 0 s C.14 EL EAIvOC? .10 tic t s t�.r•sr„�- :� � `t JGUTHG�.,�� N. Yr Ir e • <:::�G�Yom,.��-��lt��:, -,�-��,�-��f�;tai�, �� /� o C Va y 74:,l C:� l �~ %�w r h�� VSA � � r� • y a--�- I ve Vr'`