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Home My WebLink About23823-z I' I Ie 1.11 IlI:il'lee I It II I 1l1~1'l1l1T IMn: eOlltJEIHti .....~,...,...,_......,....".""'.............. ..........-, - ""~ii r,'~_"'_'__~__'~'_"_"'~"_ --"..-.....,.. ~'-~-...--~~M~ft...~~~~._"..r,...__,~_______ 'W q r, .~ n TI 11lltlll^TION ( l!iT ) "I. ".... ~. - - n__m' , ---. .., I/IIIMT LOll UIIIl) Y-\ .~p'r~~~~"~~~~~=~~~"a~~~~ .. ... " T""'"1'"O,..,.,."...........-~,...,..~..._._. -..=..-r=-O:>7n-,.-""'n-,.,...n=-,..,...n......... ~- _Z 0 1111:11 FnMlI~ A 1'1. I/H II I ~I(: ... .....-- _. .. ~ _._-~-_. r ~~~==~~~~~=~~~...=R_~mft_~ ......,.,.,........,..,....,""' .........,...... '"' "..,.., ",... "''''':n,.,...., "" "'" "..u.... """"" '" "" '" "" '=;"l:t1 "" ""'1"2 """" "'... ""..... III '""""..._"'.... 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U lAC/V <-' / -- .- .. -~-- V -- ~." <...~...~.~..~.. ..,-~- .... . ..}L-_.._.._.~m.._..._ .._..... F , ..~..__._-~~~.-._.- .~.~--..---_..__.~-~ ,'''--''-- ... -~., -...--...~. i-..----~,--,....-....~ '~W', .. ....,. \ , b' ,. - .. __.n .....~---'--- -{ --. .... .. r , I --, ,. 1'0 ..... III ~ ().l ~ W ~ ~ \~ ~ v-. r ~ .~ \ I j ) J ~~ .~ ~-\;; ... , ,;1 ,(: ~ t:J 'i ~ I I~OBM NO. O 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) ~T.° 23523 Z Building Inspector. Rev. 6~30/80 FORM NO, 1 TOWN OF SOUTHOLD . ~ 1:':"~ BUILDING DEPARTMENT; TOWN HALL , , , SOUTItOLD, N,Y, 11971 ,','/' ' ~ <', ~ TEL.:765-1B03 Examined .... 19..~ · /, ~PPLICATION FOR BUILDING PERMIT B~)~(RD ' OF * HEALTtl SURVEY ............. 0 .... CHECK ......... ~ ......... SEPTIC FORH ............. CALL HAIL TO: Date {~2(<T~,,, INSTRUCTIONS · a. This spPlication must be con]pletely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 set, s of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan sbowiug location of lot and of buildiugs on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property mu~t be drawn on fire diagram which is part of fids appli- cation. c. The work covered by fifis applicafion may not be commeuced before issuance of Building Permit. d. Upou approval of fids application, tile Building Inspector will i~sued a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No buildh]g si]ail be occupied or nsed ill whole or hr part for any purpose wbatevei' until a Certificate of Occupancy shall have been granted by the Building luspcctor. APPLICATION IS IIEREBY MADE io the Building Department for the issuance of a Building Permit pursuant to the Building Zo,e Ordiuance of the Town of Southbld, .Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descrlbbd. The applicant agrees to comply with all applicable laws, ordinances, build',u)g code, housi~fiode, and regulations, and to admit authorized i rspectors on prenlises and in building for necessary in, scegzlons. \ / /) . .-< ....... i. __ (S~na~'Gr~Vf"~rfican[;~or name, if a corporatiou) . . .. . . (Mailing address of applicant) State whether applicant is owuer, lessee, agent, ~e-~'t_~, ngineer, generai coutractor, electrician, plumber or builder. (as on tile tax roll or latest deed) If applicant is a corporation, siguature of duly authoriied officer.' $' '~-" (Name and title of corporate officer) Builder's License No .......................... Plumber's License No...' .... ' .................. Electric a ] s License blb ..... ~ ................... Other Trade's License No ...................... 1, Location of land on which proposed work will be doue ................................... , ............... llouse Nmnber Street tlamlet Cou'ntyTax MapNo. IO00Section .../ff,3.¢ .......... Block ...//. ' Lot .... .c,_.~. ............ Subdivision .,; .......... ;.--: ..................... Filed Map No ...... ~-.- ....... Lot ..... ~ ....... (Name) 2. State existing use and occupancy of premises and iuteuded use and occupancy of proposed construction: ti d y a. Exis ilguse all occtlpanc. . . . . . ~. ~ ....................... b. h)(e.ded use a,d occupancy , f~ ~).~-,~ .... P. epair .............. Removal ..... Estimated Cost /J -'..2),,~/¢20,o. Nature of work (check which applicable): New Building " · ..... Addition . · .'~ .... Alteration ~.; ..... ...... Demolition .... : ......!.,. Other Work ............... (Description) ........... Fee .......... ! .......................... (to be ~aid on filing this application) 5. If dwelling, nnmber of dwelling units .... / ....... Number of dwelling units co each floor ..... "-7 ........ . If garage, nnml~er of cars ........... '2. ....... ~ ' . . If business, commercial or nfl.xed oc~u >ancy, specify nature and extent of eac I ty ................... 7. lhmeosionsofexistingstmctures if any:Front .... ,~ ( Rear ,~}oftse Deptb..~D.(.~.. lleight ,..2~[ ........ Number of Stories ....... ]. ' ' Dimension~,~f me ?ructure with alterations or add tions: Front ~ / i ~ / Dept ~ · .": ~ [? ..... tteio it ¢ ~ t .... ~ ..... I ..... Rear ...~¢.~. .......... ...... ~ ....... ~ ............ ,.; Number ofI Stories .... ~ .... '.; .......... 8. I ll~nslons of enhre new constmchon: Front ....... w.~7...; Rear ...... F:i ....... Depth .... ~7. ........ lleight ...... ~ ...... Number of Stor es ...... -~ . 9. S ze of lot: Fro ~t ~ ' . . Rear /~ ......... ' ..... IL' ' '. ..... ~/~ ~'~ .............. 10. DateofPurchaso ':~]t~Z~(~ ..... :'.. ~'~'/~;~d:;": ..... ~?t"~2T ............ Il. Zone or use district in ~hicl<p;emis~s aro situated. ~-7.~ ..... n.n. tr.uF??~.~f,:t~/::. F~:....... ..... 12. Does proposed constrnctJon v/olat~ any zooing law, ordJnau'ce or rem lation, o~ . ' ............. 13. WII otberegraded ~o .. m ~_0 ~ , ' ' ~ ...................... ...... ] .. .................. wm ~xcess un oe remove0 lrom premises: Yes ( N~ , . ~, ~ ~, · , ............. [ ....rnone l~o./.~.~, ~cv(~... ' Name of Arclutect~.~ZC~/,~ ~ ~/~,,~ ~ddress~~)0, ~d , Phone N~ Name of Contractor :{o, .~. c/cff~FlWlCma[ ....... Address .... ~- ,; , Phone ~ -- ' [5.' I,s this property u~thtn 300 feet of a tidal wetla~¥? '~ye'~ ..... I''~ ................... . ~If yes, Soucbold Town Trustees Permit may be roq. ;fi2" " ....... . PLOT DIAGI~M . Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensf6ns from' property lines. Give street and block number or description according to deed, and sho' v street names and indicate whether interior or corner lot. CTATE OF NEW YOJ~, . , - ~ ' ......... ~/~ ,A,( ~, ~ , ,, ~. ~¢~ ~ .4-.4'~ .4,~ ...... being duly sworn, deposes and says thai he is the applicant (Name of individual signing contract) ,bore ~lalned. ' I le is the .............................................................................. (Contractor, ageot, corporate officer, etc.)[ .f said owner or owners, aod is duly autborized to perform or }lave performed tim sflid work and to make and file this pplication; that all stntements contabmd in tl~is'npplication are (me to the best ofh s~ knowledge and belief; and that the mtk will be pe~ fox, ned in the manner set forth in the application filed therewith. worn to before lne~h~ '; ~]ol~W PubF~ StatoofN wY . // ~' ~' ' ~ ~ (Signature ora ca~t H0.49~SS63, Suffolk County ~ //~'~ ' pp ' ) ~ e~m Expires Sept. 3, 19~ ' ~ ff~ ,