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Home My WebLink About23494-z TOWN OF SOUTHOLD ~UILD~NG DEPARTMENT TOWN HALL SO~O~.D, (THIS PER~IT MUST BE KEPT ON THE PREM SES UNTIL FULL COJ~PLETION OF *THE WORK ^UTHORIZED) N.o 2349~t Z , ~o ~.v..~--,~7,?~.'-~- .. ~,~,.~..:...~_--~,~ , ~. '. , _ /~ / ~ ~.~..~~-~.....~~..~ .................. ~~;-j-~j ~' ~J .~~~ at premises I~ated at~ ~~': ......... ~.~:~?~;~, ~'~';c .......... :' - .............. ~~ ....................................... .' ~a~ w~ ~ ~o. ,0oo s~,~o~ ...Z~Z .......... ~,~ ..... ~ ............. ~o, ~o....i~Z ........... pu~uont tO opplicotion dot~ .... ~ ...................................... , 19...~'ond opprov~ by ~e Building 16spector. ~g nspector .............. Rev. 6/30/80 APPLICATION FOR BUILDING PERHIT INSTRUCTIONS BOARD OF IlEAl,TH ............... /O SETS OF PLANS ............... IIEVEY ........................ ltECK ......................... EPTIC FORH ................... NOTIFY: ~ , ~ ~' .. .a~..-c~..c../:~...~? ....... ............ l.~..~.ff..~. ........... a. ~his application mJst be completely filled in by tyl~.~riter or in ink mgl ~l~itt~ to ~e ~dldi~ Ins~ctor with 3~ts of pl~s, ~ate plot pl~ to ~cale. F~ aeco~llng to sd~de. ;~ b. Plot pl~ fl~ing l~ti~ of lot ~ og hdldit~s ~ W~s, mlatlonsldp to ~joinlng prmi~s or ~bllc str~ts or areas, ~1 glvi~ a {htail~ ~rlptlm of l~t of ~rty mqt ~ dr~ m ~e dla~ ~fid~ is ~rt of this a~l icatlm. d. U~ a~al of fids a~licatlm, t}~ h~ildlo8 Ins~ctor will ism~ a ~ildi~ Pemit to the a~lleant. St~d~ ~mit ~all ~ ~pt ~ tlw ~i~s ~ailabl. o for ins~cti~ th~O~t the ~rk. e. ~ hdldi~ ~mll ~ ~o~i~ or u~ in O~le or in ~rt for a~ ~t~m ~mt~r mtil a ~rtlficate of ~ ~ml[ h~ I~n ~ant~ 1~ tl~ hfildi~ lns~tor. A~,[~'I'[~ IS [~g~ ~l~ to tl~ hfildlng l~rtmnt for the ismm~e of a l~ildi~ Pemit ~rmmnt to the ~ildi~ ~ O~i~e of tim '~ of ~t~ld, ~[folk ~mty, ~* York, a~ other a~licable I~s, ~llm~es or ~lati~s, for tl~ ~st~tim of lmildlngs, a~itlms or alteratims, or for r~al or ~litlm, as lwreln ~ri~. ~ a~llc~t ages to ~]y with all a~llcable 1~, ordi~mes, h~ilding re.latins, a~l to ~it ~t~rlr~ in--tots ~ ..... ", (Si~atum of al~llcant, or m~, if a cor~ratloo) State O.tt~ a~i~>~r, les~, agent, amldt~t, ~ o~ ~ o~ ~.~ .~.~/L. ~.~?~ ................................................... (~s ~ tl~ Lax mit or latest d~) If a~llcant is a m~ratlm, si~tum of ~ly ~tl~riz~ officer. (Name and title of corporate officer) Boilders l,icense No .......................... Plt~bers License Eo .......................... Electricians Licen~ ~ ...................... Otter ~'s Li~n~ ~ ..................... 1. I~atlm of lam m ~id~ ~ turk will 1~ d~ .............................................................. .............................. ~ty Tax ~p ~. I~D ~ti~ ...~ ............ B/~k ................ I~t ................ aaxlivlsi~ ...................................... Fil~ Bap ~ ................ l~t ............... (~) 2. State ~isti~ um aid mm< of,~i~s aM int~ u~ ~1 ~ of ~ c~stmcti~: ,. n. .... ..... ........ I0. Il. 13. 14. 15. N~lture of ~tk (dmck which nl~)licable)~ l~.~ Ikdhlin (tO If garage, ~dmr of cars ...~ .................................. If Ixmilmaa, cxmlercial or mi~l ~:tnqm,~y, almci~ ,mture al.I e~ten(; of each t'yl~ Ge use ...................... Dinnnai~m oP ~ia~ing atnmtt}rea, ie any: I?ra~t ................ l~ar ............... I~pth ................. I~i~tt ...................... {.. a,dmr of Stories ...................... I)innnaiam o~ sam atnmtnre ¢ilh alleratitma or ~klitiona Fr~rt .......... l~ar ............... I}i,mnai~ma of entire ~ ~mtrtml'i¢au Frtml: ................ [~ar . .............. ~l)lh ... I~lte of l~lreha~m Ikms proln~l c~ml:~tt~* viSlate any ~fieg PI.O*I' Ixx:aLe clearly at~l distinctly; all Duihlings, ~dmlher enial:ing or prol~s~l, mgl it~licate all set-link dineeaiona Prixs prolmrt'y li~ma. Oi~ strut alii bilk aa~Imr or &acrlptkm according Lo l~ed, m~ d~ street lumina m~l ialicate tdmtlmr leterior or co~r lot. .. 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL THE ~EQUIREMENTS OF THE N.Y. STATE CONSTRU~ION & ENERGY t;tA'll;(a~ A~,~ // CODES. NOT RESPONSIB~ FOR tXX,N,~ (~ ~.~~.~__.. Ss DESIGN OR CONSTRUOTION ERRORS ' (Nme of i~xl[vi(hml signing i. ,,,. ............... ..................................................................... ((kmlractor, ngen(, corlx)rate officer, etc.) of said ~r or ~n-s, e~l is duly auHK~iz~l to l~r[onn or haee [~rfon~M th~ said ~l~ m~l LO n.qke application; tlmt aH 8tatca~e~s cOntai~M in Ibis alqdication are tn~ te the I~t o~ his k,x~k~lg~ m~l I~lief~ s~xl tidal the ~n'k ~iH I~ I~[onl~l m ]lhe n~m~r ~t forLl~ in Um appl ication filed tlmr~ith. CLAIRE L, GL,EW Notap/Publio, Stere ~of Now York No. 4879505 i Qualified in Suffolk COunty Commission Expires December 8, 19.L~ / (Sig~ml:ure of ApplicanL) P20"E ~Z25 ~ 03. 5' 0 74. 7' ',HEO~ MAY 131 BLDG. DEPT. TOWN OF SOUTHOLD ..~ CERTIFIED TO: ALL STATE ABSTRACT coRf~. FIRST AMERICAN TITLE iNSURANC£ COMPANY OF NEW YORK. : TERESA PADULA ,.':"D~TBUSH IFEDERAL SAVWGS AN[~ LOAAI 2z2'j ;I 33, o6 S.F. : 0.7692 Ac.~ suRVEy o StTUA~'~ AT MA tTItUCK TOWN OF. SOUTHOLD SUFFOLK COUNZY~ NEW YORK SCALE i~; = 40' AUGUST 8, t994 EASEMENTS ANO/OR SUBSURFACE STRUCTURES RECORDED OR ,UNRECORDED ARE NOT GUARANTEED UNLESS PNYSICALLY EVIDENT ON THE PREMISES AT THE TIME Or SURVEY. GUARANTEES INDICATED HEREON SNALL RUN ONLY TO 1HE PERSON FOR WI{OM TIlE SURVEY PREPARED, AND ON NIB BEI~LF TO TIlE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTIONS LIS~ED HEREON, ,)IND. FO THE ASSIGNEES OF TI{E LENDING INSTITUTION, GUAR/WTEES.ARE NOT TRANSFERABLE TO AODITIONAL INSTITUTIONS OR SUBSEQUENT O~YNIT',q THE OFFSEPS(OR DIMENSIONS) SI/OWN NEREOh FROM R{E STRUCTURES TO THE PROPERLY LIN£5 ARE FOR A SPECIFIC PURPOSE AND U5lv AND TNEREFORE ARE NOT INTENDED TO GUIDE THE ERECTION OF FENC~.~, RETAINING ICALLS, POOLS PATIOS, plANTING AREAS, ADDITIONS 10 BUILDINGS AND }INY OTI/ER CONSTRUCUON. S.C. 1;M. DIST, 1000 SE[;. AMERICAN ENGINEERING SERVICES WesfbDky, N.K l~~omo, N.~ ~779 -2487 lY~ 0894M