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Home My WebLink About22898-zFORM NO.3 TOWN OF $OUTHOLD BUll. DING DEPARTMENT TOWN HAM. $OUTHOLD, N.Y. N9 BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED,~ ' ~/,-./,,~...,'..z.. , ~..~..=...~ Date ................. .~... ~ ..................... 22898 Z / Permission is hereby granted tQ;---~ ~ .,,'7~, / J ~~..:...~...... ~:/..,~ ......... ........ z~....~ ..:....~......~ ......... ......... :~~.:~...~:~ ............... ........... ........ ~......~~:....~~:~..:~~. ............................ OounNTaxMapNo. 1000 Section .......... .~.....,/_~..... Block .......... .',~.... ........ Lo'No......~......~.... ............ pursuant to applloa'~lon dal'ed ....................... ~.. ............... 19.. , and approved by ne Building Inspector. Fee $..~...,~,,. .............. Rev. 6/30/80 Building Insp~tor FOI1M NO. 1 · t , 1'OWN OF SOU'IIIOLD BUILDING DEPAI'I'I M ENT 'IOWN ItALL SOU I IIOl_l), N.Y. 11971 I)isappmved a/c ' ' I~STRUCTIONS ] SETS OF I'I. AHS ......... SURVEY CIIECI( ................... SEPTIC CALl, : ............. tlAI]. TO ' a. This alq)licalion must be complelely lilled in by lypewliler or in ink and submilled to Ihe Buihlin~ hlspecloh wilh selsoFphms, nccuraleldolplan Ioscale. FeeaccmdlnB lo schedule. b. Plot phm showing Igcalion of IoI nnd of buihlin~s on premises, ielalionship lo ~(I]oinin~ premises or public slieel or areas, and giving a detailed description of layoul of plopeHy musl be IJlaWll OR Ihe diaglam which is pall of this al)l)t cation. c. The xvork covered by fids npplicnlion may not be commenced before Jssuallce O[ Building Permit. d. Upon npprovnl of Ihis al)plicalion, the Buildh~B lnspeclor will i~sucd a Buihling I'eHnit Io lira npplicanl. Such prom shall be kepi on Ihe luemises availnble for inspeclion Iluoughout lhe wink. e. No building slmll be occupied or used in whole m in pml for any propose whalever radii a CeHificnle of OcculUmC shnll have been Branled by lira Building lnspeclor. AI'I'I.ICATION IS IIEREIIY MAI)I~ 1o Ihe Ihdhling DepaHmenl for Ihe Jssualme o[ n Buihlhsg l'eHnil pulsuanl Io Ih I'hfitdin8 Zone Ordimmce of Ihe Town of Soulh[]hl, Suffolk Comity, New Yolk, and olher npplicable l.nws, O.limmces ( Reguhdions, [ol Ihe consh-uction of buildings, nddilions or Mlemlions, or for ]emov01 ~ I demolition, ns herein descHbe~ The apl)licanl agrees 1o comply wilh all alq)licnble laws', mdinances, bhihling code, housing code, and ~e~ulalions, and t admil nulhoHzed iuspeclms on plemises and in buihling roi necessnry inslmcli(ms. ............. " (SJgnahue of npplicnnt, or name, if a coHmlalion) (M~iling address of ~pplicmd) j~/ Siale whelher ~Hq)lic:an{ is owne~, I~ssee. age/il, alchilecl, engineel, genelaJ conhaclor, elechician, plural)er m builcle .... ~et ............... II'npplicanl isaco~po~alion.siBnalu~'eofdulynulhod~ed ol'fiber.:;~''' ' ': ~ FEE.~i (Name and lille ()Ir (:mpolal¢ ollicel) Ih Iltl(,~ s l.iccnse No .......................... Iqlmlbel's I,ice, nse Ho ......................... Elech ichm's License, No ....................... FOR THE FOUNDJTJON . REQUIRED F:~J~ou~EJ~IpNgRETE ROUGH --FRVA'IV~IN~ & PLUMBING MUST C.O. ALL CONSTRUCTION SHALL MEET , THE REQUIREMENTS OF THE N.Y, OIher'l'uMe's I,icense lqo ...................... STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR I,ocalion of hind on which proposed worn k will be done ............... PE$.~N.OR,~s~uCTIoN ~ROR~ .... Ih)usc Number Sheet I lamlet Courtly Tax Map No. I000 Sccl ou ............. Subdivision ..................................... Filed Map No ............... Lot .............. (Name) .";hHt; existing use and occupancy of p~emises ~md intended usc and OCCtll)amlcy or proposed,,conshuclion: a. Exisli,,g use nmi occ,,pa,,cy .... ....... (. F~ ~{ ..... ('fr~ .............................. l(uJ);lil .............. JLCIII ]VIII .............. , ........ w,,,k ...... 'l. J~slJlllaled CosI ........... ~ ................... Fee ...................................... (1o b~ I)aJ(l oll [ilinB Ihis ap )lJcMion) 5. I[ dwelling, llillllJl~l, o[ dwelliu ?nils ............... NIIl~ll)el' o[ dwellinB unils ou ~[loJl floor., . I[JJ~FllBe,llUIIIj)el'O[gll[s , . , ' .............. ~ ify IYl df ............. [i, JJ JIII[iliI~SS, CoIlilllel'cjllj of IliJxe OCaUI)IIIIey~ Si)go Ililllll'O lllld ~XJ~llJ Of [~liOJl ]e [JS~ ....... 't. J ItllellSlOllS Ol exJsIIII[ ~lnlchlrqs. J[any: J~l'Olll ............... l(e~r J)eplh iBI ...... lie Il ............... Nuu her ors o ~ ''" ..... ' .............. ( t~ ........................................... ' ..... ) Ille sJo S Of SJllll~ SlnlC 'U e W I Idleralions or addJliolls: Flolll ' ' ...... ................. ~ Rear .., l)elHh ................... ' l lei[hi . , . , Number of ~lories .......... ~. I)illlellsJons o[ ~lllJl'e ii~w ~Ol Sll~llclio J;l'olll .............. : I(ear . .............. DoiHii ............. '. , , g. ~ Z~ OJ' O ; ) Il ~ ' ' I(e~r . . ) ) I ............... J0, Dale o[ l~lll'ohjl~e . I .......... j ......... ' ......... Nllllle o[ Folmer Owner ......... I I. &()lie or use dishicl ill which pi5 I ses lite silual~d ' ........... : ....... J~. J)odS J)ll)J)osed c ) sJlJ ~ IO v'oJ'~ e I ~ ZOlllli~ IJ~V~ ' ' '' 'ii. ~VJJi I~)J I)e CBt ~ ' OIdlIIliITCC Of leBtllalJOlJ: ................... . .......... .......................... Witl~xcessfi berciov d r ' . , HiHDO O A d ec . - SS/. ................. I Ilolle N().~ ........ ......... , ................. It(lille,S ................... J~hoIld NO Jqllllle o[ (-oIIhllclof , ........ i ................ Add ~ss ..... J~. I~J I:hl.s prop2~'l:y wiLhln ]~)) feel: o~ a tidal '~4eL[flllcJ~ ........ ' ...... J~hollc No ................ :' I'1~O'1' I)IAU RAM ~(c la :ea~ y I (isl lc y b Igs, wile er exlsli~ or )lo~ose( , , , . plOl)czl~ lilieS, (]IWS r~Cl ill( )ockl'u b 'o < ~ I,,~ , f I ~ I nl.l(.lll(llOale MI sd back (,llllCliSlOliS JllJ(~liOl'OI COl'lieF JoJ , I f--o-~--~ .......... OI(HII~ IO (1~0(1~ dll(I BIIOW SJl'e~j IlilllleS ~ll(J llldle~Je wJi~JJie[ - (N~lm~ of h~fli.vith.~(I ~t~nit~ c<mh';~cl) 11 . . ~ :. I~ ? lie i~llte'..,: . .,.: . . t ................ ' " / ' ol sldd owner or owners, m~d is dulyiaulhoHzed h~ p~onn or have p~rEormed Ihe said wink and Io make and fil~ IlJis applicalion; Ihal all slal~m~nls conlai lcd ill Ihis ~l)lAicalion ar~ (rue 1o lira bdsl o[his knowlmlB~ ami belial; and Ihal Ihc wo~ k will bc p~i Jorm~d in lira manner ~el [orlh in lira apl)licalion filed Iherewilh, ' Sworn Io hcJo~e me Illis ........ ....... ' , ...... ~ ........... ~omm~sSion Ex~ ~u~?~ Coun~ ~ ~