HomeMy WebLinkAbout22926-zFORM NO.3
TOWN Ol: $OUTHOLD
BUILDING DEPARTMENT
TOWN HAM.
SOUTHOLD, N.Y.
N? 2292G Z
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Date ' ~ ' ,
Permission Is hereby granted to:
.~.¢t~.~...~..o~..¢..,.o.....£.a.L~.~..o. ..............
.~o../....../.)~..u.~,c...~~ .............................
. , . . . /. ./. . . . . . . . : . . z c .
to..~~..~z,.. .......... ~ ........... ~.z:.. ....... ..~.....~.....~ ......... ~ ...................
..~, ./..Z...~.~ ........... ~.: ...........................................................................................
.......................................................... .~.~.~..~.z~.,.~ ...............................................................
CounhJTax Map No. 1000 Section .../i~, ,~,.. .......... Block .,....~...~.. ............ , Lot No ...... .~.. .................
pursuant to application dated .............. .~/..~.../.. .............................. 19....~...~....., and approved bvthe
BuS,ding ~nspeolor.
FeeS...~ ......
/ ~/ / Building Inspector
Rev, 6~30/80
TO~
FORM NO. I
'1 OWN OF SOU IlK)lA)
13UILDING DEPAI1 IMENT
]'OWN IIALL
SOUTIIOI_D, N.Y, 11!)71
TEl..: 765.1803
I)isnpl)mVed a/c '
APPLICATION I'C()t{ BUILDING PEI{MII'
C A 1, l, '.~l~i~ .......
I/A I I. TO:
Date 19
INSTRUCTIONS
n. This npl;licalion must lie complelely filled in by lypewriler m ill ink nnd submilled lo Ihe Buihling Inspeclol, wilh
~cls of phms, nccurale plol plan lo sortie. Fee nccmding Io schedule.
b. Ptol plan showing Ipcnlion of lot an(I of lmildings on l)mmises, relalionship Io adjoining p~emises m pul)lie shccl
'or incas, and giving n dehdled desc~iplion of hwoul of properly musl be dH~wn on lira dingum~ which is pad of riffs aplfl
calion.
e. The wink covered by fins npplicalion may nol be commenced before issuance of Building Pennil.
d. Upon lqN~rovnloflhisnl)plionljon, lheBuildinglnspeolorwillbsued al}uihlingPe,mitlothenl)plicanl. Such
slmll bo kepi on Ihe p~emises nvailnble for inspecUon Iluoughou{ Ihe wink.
e. No huihling shall be ocmq~ied or used in whole m in pm l I'(n any propose whnlever mflil a Cedificale of Occupant
shrill have been gumled by Ihe Building Inspeelo~.
Al'PlACATION IS IIEREBY MADE to Ihe Building I)epadmenl [or Ihe issuance of n Building l'emdl pmsunnl ~()
Building Zone ()~dinnnoe of II~e 'l'o~w~ of Soulh~fld, Suffolk Courtly, New Ymk, and olher npplicnbl~ Laws, Oulinances
~?:gulnlions, for the oonsh-uclion o[' buildings, addilions or alleudions, or for ~emovnl ~ · demolition as herein descfibe~
Ihe npphcanl ng~ees Io comply wilh nil applicnble laws, mdinnnces, buihling code, housing code, and ~eguhdions, ~md
admil mdhmized iuspeohns on p~emises nnd in building fo~ necessary inspeclions.
(Signahue of npplicnnt, or name, if acm i~oHdion)
(Mailing address of applicnnt)
Slnle whelher IiI)lHic:anl is o~vner, lessee, ngenl, amhilecl, e~)gineer, gene~nl conhaclor, elechicinn, phu;fl~e~ or Imilde~
OWNER - as of ,7/28/95
h[alllt: ()[ O~Vllel of p~emtses (ns on the Inx roll (n hflesl d'e
If applica,d is a uou~o,alio,i, sigm, lu,e of duly nulhotized
(~nmc and (Hie of colpolalc oHJceO
NOTI~ BUILDING'DEPARTMENT AT
BuihleCs License No .......................... 78~1802 8 ~ ~ 4 PM FOR THE
~O~NG INSPE~ONS:
I'lumbeCs I,icense No. 1. FOUNDATION ~' ~O REQUIRED
........................ FOR ~URED ~R~
2, RO~H - F~MING & PLUMBING
Eleci~ician's License ~o ....................... ~, INSU~ON
4. FINAL - CONSTRUCTION MUST
(*){he~ 'l'utde's ],icensc~Ho ...................... BECOMP~E FOR C.O,
ALL CONSTRUCTION SHALL MEET
I. I.o~ndon (ff hind on which pml)OSCd wink will bc done ..... THE REQUIREMENTS 'OF THE N.Y.
1140 CRo~ L~D ~D CU~C~OGU~, ~.g. CODES. ~OT RESPONSIBLE FO~
County Tax Mnp No. 1000 Section . 102 Block 07 ' Lot 11
Subdh, ision . .; .................................. Filed Map No ............... Lol ..............
(Nnme)
2. Slah: cxisling use Illin ()Cglll)[lllgy or plemises nnd inlended uso nnd occupallcy or proposed consltucliou:
a. Exisliug use nnd occupancy ....................................................................
b, hdemled use mid occulmnCy ..................................................................
Itcpair . ............. ltemOv~d 13emulilJon .... : ......... Olhei' ~' ~ ..............
'1. listinmlcdCost $5,000 [ . , (l~escJJplioli)
............. ~' · ........ fed
J (to be l)~li(I on filing this M~l)lic~dio.)
~. I~ thvellin~,r]i~t I~e~'0 r dwellh~fi ~ IHIs .... ~ .......... ~ul[iber of dwellinl] units on e~lch floor .....
. 1[ gantge, munber of c~u's ..... ! ........ 2 .......... ' ............ , , '
6. 1~ business, commolcJal or IIiJ.xe~l occup~ulcy, specify Imlur~ ~lld exle~H oFe~ch type df use ...............
el exlslhlg s ['tic [I e?, il' filly: I:mn( ' Rear , ............. l)eplh ...............
lleighl ............... Number oFS o' es , . ~ .....
' , ,
................. [(.,ir ..............
~?1 t ...................... lleighl ......... , ......... '.~ Nmnl~e[ ol'Slmics ........... : .........
}~. IJHlleltSJOllS o[ fllilJl'~ new collsll,llglJOlV. I'lOll[ .............. ; I[e~u' . ........... Del)
I lei dd ............... Num~l}e~' o[ ~lorles ......
9. Siz~ oJ'lol: l;[qnl ................ . l[e~r ' ' ~ ......... : ................................
10. I)~ eel ~ rc se ' : ........ [, ....... ~ ........... I)el)lh ......................
II, ' .......... ~ .................. n~lmo o[l,onne~ Owner
Zmle or use dishict in which )l~Jnlse~resltut ed ........ ' ............................
J2. I)oes i)lt)l)()se(I consh'ucholt vJolhle ~llly zonhlg J~lw, Oldlmlllce of [egtlhll~on: .......................
I ].
, ' .......................... Add,ess ................... Phmm
I%me o[ (.o.t~clor R~AD FENCE 421 RIVERLEIGH A~. ' 7'27~37'9'8 ....
l'eel: of a II(Iai '~e[~and7 ~Yes
~[~ yes~ Soul:hold '[~o~ '[~rusl:ees [)erm]~ may ~)e required, ' ....... .
P[~O'r DIAGRAM
Loe~de de;uty m~d disHncHy MI ibuihling% whelh~r ~x~sling or proposed, ,~.l,h}dic~l~ .~ s~-I~ack dim~.sions from
I~mpe~(y lines. {~iw sh'eel ~nd bJock i~umb~l or (lesclipHol~ ;recording Io demi, ~uld show sh~u{ immes and ilidJc~du wh~lhci
[nit, riel m' cornel lei.
!1,
being duly ~,VOl'll, del)()ses tutd silys II is (lie
s~li(I ()%Vllel o1' O~VllelS, flll(I Js duJyJ llHlholJze(J Jo i)af[Ollll or ]lflve ])el'J'O['llle(I rile slli(J WOlk itll(I (o Illflko JllliJ Jilu l]lJs
will be pet formed in Ihe IllfllUlel'Js(tl [Ollit iii IJlo fll)pJic~JJon [tirol lJiel'ewJlll.
SWOIII lo J)eJ'Ol~ IlIB IIIJs i
Notaw pu~ of K=w York '
No. 5~-8~25850, Suffolk Cou~ , (S grot tire of ;ll~plic~ml)
T~rm Expires October 3~, ] g~