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Home My WebLink About20297-z FOBM NO. ~ TOWN OF $OUY~OL~ BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 20297 Z Date :/...: ........... , Permission is hereby granted to: -- .......................... at premises located at ....~;,,~,...,~..~.....~..~ ................................................... County Tox Map No. 1000 Section ....... ../../.~.. ....... Block......................~ Lot No ..... ~.~. ............. pursuant to application dated ..... .x/~...../.../....~.. ................................ , 19..~./.., and approved by the Building Inspector. Rev. 6/30/80 , ,. . [ .... , , , , ~- .... .. ~ ~ ~ :.~ . ~ ~ ~ ..~,. ", ~ ~ ' ~ ~ .~ ~ ) . I . ,... . .' ~ ,~ . ,~ ~ / ~.. . ~ ' ' :~ '. . -:':'.., .'x '~ -.' '~ / .~ : ' ' ' ' ':. ~.~¢~7 , ~" , ::'" ~' -' '"~ d ~ ' -: / ~ H .' ' '1 SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVtCES FOR APPROVAL OFCONSTRb'CTION: OtlLY . DATE HS .REF NO APPROVED THE WATER SUPPLY & SEWAGE· DISPOSAL'FOR THIS RESIDENCE WILL CONFORM TO THE ' STANDARDS" OF 'THE SUFFOLK COUNTY," DEPARTMENT OF- HEALTH '.SERVICES " ADDRESS TELEPHONE )ARANTEED ONLY TO ~F_. -1-i'FLF- C')UA~N'TE~_ SAG ~RBo~ SA,briC5 ~1( ' ". L ',ROLD ¢ ~RANCNON ~ NY2 LIQ NO~04~992" PENN. LIC. NO. 21115-E 'J~)B NO, 7(~-_-~,0,~, FIL& NO $1RvEYED FOF? ~N~[]NI~ 4 I~ll DA :Jl~lNF~. SITUATED AT: TOWN OF ~UTflOI.D - SCALE. I''= ~O' DATF' ~]L~ 17. 1'17~ ~ I:...' FILED MAP NO: DATE. BOOK NO.' H/~ROLD E TRANCHON JR. P.C, LAND SUR VE ¥OR · SUCCESSOR ,TO WILLIAM 6 N1EipR NORTH COUHTRy ROAD-'WADING RIVEN NY ' 929-4695 , · ,':. (516) ~;'3-3b~O ALT. C.ALL NOV 2 01991 ,! FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 BOAKD OB HEALTH ......... 3 SETS OF' PLANS .......... SURVEY ................... ClIECK .................... SEPTIC F'ORH .............. Exan]ined . / ..... '., 19 Approved .... , 19 Permit o Disapproved a/c ..................................... APPI~O,VEO AS NOTED, ~- ..~ NOTIFY BUILDING DEPAR~Em AT . (B~ding~;it~rC FOLLOWING INSPECTIONS: APPLICATION FOR BUILDING PER~JT 2 ROUGH- FRAMING & PLUMBING 3 ~NSUL.ATION ZNSTRUCTIONS CALL .................. FLAIL : 4. ~N. AL -. CONSTRU, ION MU T . ' · a. ;[~¢~1~'6~[!~.~e comp~tely filled ia by Wpewfiter or in ink and submitted to the Build~g Inspector, with 3 ,~ts o~k%~ht ~e ~ Fee according to schedule. 5~I~[~ l~t~o~9~ and of build~gs on premises, relationship to adjoining premises or public streets ~,~5[l~q2~~e~d~n of layout of property must be drawn on the diagram which is pa~ of this appli- ..... n,'OES NCYr ~ESPONSIBLE FOR . c, .r:T~qv~yg[~~~tion may not be cbmmenced before issu~ce of BuQding Permit. d. pp~p ap'broval of tlus applibation the Building Inspector wil issued a Bufld~* P ' ' . . <~.,.. ._ . ......... emzt to the applicant Such pe~it ~mt De Ke~ on t-he"pr~b~':~a~-b ~-for~spectlon throughout the work. e. H~: building shall k?~,occp~ied or used in whole or in part for any purpose whatever until a Ce~ificate of Occup~cy ,hall haVd~ b:a~ k~"k~6~ Ap~L(%~'i~¥L)~ AM ~fD ~t P6~ FOR THE l}kJ,~J~,~ ~$~~ADE th- the Build~g Dep~ment for the issuance of a Building Pemit pursuant to the Juildin~ ~':~r~-~cd-6f[~OlS~outhold Suffolk County, New York, ~d other appncable ~ws, Ord~ces or {egulatio~};~qrO~pO8~ ofbu2-~mgs, additions or alterations, or for removal or demolition, as here~ described. Fhe ap~li~bt~[eeg~R~f¢~~ K~plicable laws, ordinances, building code housing code, and regulations, and to ~dmit a~lt~n~f~;ctG~ on'premises and ~ build~g for necessaW inspe~ A*L CONSTRUCTION gMAt& ME~ , ~/;oTa~ii~', r name, if a corporahon) CC, DES. N~ RESPONSIBLE FOR (Mailing address of applicant) State ,~[~JgP P~?~T~Ugg~,E~agent, architect, engineer, general contractor, electrician, plumber or builder. ............... ~~ ....... ........................................... (as on tha t~ mH o~]at~st dead) (Name and title of corporate officer) Builder's License No .... ~..~,<. ............ Plumber's License No .......fid/..~. ....... ' ...... Elcctrc an s L~cense No ...................... Other Trade's License No .... ~ff/~. ............. Location or land on which proposed work will be done .... /.a:'. ~7.~....././~.~..~.,~...~....(~ ..... ............ .............. ...'. ........... llouse Number Street Hamlett County Tax Map No. 1000 Section .... /../.~. .......... Block ...... q .......... Lot Subdivision Filed Map No Lo (Name) · State existing use and occupancy of premises and intended use and occupancy of proposed constructioh': a. Existing use and occupancy ~..~[i..~?..~.. b I d d d re~ .~..,.~ ' · nten e use an occupancy ......................................................... 3. Nature of work (check which hpplicable): New Building .......... Addition .. . Alteration ......... Repair .............. Removal .............. Demolition .............. Other Work .............. 4 Estimated Cost ~.~:'~ (Description) i (to be paid on filing this application) 5. If dwelling, number of dwelling units ............ Number of dwelling units on each floor. · If garage, number of ' ' ' · .............. cars .... ' ................. . ......... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................. 7. Dimensions of existing structures, if any: Front.. · Rear . He ght Nuln' . - ' ........................ Depth ......... ........... . ocr otStorles ................. · ..... With .... Dimensions of same structure alterations or additions: Front Dept ~ .... · ................ Rear .................. · '. · .......... i... nmgnt ......... ~ ....... Number of Stories ...................... 8. Dm~ensmns of entire new construction: Front ...~.. i · · · Rear ............... Depth ............... Height ............... Nu~p ber of Stories ......... 9. Size of lot.' Front , ' ........................................... .......... : ............ Rear ............... Dept~ 10. Date of Purchase ...... · .. ..................... i I . · ..... Name of Former Owner ................... · Zone or use district in which pr raises are situated ...................... ii'i ............. i. 12. Does proposed construction rio ate any zonin aw, ordinance or regulatio Will lot be regraded . . ~ 6f p ...... * ................... Will excess fill be removed from premises: Y. es No 14. Name of Owner remises ................... Address ................... Phone No ........... Name of Architect .... ~ ..... .... .................. Address ................... Phone No ................ Name of Contractor ........ i ..... · Address ................... Phone No ......... . ........ 15. Is this property within 300 feet of a tidal wetland? *Yes ........ No ..... · If yes, Southold ~own Trustees Permit may be required. '''' .. ; PLOT DIAGRAM Locate clearly and distinctly alli buildings, whether existing or proposed, an&indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or coruer lot. (Nam; o72~aik}afi~i .......... ' ~ duly sworn, deposes and says that he is the applicant )ore named. is the (Contractor~ agent, corporate officer, etc.) said owner or owners, and is duly ' ' , authorized to perform or have performed the said work and to ~nake and file this plication; that all statements containdd in this application are true to the best of his knowledge and belief; and that the 2rk will be performed in the rammer se~t forth in the application filed therewith. 'om to before me this Pubhc,i State of New Notary ~y Corem ss on Expires June 9, 199~,. p] t)