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HomeMy WebLinkAbout25702-Z I~O1~4 NO. ! TO~Iq OF SoITrHOLD BUILDING DEPARTHENT TO~N H_AI .L SOUTBOLD, N.Y. 1197 I TEL: 765-1802 BOARD OF HEALTB ............... 3 SETS OF PLANS ......... ' ...... SURVEY ........................ CHECK ......................... SEPTIC FORH ................... NOTIFY: CALL .................. HAIL TO: .................... Dis,~ '~! a/c .................................. ', ?"i' _ :'Iii APPLICATION POR BUILDING PBRH'T ~hi 4 !~ ~i~ D~ ......... ~/X(~ ~ .... [ ~;~ ~ T~WN QF SOUTHOLD a. ~is ~li~ti~ m~t ~ ~letely fill~ in ~ ~iter or in 3 ~ts of p]~, ~ plot pl~ W ~le. F~ ~i~ W ~e. b. ~ot pl~ ~ l~ci~ of lot ~ of ~ildi~ ~ ~s, ~lati~ip to ~joini~ p~i~s or ~lic s~ts or ~, ~ gi~ a ~i1~ ~i~ of l~t of p~o~ ~C ~ ~ ~ ~ di~ ~i~ is ~ of ~is awli~ti~. c. ~ ~ ~ ~ ~is ~li~ti~ ~,~ mt ~ ~i~=~ ~fo~ i~ of ~ildi~ ~t. d. U~ ~,~ of ~is awli~ti~, ~ ~ildi~ v~tor ~11 ~t ~1 ~ ~ m ~ ~s ~il~le for i~ti~ ~t ~ ~. e. ~ ~ldi~ ~1 ~ ~i~ ~ ~ in ~le ~ in ~ for ~ ~ ~t~r ~til a ~ificate of ~ ~1 ~ ~ ~ ~ ~ ~ldi~ v~t~. ~~ IS ~t ~ ~ ~ ~ildi~ ~,t ~r ~ is~ of a ~ildi~ ~C ~t to t~ ~!~i~ ~ ~!~ of ~ ~ of ~ld, ~ffolk ~, ~ Yo~, ~ o~r ~li~le ~, ~i~s'or ~ati~, f~ ~ ~ti~ of ~ildi~, ~iti~ ~ ~terati~, or ~ ~1 or ~liti~, ~ ~in ~i~. ~ ~plic~t ~s W -..~.ly ~ ~1 ~lic~hle 1~, ~i~s, ~ildi~ ~lati~, ~ to ~it ~i~ i~tors ~ p~,~s ~ in ~ildi~ ~r ~s~ in~ti~s. .... ...... A ..... ............ ...... (Si~e of a~li~t, or ~, if a ~ratim) ~ili~ ~ss of ~li~t) S~te ~r ~limt i~ mr, le~, ~d~it~t, ~i~r, m~ral ~tmctor, el~trici~, pl~r or ~il~ ~ of ~ of ~ ..~.(7...~(...~q~..~g~ ................................................. If ~limt i* a ~t~, ~i~ of ~ly ~i~ offi~r. .... ................... (~ ~ tit~ 6f ~mte Electricinr~ Lic~r~e NO ...................... Other Tr';~'s Lice~e ~ ..................... ~ ? Z 3--~ d~-~ffl I. ~ti~of ]~~~~11~ ..... ~.~ ................................................... ................. ................................ ................... ~ ~r S~t ~let ~ T~ ~ ~. 1~ ~tim .... ~ ........ m~ .... ~.. .... %.. ~ . S~t~ ~tl~ ~ ~ ~ of Vt~.~ ~ ipt~ ~ ~~~~t~tlm: ...... ~ ..... ~ .................................... ~'~ '~[~ e~.~u~g t 0 t O~ ....... ~ .... F ~ X ~ ~iqx~ ~oT b. ~~~ ..................... ~: ..................................................... 3. N~ture of'kork ('check ~hidt applicable): Ne~ Boildir~ .... ~ldition .......... ~terati~ . ~ ' ' ~ ~ir ............ ~1 ............. ~liti~ ............ Otl~r ~ .................................. ~. ~sti~t~ ~st f~ ............................ (to ~ ~id m fili~ this ~li~tlm) 5. If ~lli~, ~r of ~lli~ ~mits ....~ ...... ~r of ~lli~ mits m e~ ~r ..... ~ .......... .......... ................... 6. If ~i~ss, ~ercial or ~ ~, ~i~ ~re ~ ~tent of e~ ~ of ~ ...................... 7. Di~nsi~s of ~sti~ st~s, if ~: ~t ................ ~ ............... ~pth ................. t~i~t ......................... ~r of Stories ...................... Di~i~ of ~ st~ ~th"alterati~ or ~iti~s: ~t ............... ~ar ............... ~pth .................... ~i~t .................... ~r of Stories ............... 8. ,i~nsi~ of entire ~ interim: ~t ...~[~ ....... kar ...Z(.~. ..... ~fi ...5~ ...... thi~t ...... ~.~. ............... ~r of Stories ..... ~ ............... 9. Si~ of lot: ~t .................... ~ .................... ~pth .................... 10. hte of ~d~ ..................... h of Fomr ~r ........................................ II. ~ or ~ district in ~i~ p~i~s am si~t~ .......................................... ;; .................. 12. ~s ffo~ mt~tim violate ~ =i~ 1~, o~i~ or ~latim: ........................ 13. ~ill lot ~ ~ .................... ~ill ~ fill ~ ~ ~ ~s: ~ ~ 14. ~s of ~r of ~s ........................... ~mse .............................. ~ ~ .............. ~ of ~it~t ...~/[.~ .... ~ff.~( ........... ~mss ..~ .......................... ~ ~ff~ ~ ~ .............. ....................................................... 15. Is Otis p~ ~in ~ f~t of a ti~l ~tl~ ~ ~ .......... ~ .......... PLOT DIAGRAH locate clearly ~nd distinctly all buildings, ~hether existing or proposed, ~nd indicate all set-back dimensions property lines. Giw strut ~md block r~ber or deseriptio~ nccording to dccd, and sho~ street nmos snd indicate ~hether interior or corner lot. ~FAIE OF ti~ OB~IY OF ....................... ....................................................... ~i~ duly ~m, ~s ~ ~ys ~t ~ is fl~ ~li~t (~ of i~ivi~ si~it~ ~tr~t) '~ is the (~tr~tor, ~nt, mDr~te officer, etc.) ~f ~id ~r or ~rs, ~ is ~ty ~t~ri~ to ~rfom or ~ ~rfo~ fl~ ~id ~& ~ to ~ ~ file this a~licati~; ~at all stat~ients ~tai~ in fiis a~licati~ a~ t~ to ~ ~st of his ~1~ ~ ~lief~ a~ chat ~ ~ will ~ ~rfo~ ....... ..... .............. MAP SIlO WING UN/TS _2_9_,30.31 & 32 PI'EASANT R~TA TE$ A T GREENPORT TOWN OF SOUTHOLD SUFFOLK C~UNTY, N Y. I ...... ,~ ~ .~'l 1000 - 40.01- 01 29,30,31& 32 ~.i n'" 19~,~ijjl July 8, 1999~ Iu~' ~ ~/ ~-T~ ~ ~T ~ c~ ~ ~ ~W. 1~30 TRAVELER ST~ET S~THOLD~ N.Y. 119~ 93-300 (29,~0,$1 & 32)