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Home My WebLink About23966-Z IN)mM NO. · TOWN OF SOUTiiOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 23955 Z Permission is hereby granted to: ....... at premises located at ............ .~.~.~..'~...,~--/.~.~.,~..~....,,,0/,,~..~'.. .......... ~...~Z~.~..f.~ County Tax Map No. 1000 Section ..../.....~...Z ....... Block ...... Z ........... Lot No .... .~...~....g...'.~.. pursuant to application dated ................ ~~..~..../.. .......... , 19..~..Z and approved by the Building Inspector. ~;;.;.~. ....... R~,. 6/30/80 FORH NO. TOI~N OF SOUTItOLD BUILDING DEPARTHENT TOb/N HALL SOUTUOLD, N.Y. 11971 TEL: 765-1802 Disappi~ed a/c .................................. /~I~ICATION FOR BUILDING PERHIT INSTRUCTIONS BOARD OF HEALTH ............... 3 SETS OF PLANS ............... SURVEY ........................ CHECK ......................... SEPTIC FORN ................... NOTIFY: CALL .................. HAIl. TO: .................... / Date. . 21 .,~9.'tl. / a. This application ntmt be e~,~letely filled in by typo~iter or in ir& and submitted to the Building Inspector with 3 sets of plm~s, accurate plot plan to scale. Fee according to schedule. b. Plot plan sho~dng location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed descriptitm of layout of property mint be drmm on the diagr~a ~dlich is part of this application. c. The ~ork covered by this application way not be co,,,eoced before issuance of Building Permit. d. Upon approval o[ this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the ~ork. e. No building shall be occupied or used in ~ahole or in part for auy ~ ~hatever until a Certificate of Occupancy ~mll ha~ been granted by the Building Inspector. APPLICATI(I~ IS ~ ~ to the Building Hepaxl~ent for the issu~ce of a Building Permit pursuant to the Building Zone Ordin~ce of the To~n of Sonthold, Suffolk County, ~ York, and other applicable La~, Ordinances or Regulations, for the constrtmtion of lmildings, additions or alterations, or for romoval or demolition, as berein described. The applic~t agrees to c~ly ~aith all applicable la~s, ordinances, building code, housing code, and regulations, and to admit anthorim~! inspectors on premises aed iu building for necessary inspections. _ (Signat~nm of applicant, ~r n~e, if a eorlx~r/Ition) .... ....... (I~aili,ng address of ~licant) State ~a~tber applicant is mr, lessee, agent, architect, engineer, general contr~tor, electrician, planber or builder. ~,~ of ~er of p~,ises ,~.l fi...g.~.qA d .... .~.zJ..P.4 J'.g.,.q.~.4.Sa ~.n ~.~..o~ ..................................... (as on the ta~ tnoll or latest deed) If al~Jlicant is a corporation, signature of duly onthoriz~_~l officer. (N~ne and title of onrparate officer) Builders License No .......................... Pl~nbers License No .......................... Electricians License No ...................... O~her Traders Licer~e No ..................... Location of land on ~ahich propased ~ork will be dene.2~).O..~. .... .~..~.~/F~ ~-~' c~ty T,,~ ~. ~ ~,~ ..tP.( ......... .~ ...,.¢ .......... ~ ...[b.~ ...... ~ ...................................... .... .... ....... (~) 2. State alsti~ ~ ~ ~ of ~i~a~s ~ int~ ~ ~ ~ of ~ ~st~tim: a. ~sti~ ~~ ............................................................................. b. Intended use and occupancy ............................................................................. 3. P;~{me of s~ork (dz~ck ~hids applicable): Nc~ lkfiiding .......... ~iti~ .......... Alto~~. I~l~ir ............ ~al ............. I~1 iti~ ............ Other ~ .. ~.O~ ................... /, Esti,,m~l C~st 1-5 Q- ~: (to I~ ~id on filing this a~licatt~ . 5. If ~lling. ~t~r of ~lli~ units ............ ti~i~r of ~k~lling ~its ~x~ e~l fi~r ................ if g~rage, I~l~r of cars ...................................... 6. If I~is~ss, ~rcial or mi~ ~oqm~, s~ci~ ~ture and ~tent of ead~ ty~ of u~ ...................... 7. I)iuensiols of ~isting strictures, if any: ~mt ................ ~ar ............... ~pth ................. I~i$~t ......................... ~l~r of Stories ...................... l)in~nsi~ oF ~m stn~tx~re vith alterations or ~itions: Fret ............... ~ar ............... ~pth .................... I~i~st .................... ~.l~r of Stories ............... 8. Di.~rtsi~m of entire ~ ~st~tios: I~t ................ l~ar ............... ~pth .............. I~i~t ......................... ~l~r of Stories ..................... 9. Si~ of lot: l~t .................... ~ar .................... ~pth .................... IO. I~te of l~rdm~ ..................... D~ of For~r ~mr ........................................ II. ~ or u~ district in d~ids prmi~s am si~t~ .............................................................. 12. ~s propel co~st~tim violate any ~ling 1~, ordi~e or regulatim: ........................ 13. ~ill lot ~ r~r~ .................... ~ill ~ess fill I~ r~ [~m Dmi~s: ~ ~ ~e of Arddt~t .................................... ~ress .............................. R~ ~ ............ ~ of Cmtr~tor ................................... ~ress ............................... B~ ~ ............. 15. ls this p~r[~ vitllin ~ f~t of a till ~tlmsi? * ~ .......... ~ .......... ~ ~iF ~, ~ ~ 'I~I~ ~I'F ~Y ~ ~H~). PI.OT DIAGRAH l~x:ate clearly and dis£inctly all buildings, ~heU~er existing or proposed, and indicate ali set-lmck dimensions fr~u propertT lines. Give .street and block r~]t~er or description according to dccd, m~i sho~ street ms ar~l indicate wlmtl~r interior or corner lot. &P~;~O}/EO AS NOTED . ./ ?~35-t802 9 AM TO 4 'P~VI FOR THE i:~ )LLCWiNG ~NSPECTIONS: t, FOi!,NDATiO~ - TWO REQU!RED ~, ROUGH - FRAMING & PLUMe, ~ ~¢ CO~/~PL.ETE ~OR ""~'S REQLItF~EMEN~ OF THE N,~z ..,..,. NOT RESPONSIBLE ......... ......... ~ . . -- . O' F H I -- --~....l~i.g ,luly ~,n,, delx)~s and ~ys that he is tie appli(mnt (ba~ of indivi&~l signing c~)tract) al~e ~, ......................... .......................................................... (~tractor, agent, corporate officer, etc.) of ~aid (~r or ~ers, taxi i~ ~dy ~Lho~Jr~ t() ~rfona or h~e lerfo~ I]~ ~i(I ~k and Lo ~ke and [il.e alq)licaC[(~; [1~1: afl statamn[s c~Lai~l in Ihi~ al~.licati~] are l:ne Lo [he I~L of his k~x~l~ a[~ I~l. Jef~ and OmC [he ~)rk ~i[l I~ ~r[on~l Jn [he ~m[uer ~C for[l~ tn Lhe a[~l.i~a~i~ [J]~ ~)~ to I~fore ~ this ..... .. 7 CLAIRE L. GLEW Notary Public, State of New York No. 4879505 Qualified in Suffolk County Commission Expires December 8, . ! '-,.I I