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Home My WebLink About24520-ZFORM NO.3 TOWN OF SOU'[HOLD BUILDIN~ DEPARTMENT TOWN HALl. $OUTHOL~, N.¥, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNtiL FULL COMPLEtiON OF THE WORK AUTHORIZED] Permission Is hereby granted to: CHARLES BRIGHAM ........ ~ ~,,s,.,.~,z.,~¢.~,., p.,~..T..y.~ .......................................... ........ .g..u.~.~..o..a. ~.,.~...~..z. ~..3. ~ ..................................... to ... ~ .~:.. ¢.?.,,B...~.~.¢.~...!.~.....~....A.~..~..&..~......&s.,.,,A.~,~.~..~O.~ ........................................... located at ............................................................................................................................... at premises 215 PIERCE DR CUTCHOGUE Coun~/ Tax Map No ...... ~.Z'~,8...g. ..... Section ....~:~ ............. Block ..... 9.,0...0..~ ........ Lot No..g.~.~s.:.?.g..,l: .... pursuant to application dated....?.?,??.~...~..~.. ....... ~,.~. ........................ 19 ...... .g..~ ..... and approved by the Building Inspector, $ ........ ..... Rev. 6/30/80 FORH NO. I TOWN OF SOUTHOI.D BUll.DING I)EPARTNENT TOI4N HALL SODTIIOI.D, N.Y. 1197! TEl.: 765- Iff02 I)isapl~roved a/c .................................. BOARD OF HEAI.'rll ............... --3 SETS OF PLANS ............... ----SURVEY ........................ -.--~llECK ......................... SEPTTC FORH ................... NO'Fl FY: CAI.I ................... HAIl. TO: .................... APPI.ICATION FOR {IUII.DING PERHI'F INSTRUCTIONS Date..N.q 3..l.O. ....... 19 ~ ~ a. This application must be ecsnoletely filled in by typewriter or in ii~k m~l mflroitted to the ~d]ding lns~ctor will 3 ~ts of plmm, ~ra~e plot pl~ to ~ale. F~ according to b. Plot plm fl~i~ l~ati~ of lot ~ of hdldiags ~ prmi~s, relationgdp to Mjoini~ praises or Dfl)lic struts or areas, ~ givi~ a ~tail~ ~ripti~ of la~t of pro~rty mint ~ dr~ ~ tim {lia~ ddch is i~rt of this appl icati~. c. 'Bm ~rk c~r~ by this applicatit~ ~y ~>t be c~tmt~l before issue of ~dldi~ Pe~it. d. Ol~ a~}~al of this a~licati~, tim I~ildi~ lns~ctor will ism~ a ~lilding Pemit to tim applicant. ~h l~rmi.t ~all Im ~pt ~ tim ~i~s ~ail~le for ins~ti~ thro~t the x~rk. e. ~ Imildi~ ~mll ~ ~i~ or ~ in ~le or in ~rt for any ~ ~mt~er until a C~rtificate of ~ol~s~y flmtl I~e t~n ~t~ by tim ~ildit~ Ins~tor. ~IC~'FI~ IS I~ ~ to tbe ~ildi~ ~rt~nt for tim issue of a ~ilding ~mit ~lrsx~lt to the I~dldi~ ~ ~i~ of ~ ~ of ~lt~ld, ~fffolk ~m~, ~ Yo~, ~ other a~lic~le I~s, ~di~es or ~dati~s, for tim ~t~ti~ of hfildi~s, ~iti~s or alterati~s, or for r~al or ~lition, as tmrein ~b~ril~. ~ a~lic~t ~s to c~Iy uith all a~licable re~fiati~s, ~ to ~it ~ri~ in--tots ~ ~i~s a~ in ~ildi~ (Si~ture o[ a~lic~t, or ~mI ii a co.ration) .... ~ .... (~il i~ ~ress o[ ~lic~r) StaLe v, tmtl~er applicant is o~er, lessee, agent, architect, engioeer, ~ral c~tractor, el~trician, plier or l~dlder. ............ 0.~ ~%.~ ........................ ' .......................................... o. ~ ~- APP 0 DASNOTED ...................................... ~ ....... 6~¢~" -- z' (as ~ tim ~x ~ll or latest d~) ~ '~ZL~~~ [f applicant is a co~rati,, si~t~e of ~dy ~,d,,ri~l officer. FEI=~ ~CO ,y= ~'~ N¢IR 9MILDIN6 DEPARTMENT 78~-1~2 ~ ~ ~ 4 ~ ~R THE ......................................................... (~ aal title of t~rate officer) FO~ ~dl~rs [.ice,~ ~ .......................... 3. Q Pl&rs [.[cen~ b .......................... 4. FINAL - ~~N MUST OLl~r Tr&'s I. ice~ ~ ..................... ~&~ ~~ [ ,~ ........................... ~...~. RK~NStO~. F~e ..... I. l~x:a(i(~ of lal ~ Mdch pr~l ~rk ~il] b COO . ...... .................... E i m .......... .......................... I~m ~r Strmt I~let c~,=~ ~ m, ~. ~ ~, ..... ~ ..... ,~k ..... ~.t ...... ,~= ....... Li.,~ ....... ~; ........ .~ .............. ~ ............. 2. State exisl:i~ ~ m~ <~ of lrmi~s a~ intem~ u~ a,~l <~ of pro~ c~stmcti~: a. ~xlstim t~ ~ m~y .. ~ ~ ~ ~,'~ ..... b. Inte~l u~ a~ ~o~ ...... ~J...,~-.~...~[ ~ ..~ ~.~ 16°38'50'' W 16038'50'' E · ~ ~o rc I0. Il. 12. 13. 15. II. lull r ............ Iltm~a l ............. l~ennl iL ic.~ ............ Other I~knk..I.~7~l~l~ ~ .~..ol~.~-e~.____..~ ..... ~'....[ ~ [ , (~lpti~O ~{lll If garage, I~i~[' Of ca~6 ............ O.B.~ ................... I f I*mi~mss, ~rei81 or mi~ ~1~. Sl~ci~ ~mture a~l ~tent of each tyl~ o~ u~ ......... ~ ............ I}i.~nsk. m of ~isting 8tnmture8, if any: Fr~mt ................ ~ar ............... I~pth ................. I~i~t ......................... ~i~r of Storiea ...................... Din~nsi~m of ~m ~tnmture ~ith alterati~ms or ~litions: Frrmt ............... ~ar ............... I~pth .................... Iki~t .................... ~d~r of St'ories ............... I}i.~nsi(~m of entire ~ ~mt~t i~: Fr~t ................ I~ar ............... ~pth .............. I~iO~l ......................... ~d~r of Stories ..................... Si~ of lot: Writ ....... ~.t ....... ~ar ..... ~S .......... mpth ...... [}.[ ........... .............. ~ or u~ district in Odd, prmi~8 ate sitmt~l ..... ~Z~J~I ........................................ I~m~ prol~l mmt~:tia~ ~iolate any ~dng 1~, ordi~me or re~datim: .... ~ ................ lot Im regr~ ........ ~ ........ ~ill em'ess fill I~ rm~l Uill ~e of Arddt~:t .................................... &~tess .............................. ff~ ~ ............... · ~ of C~tr~tor ................................... &klress ............................... D~m ~ ...... ' ......... Is this pm~[ty ~ithin ~ f~t of a riehl ~tlml? i B~ ..~. .... ffi .......... PI.OT I) IAGRAH I~:ate clearly and distinctly all h~ildings, ~eLImr existing or proposed, m~l i[xlicate all ~et-back dimensions interior or comer lo!. Iblock ~,~ber or descripti¢~k~=cording to de~l, and 8boa street indicate ................. I*!ing duly ~nn, deposes mKI mays that he is the appl i(:anl is~ ................................................................ (C~ltractor, ageut~ (:or.>rate officer, etc.) said (~r or ~rs, ami is (hJty mdl.)riz~ to ~rfotm or h;~e I~rlom~ the maid ~rk m,I to nnke m~l file Ihis al~l ieati(m; that all star.mats c(mtaiT~l in this nisei icatlon are tn~ to the I~st of his k]~l~gm and I,~1 ief; nnd Ihat the ~tk will Im i~rfom~l in the n~m~r ~t. Forth in the al~llcntion fil*l tlmr~[th. ~rn to Imfote n~ Ihis ..... /.2 ......... 2... JOYCE M. WILKIN$ N~ Publio, ~late of N~Y~ No. ~52248, Surfak ~u~ Term ~pir~ June 1Z I~ (Sig:mlu e of ^l$1icu~