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Home My WebLink About24522-ZFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 24522 BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UN11L FULL COMPLETION OF THE WORK AUTHORIZED) Date ...... .D. ~.C. ~.~. ~.~. ~ ....... ..3. .......................... 19_.9..?.... Z Perml~lon Is hereby granted to: ........ ~B~!...LS.....~...~!~%Q~ ....................................... ........ ~.gPQ...~&~!~.~,....~...~ ....................................... ........ ~.Q~gDk~.,.~!..~.!~.7~ ........................................ to ...... ~...6..~..A~...6~P~P...FPR..6~P...~..Q~..~...~..~8~.:. at premlses located 1060 JASMINE LA SOUTH/PEC Coun~/TaxMap No ...... ¢f..?.:~.8...8..~'..... Section ....~6.~ ............ Block ..... ..0.(~.0...3. ........ Lot No..9.2...4..:..,0...1.4. .... pursuant to application dated......O.?. ~.O...B.~ ........ .1..4. ........................ 19 ....... .9.~( ..... and approved by rne Building Inspector, Fee $ ......... .3..5..:..o...o. .... Rev. 6/30/80 FORN NO. I TO~N OF SOUTHOLD BUILDING DEPARTt4ENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL: 765-1802 Pemit PO ................. D [ sapproved a/c .................................. APPLICATION FOR BUILDING PERI{IT INSTRUCTIONS BOARD OF HEALTH ............... 3 SETS O~PLANS ............... SURVEY.~ ...................... CUECK ......................... SEPTIC FORH ................... NOTIFY: CALL ?~.~5 ....... NAIL TO: .................... · Date.. }..q/.I. 3 ..... ,,9.9.7 a. 'lhis application ~st be c~pletely filled in by ~iter or in ink and sul~itted to the Building Inspector ~itb 3 ~ets of plans, accurate plot plan to scale. Fee aecarding to schedule. b. Plot plan sho~ing location of lot and of buildings on premises, relatiomship to adjoining premises or public streets or areas, and giving a detailed description of layout oI property ntmt be dr~n on the dingr~n vi~ich is part of tiffs application. c. 2be ~ork covered by this application v~y not be ccravenced before issuance of Building Permit. d. U[xm aov,~val of this application, tim Building Inspector will issue a Building Permit to tim applicant. Such permit shall be kept on the premises available for inspection thrcmghout the ~,~rk. e. No building slmll be occupied or used in ~hole or in part for any purpose ~atever ontll a Certificate of Occupancy shall tmve been granted by the Building Inspector. APPLICATIGt~ I$ 1~t~19~¥ 14N2E to the Building Department for the issuance of a Building Permit persuant to the Building Zone Ordirmace of the To~n of Southold, Suffolk County, N~a York, and ocher appliceble Lo~s, Ordinances or Regulatiocm, for the construction of buildings, additions or altarations~ or for ren~al or demolition, as bereln described. The applicant agrees to ccmply vith all applicable 1~, ordinances, building code, housing cede, and regulations, and to admit authorized inspactors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) (Hailing ~Aa~ess of applicant) State ~ether applicant is (~aner, lessee, agent, architect, engineer, general contractor, electrician, plauber or Imilder. ........................ ~.~..~...~f .................. : ................................................................ · ,, Pr, ...... :.!a...L..,. n. (as on the tax mi1 or latest deed) -- If af~olicant is a corporation, signature of duly antl~)~]zed officer· (Nane and title of corporate officer) Plm~bers License No .......................... Electricians License No ...................... other Trade's License Po ..................... 1. l~mtion of land on ~ahich proposed ~ark ~ill be done ....................... .~l~ .1~~0[~ .$}4~[.k .l~lf~'~ .... THE REOUIREMENT8 OF THE N.Y. .... [ ¢~.' ~, ......... ~.o,£ :m. ~..~....~ .n...~. .............. ~9.w.-~.~k..~_~! .~.u..~...o~ .~ ..~.~.~.o.v. .... ¢O~L~I~' ~$~0N8~.~ ~0~ c~t~ T~p Po. ~000 S~don .~.q..~ ....... msek ..~..'~. ........ but · ' '~0 /~f Lot s~i~i~on&x~.-ttt<~l&.~O.d~os.~e~t-.~... Fried ~p Po..:r..~S.~ ........ [.q ......... 2. State existing use and eccupency of premises and intended tree and occupancy of proposed eormt:mction: b. fn~eaded use and occo~ ................... ._~L.I..~.. ............. ~w~,~. ............... APP~.O~D AS NOTED . AM TO 4 ~ ~R THE I F~ - ~ R~ED 2. ~-~ & ~MB~G 4. FINAL - CON'RUbeN MUST BE ~ ~ ~ ~ C.O. 3. I~.~tme of ~ork (d~ck ~4~iclJ applicable): ~ lh~ilding .......... fi&lition .......... ~erati~ .......... ~,~ ............ ~t.. ............ ~ ~t,~ ............ oth~ ~ ...~ ~ · ~.c L..V~c~ ,,. ..... ...... O o ~ ~id ,m filing thls[a~~ j If 11 f } 5. &~ lng, a~d~r o ~llingtmi~s ...... ~ ..... ~mr o'~ ~lling t~ita ~eadi ........... ~ ........ If ~rage, ~r o~ ~ra ...................................... 6. If lami~ss, ~rclal or mi~ ~, s~ci~ ~mre m~ ~tenC of ead~ ~ of u~ ...................... 7. Dinensia~s of ~isti~ statures, if ~: Fret ................ ~ar ............... ~pth ................. Ibi~st ......................... ~lar of. Stories ...................... Di~nsi~ of ~ st~mre with alteratims or ~iti~s: ~mt ............... ~ar ............... ~pth .................... Igi~t .................... ~r of Stories ............... 8. Diuensi~ of entire ~ ~stnetia~: l~rmt ................ ~ar ............... ~pth .............. Ibi~t ......................... i~der of Stories ..................... s. .... ..... ..... ..... .................... I0. lhte of ~,rd,a~ ..................... ~ of Four ~mr . .~f~.('{~(~. ~/~.ff(?~ ..... II. ~m or u~ district in ~id~ prmi~s am si~tM .............................................................. 12. ~s pro~ ~t~ti~ vi61ate ~y =i~ 1~, o~i~e or re, latin: ..... ly.~ ............... N0 I~. gill lot ~ ~r~ .................... gill ~ lilt ~ of A~dt~t .................................... ~ress .............................. ~ ~ ............... ~ of ~tr~tor ................................... ~ress ............................... H~ ~ ............... 15. ls this p~rty ~thin ~ fat of a till ~tlmd? * W3 .......... ~ ..~.... PLOT DIAGRAM l~cate clearly and distinctly all btdldings, ~lmtlmr existing or proposed, and i~licate all aet-lmck dimensions From property lines. Gixn~ street and block ra~daer or descriptiofl accoxding to deed, and sho~ street names and indicate ...... ~ .~ .............. I~ing duly ~s~n~,a~l rows that he '~ ~aJ ~ ~t~t~lg'~r~rate o[ficer, etc.) a~l ~eatton; '{~t~' stat~nts c~tat~ m thts ~1~1 ication ~re trim to the Imst o[ hi. k~l~lg~ that the ~rk will Im ~rron~l in tim runner ~t forth in the a~l icati~ fil~ (Sil;Ital]Jre o[ ApDI ic~mt) ,~q, SURVEY OF LOT14 FILED Aug. 4, 1993 File No. A-434 A T SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y. 1000 - 69- 03 - 24.14 Scale: 1"= 40' Mar. 22,1993 Aug. 17, 1993 (foundation) Nov. 19,1993(final) Dec. 17, 1993 (Tax Map#) The Iocolions of wells and cesspools shown hereon ore from field observations and or from dolo obloined from olhers. Prepared in accordance with the minimum slondnrds for lille surveys as established by lhe L.I.A.L.$. and approved and adopted for such use by The New York Slale Land Tille Association. SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY DATE HS. REF. NO. 93 SO 32 APPROVED CERTIFIED TO' JON F. BAKER SHEILA L. ELLISTON THE LONG ISLAND SAVINGS BANK SUPERIOR ABS TRA C T AREA = 29,626 sq ft. ELEVA NONS ARE REFERENCED TO AN ASSUMED DATUM. The wafer supply and sewage disposal ~[~.{ ~7~ l~'Jl syslems for th/s residence will conform . 1o fha slandards al The Suffolk Courtly Deparlmenl of Heollh Services. .Y.S. LIC. NO. 49618 //~ECONIC 7VEYORS~ P.C. (516) 765 - 5020 P. O. BOX 909 MAIN ROAD SOUTHOLD, N.Y. 11971