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Home My WebLink About24263-Z (2)APp~LICATION FOR BUILDING PERNIT INSTRUCTIONS / k~'~'BOARD OF HEALTH ............... -~ SETS oF pLJaS ,/su.v~Y ........................ ~CHECK ......................... SEPTIC FORH ..... ~,.~ .......... NOTIFY: HAll. TO: .................... Date ................ ,19 .... a. ~his application ~ust be ct~,~letely filled in by Dype~riter or in ink ~ ~itt~ to ~ Buildi~ In~tor with 3 ~ts of plus, ~ate plot pl~ to ~ale. F~ ~i~ to ~le. b. Plot pl~ ~ l~ati~ of lot ~ of ~ildi~ ~ ~i~s, ~lati~ip to ~joini~ ~s or ~lic st~ts ~ ~a, ~ givi~ a ~tail~ ~ri~i~ of l~t of ~r~ ~st ~ dr~ ~ t~ di~ ~ich is ~rt of ~is a~lieati~. c. ~ ~ ~ ~ ~is a~li~ti~ ,uy ~t ~ ~,~e~ ~fo~ is~ of ~ildi~ ~it. d. ~ ~1 of ~is a~licati~, t~ ~ildi~ In--tot will is~ a ~ildi~ ~t to t~ ~l.i~t. ~ ~t ~1 ~ ~ ~ ~ p~s ~il~le for in~ti~ theft ~ ~rk. e. ~ildi~ ~11~ ~i~ ~ ~ ingle or in ~rt for ~ ~at~r ~til a~rtificate of ~ ~11 ~ ~ ~tM ~ ~ ~ildi~ I~tor. al~ I~ m~i ~ to t~ ~ildi~ ~h~ent for ~ is~ of a Mildi~ ~mit ~ to t~ ~ildi~ ~ ~i~ of ~ T~ of ~t~ld, afffolk ~, ~ Yo~, ~ other ~lic~le ~, ~i~es or ~ati~s, f~ ~ ~st~ti~ of ~ildi~, ~iti~s ~ alterati~s, or f~ ~al ~ ~,~liti~, ~ ~in ~ri~. ~ ~pli~t ~s to ~ly ~ M1 ~licable 1~, o~i~es, ~ildi~ ~, ~i~ ~, ~ ~lati~, ~ to ~it ~i~ i~tors ~ p~,,i~s ~ in ~ildi~ for ~s~ in~ti~s. ... ........ (Siam of a~lle~t, m m, if a mratim) State ~r a~limt is mr, les~, ~ut, a~it~t, e~imr, ~ral ~tr~tm, el~triei~, pl~r m ~il~r. ...... .~m~,~. ....................................... (~ m ~ t~ roll m lat~t ~ (~ title ~ mt~fi~r) Builders Licen~ No .......................... Plt~bers License No ..... ~. ~P~. ).T.~. ............ Electricians License No .... J..~.a.7.]~ ....... Other Trade's License No ..................... [k~se N~ber Street Hmdet Cotmty TaxNapNo. 10(D Section ...~.(~:.! ...... Block ..... ./. ......... Lot ...~.(~...I ........ 2. State existing ~se and occupan~ of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............................................................................. 3. I%lme of ~ro~k (clv~ck ~dJid~ applicable): Neu lloihling ...~ .... ~gliti~ .......... Alteration .......... I~l~ir ............ ~al ............. !~1 iti~ ............ Other ~ ~riptim) 4. Est in~t~l (bst .... %-- ]~.~ ~ .O.O.~... (to ~ ~id an filing this al~licatia}) 5. lg {k~lling, an~tmr of ~lli~g ~mits .... ~ ...... ~l,~l~r of {[~lling tmits.{m e~ flmr ...~ ........... 1[ garage, ~t~r of ears .............. 6. If I,,si,~ss, ~,erci,l or ,,dml ~,,,~t~y, Sl~ci~ tmtt, re a,,l ~tent of 7. Din~asimm of ~iati~ stnm~res, if mW: ~mt ................ ~ar ............... ~pth ................. I~i~nt ......................... ~tmr of Stories ...................... llin~nsi~m of sam stn~t~re with alteratirms or ~it:ions: Front ............... l~ar ............... l~pth ................ ['... Ibi~t .................... K=xl~r of Stories ............... B. Din~nsi~m o~ entire ~ ~strtmtio~: Frtmt ................ I~ar ~pth I~i~t ......................... K=~t~r of Stories ..................... 9. Si~ of lot: Fr<~t .... ~ : .... · ........... I~ar .................... ~pth .................... lO. I~te of }h~reha~ ..................... ~e of Foruer II. 7~ or u~ district in ~,id, pr~i~s are simt~ ~¢~)6¢.~'~ 12. l~s pro~zl ~t~tim violate any ~ing 1~, onli~re or regulatim: ..~Z~ .............. 13. ~ill lot I~ r~r~ .................... Uill e~:ess fill I~ r~ fran ~i~s: · ~ of Cmrractor ................................... ~klress ............................... Ilm~ ~ ............... 15. Is lids pm~rty ~ithin ~ f~t of a riehl ~etlm~l? ~ H~ .......... ~ .~ ...... I'l.OT I~eate clearly ami distinctly all I~dldings, ~hetl}er existing or pro~l, nr~ imlicate all ~t-I~k di~mnsions fn~u prole~ly li~s. Gi~ at.mt as~ bilk ~mn~Imr or tbscripti~s according to ~1, a~ ~ strut ~es a~l ialicate xdmtl~r interior or corer lot. ~(~t.._ ................ I~ing duly ~rn, delx,ms a,~l ~ays that he is (~a~ of i~lividml signing ccmt_racL) (xa tractor, agent, corl~rate officer, etc.) .................................... of said ¢~mr or ~rs, m~l is {h~ly ~mthori~ to I~rfonn or h;~e l~rfon~l the ~id turk ami to rake a~l file this alq~l icati(m; Oral all statemnts c{a*tai~l in this al~l icat'i{~ are I-n~ Lo the I~st of his k~.~l~ that the ~}rk ~ill I~ ~r[on~l in the ~m~r ~t forlh in the al~l.h:ation fi]~l tl~r~i~. ~)r~ lo I~fnre n~ Ilnis . ' da ' ...... ............ MAP SHOWING UN/TS 27 & 28 "AMENDED MAP OF MOORESLAND" PHEASA~ RUN ESTATE$ CONDOIVaVlUMS FILED JUN 13,1996 FILE ~V~.& III 257A AT GREENPORT TOWN OF SOUTHOLD SUFFOLK COUNTY, N Y. 1000 - 4001- 01- 27&28 SCALE.. I" = 30' JAN 21, 1998 MA Y 27, 1998 (final) N,Y,S. LIC.,i.:' NO. 49618 1~3~'ff~ /ELER STREET SOUTHOLD~ N. Y. 11971 93 - 300 ( 27 & ~8 .),c; MAP SHOWING UNITS 27 & 28 PHEASANT RUN ESTATES CONOO~N~M~ ~l & l FILE~ OEC. 22, ~ MAP NO. 257 AT GREENPORT TOWN OF SOUTHOLD SUFFOLK COUNTY, N Y. 1000 - 40.01 - 01 - 27& 28 SCALE.. 1" = 30' JAN 21, 1998 93 - 300 ( 27 & 28 )