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Home My WebLink About24191-Z IeOF,,M NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, No Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 24191 Z Permission is hereby granted to: .... .>...:.......~~...~ ..................... _ .....:.~c...~.~...-: ........ ~.'/..:..z.xZ~ · · ,o ......~...~,.~.:.....~.....~...~.;..?..o....~. ....... .0:>.~.~c,~.......~.,..~..~ ...... ..,:..~ ............ ..................... ..~ ...................................................................................... ~.~ ........ ,~.:....~.~,:~."...,~..~:. ............................................................................................... County *ox Map No 1000 Section ...... .~.~.. .... Block ..~...~... Lot No pursuant to application dated .............. ~.....~... ....................... ,19.~...~.,ond approved by the Building Inspector. 6130180 FORH NO. ! TOI~N OF SOUTHOLD BHILDING DEPARTHENT TOi~{ IIALL SOUTHOLD~ N.Y. ![971 TEL: 765-1802, Disapproved a/c .................................. BOARD OF HEALTH ............... --~3 SETS OF PLANS ............... SURVEY ........................ CHECK ......................... SEPTIC FO}{}{ ................... NOTIFY: CALL. Z HAIL TO: .................... APPLICATION FOR BUILDING FERHIT INS~UCTIONS a. ~his application mist be completely filled in by typa~iter or in ink and submitted to tbe Building Inspector with 3 sets of plans, eceurate plot plan to scale. Fee eceordiug to schedule. b. Hot plon shewing location of lot and of buildings on premises, relationship to adjoining prenises or public streets or areas, and giving a detailed deseriptlo~ of layout of property ~aist be driam on the dingran ~hich is part of this application. c. The ~ covered by this application my not be eu~,,r~ced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector Will issue a Building Permit to the applicant. SucJa pamit ~hall be kept on the p,,~,dses available for ir~spection thrc~dghont the ~aork. e. No building shall be occupied or used in whole or in part for any purpose ~dtatever ontil a Certificate of Oeeupaocy shall have been granted by the Building Inspector. APPLICATI(3el IS Ems~isY ~ to the Building Department for the issasr~e of a Building Permit pursuant to the Building Zone Ordinance of the Team of Southold, Suffolk Coanty, N~ York, and other appllcable Laws, Ordinmmes or P~,gulatioas, for the coostroction of buildings, additions or alterations, or for tui~/al or demnolltion, as herein described. The applicant agrees to eanply With all applicable la~s, ordinm~es, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for recessary inspections. (Signature o[ applicant, or n~e, if a corporation) (Mailing address of applicant) /[7{ C State ~daether appliomt is {~mer, lessee, agent, architect, engineer, general ecmtraetor, electrician, phmnber or builder. Nasa of career of ptemises / ¥(7( / (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Nam and title of corporate officer) Builders License No .......................... Plmi~ers Licen.~ No .......................... Electricians License No ...................... Other Trade's Liceese No..j .................. I. Location of land on vshich proposed work will be done. ~C' tA)~( { Lc~/Zd~ ~bk' · Bouse N~m~r Street "--- ..... a 2 ~ Badet No. tlon ..... ...... .......... /. .... ...?..,C. ....... ~lxli~ision ...................................... Filed ~ No .......... ; ..... Lot ............... 2. State ~ting ~. ~ati~ ~ ~ ~ .........................................................................., . . n. ~t~ ~ ~ ~ ... ~.~.'?)&$. ............................................................. 3. ~.'}lme of ~o,k (dv, r~k ~hicln applicable): ~l~ Ihdhli~ ......... ~liti~ .......... Alteration .......... I~l~ir ............ ~al ............. I~>1 ition ............ Other ~ .................................. 0a (~r i pt (to I~ ~id ~ filing this a~licatim) 5. If ~[~lli~, a~t~r of ~lling ~mita ............ li~lt~r of ~k~lling mits ~ e~ fl~r ................ If garage, ~r of tara ...................................... 6. If Imsi~ss, inertial or mi~ ~oq~, s~ci~ mture a~ ~tent of ead~ ty~ of ~ ...................... 7. Din~nsions of ~istiq stnm~res, if any: Fr~r ................ ~ar ............... ~pth ................. I~i~r ......................... ~ier of Stories ...................... I)in~nsi~m of ~m stnmture ~ith alterations or ~i~ions: Fret ............... ~ar ............... ~pth ..... [~ ........... l~iJ~t .... tD~ ............. l~t~r of Stories .... ]. .......... 8. Diuensi~m of entire ~ ~st~tion: l~t ........ ~ ..... ~ar .... ~ ......... ~pth .............. I~iO~r ....... t ~ [ .............. ~l~r of Stories ...[ ................. 9. Si~ of lot: l%~t .................... ~ar .................... ~pth .................... R). Ik~le of h~rdm~ ..................... ~ of Fonmr ~r ........................................ I I. ~ or u~ district in O~id~ pr~i~s am si~t~ .............................................................. 12. ~s pro.mi ~t~tim violate any m~i~ 1~, o~i~re or re~latim: ........................ 13. ~ill lot I~ ~r~ ..................... ~ill ~:ess fill ~ 16. ~tes of ~r of ~s ........................... ~lres8 .............................. ~m ~ ............... gme of ~rddt~t .................................... ~lress .............................. ~ ~ ............... · ~t~ of C~tr~ror ................................... &klress ............................... ~g~ ~ ............... 15. Is Ihis p~rty within ~ f~t of a till ~tlml? * ~$ .......... ~ .......... PI.OT DIAGRAH l~cate clearly and distinctly all Imildings, ~,.l~etl~er existing or proFosed, and indicate all set-lmck dimensions I:mn prOFerty linea. Give street and block onat~er or description according to deed. and sl~ street hanes and indicate h4~etlmr interior or corner lot. b'I'^'IE OF EI'M ¢~ 1 Ibl l"l' {!1,' .............. ........ 9. ..~. " ...................... beiz~l duly .qvn~n:, delx~ses taxi says tlmt he (~ of ind[vi~ml signing contract) ((~mLr~Lnr~ ~ent, corl~rate o[[[cer, e~c.) .............................. of said {~mr or m~rs, alii is {h~ly ~lhoriml to i~rfoim or h~e I~[lol~ tl~ ~itl turk ai~l to rake and file this aloft icatin:l; that all statomota c:mtai[~l in this alq~l icat ion are tn~ to the Imst oE his h~ul~lg~ and Ix~lief~ a~l that the ~)[k wi[[ I~ I~rfom~l in tine ~an~r ~t forth i~l tl~ a~l. ication fil~ tlmr~ifll. JOYCt= M. WILKIN$ Notary Public, State of New York No. 4952246, Suffolk Cour~ Term Expires June