HomeMy WebLinkAbout24067-z JP*ORH NO. s
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N.o ~405T Z
Permission is hereby granted to: ·
. ..~...~.../..~.,~.,~..~.~.~.../...'. .............
,o..~....~::... ....... ~... ......... ~...~..~ ........ ,~.~........./.,~.~ ...... ~.......~'/.~ ...............
...~ ...... /..~........~.~.cc~..~ ..........................
.~L./.~./~_~. ........... ~ ...... ~..4,2~ ......... ~. ..............................................................
pursuant to application doted ...... ~,,Z~.~.,'.~. ............................... , approved by the
Building Inspector.
Rev. 6/30/80
.FORIq NO. !
TOqN OF SOUT~OLD
BUILDING DEPARTHENT
TOIJN HALL
SOU'[TflOLD, N.Y. l!9Fl
TEL: 765-1802'
BOARD OF HEALTH ...............
3 SETS OF PLANS ...............
SURI/~Y ....
CHECK ..........................
SEPTIC FOP, lt ...................
NOTIFY:
l/IlL TO: ................ .. ..
APPLICATION FOR BUILDING PEP, NIT
INSTRUCTIONS
'Date..., ............ ,19 ....
a. ~his applicatiq~ ~ust be completely filled in by ~iter or in ink ~ ~itt~ to ~ ~ildi~ In--tot with
3 ~ts of plus, ~ate plot pl~ to ~le. F~ ~Mi~ to ~le.
b. Mot pla ~ l~ti~ of lot ~ of ~ildi~ m ~ms, mlatim~ip to Mjoini~ ~ms or ~blic
st~ts or a~as, ~ givi~ a &tail~ &~ripti~ of l~t of ~ mst ~ dr~ ~ ~e di~ ~i~ is ~rt of
~is ~licati~.
c. ~ ~ ~ ~ ~is ~licati~ ~ mt ~ ~ ~fo~ isle of ~ildi~ Pe~t.
d. ~ ~al of ~is ~licati~, t~ ~ildi~ In--tot x~11 is~ a ~ildi~ ~t to the ~limt.
~t ~all ~ ~pt ~ ~ ~s ~il~le for in~ti~ a~t ~ ~.
e. ~ ~ildi~ ~11 ~ ~i~ or ~ in ~le ~ in ~rt for ~ ~ ~at~r mtll a ~rtificate
~ i~l ~ ~ ~at~ ~ & ldldi~ I~tor.
~I~ IS ~m~I ~ to ~ ~ildi~ ~t for ~ is~ of a ~ildi~ ~t ~t to the
~ldi~ ~ ~i~ of ~ T~ of ~ld, ~folk ~, ~ Yo~, ~ o~er ~li~le ~,
~lati~, ~ t~ ~st~ti~ of ~ildi~, ~iti~s ~ ~te~Ci~s, ~ f~ ~ or ~liti~,
&~ri~. ~ ~limt ~s to ~ly ~ all ~li~le 1~, ordi~es~ ~ildi~ ~, ~i~
State ~r ~limt ,s ~r, lesa,_ ~t, a~it~t, ~i~r, ~ral c~,~[ff~, pllr~~
f..~.~
................................. .... ....... ,~ .................... , ......... ~ , ....
BATE. ~~.P-~- '
765-1802 9 AM TO 4 PM FOR THE
If ~lic~t is a ~ati~, si~ of &ly ~ri~ officer. FOLLOWING INSPE~ONS:
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRE~
(~ ~ title o[ ~ate o[[icer) 2. ROUGH - FRAMING & PLUMBING
3. INSU~TION
4, FINAL - CONSTRUCTION MUST
BE COMPL~E FOR C.O.
~il~rs Lic~ ~ .......................... ALL CONSTRUCTION SHALL MEET
~rs Li~ ~ .......................... THE REQUIREM;NTS OF THE N.Y.
STATE CONSTRUCTION & ENERGY
El~trlci~s Li~ ~ ...................... CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
~r ~s Lic~ ~
....
~ ~r St~t
~ ~ ~. ,~ ~ ...~.~ .... ~ ..:~.' ........ ~, .... ~.~.
~ivlsi~ ..................... .. ... .. .. .. .. . ... Fil~ ~. ............... ~t ............ .. .
(~)
2. State ~sti~ um ~ m~ of ~s ~ inte~ m ~ m~ of ~ ~st~tim:
a. ~sti~~ .....................................
3. l, htnre of ~rk (clmck ~/hid~ ~ '
sppheable): l~a Ihdlding .......... Nklition .......... Alteration ..........
lleImi r~ .............. 4 .......... lk~mh~z ~[]!~.. ............ Other l~ork ..................................
(to Im paid on filing this application)
5. If &~lling, slx,bet of d~lliog units ............ tlt,d~er of d~mliiog traits on ead~. Iqoor ................
If garage, tmei~er of cars .... ~ .................................
6. If Ixmi~esa, coramrcial '
or mill o(:clllm~y, specif~] nature and extent of e~ch
?. Dinr~n~ic~m of existing stnYa~u~es, if any: Frcmt ................ Rear
Depth
I~l~lt .......................· Hll r o or es ......................
Dinensions of sa,~ struct~Jre with alterations or additions: Front ............... Rear ...............
Depth ................... ilei0~£ ............... l'lt~i~er of Stories ............
8. Dimensicms of entire new const~ctitx~: lh:ont ................ Rear ............... Depth ..............
Ileight ........................ i. ti,,tmr of Stories .....................
I0. It,te of l'urcha~ ...Z..~....~/.I~..., l~ae of l,,n,nr O~er ................ ; .......................
I 1. Zone or uae district in ~dsid~ ~raniaes
12. l~ma propo~,M co~mtrt~.tlon viol!ste any zeroing l~a, orxlinance or regulation: ........................
14. Nanes of Oaner of premises .... I ....................... Nklress .............................. H~one ~ ...............
fi`ame of Arddtect ............. i ....................... Nldress ........ ll~me lto .
· ~a of Cxmtractor ........... L . Mdress ............................... Hone No ...........
15. ls this property within 300 fee~t of a t;dal x~etland? YF~q .... tx~3 ..........
l~cate clearly and distinctly all
properl:y lines. Cive s~reet and
interior or corner lot.
S'['A'II'~ (X~' I'~',M ~)]~,
SS
PLOT DIAGRAH
b~dldings, ~etlmr existing or proposed, and indicate all set-back dimensions
block nt~ber or description according to deed, and ~lm~ street nmaes and indicate
.............. ~.F~.'t~..ah~.,.kX.l ........ Imi[~ duly swon~, delx~aes and says that he is Lhe applicant
(Na~e o[ individtmt signing contrset) ]
(C~tractor, agonE, ?r~rate ofifilcer, etc.)
oF said {~mr or ~rs, ami is duly ~tlorlM to ~rfom or h~e lerfon~ Ihe ~id ~rk m~l to ~ke a~l file this
al~fllcatlon; that ntt ' ' ' :' ' '
atat~mnts cCmtai~l in ti ~s aH~I tcatton are trim to the Imst of hla kt~l~ m~ la~lief~ a~gl
that the ~rk will I~ I~rfon~l in IheIsumner ~t ford~ in the al~lication film tlnr~ifl~.
~n, to Imfore ne this , I
Note~}y ~u~l/c, S~ate of E 'w ~ork / ~