HomeMy WebLinkAbout24077-z IPO]~B~ NO. 0
TOWN OF $OUTHOLD
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.° 2407T Z
Permission is hereby granted to:
~..m~...~...~.:;~.;.'"~ ......... ./../.~.. ~
,o....~.~... ........ ~.. ......... ,,~.~....~.../~r,,~ ....... ,~..,,~.... ...... ./....,~.... .................
~.'~4~:. ........... ~.~ ......... .~.../..~.. ...... ~/... ...........................................................
Coun~ To× Map No ,o0o s,ct,o, ~ .,~ ..... ~.~.......~Lot No ...... ~ .....
Building Inspector.
Fee $ ...... '...~...
Rev. 6/30/80
nisa~xr*ed ale ...........
/'(Buildig~ ~ee~gr )
APPLICATION FOR B~ILDING P~RIilT
INSTRUCTIONS
BOARD OF BEALTU ...............
3 SETS OF PLANS ...............
SURVEY ........................
CBECK ..................... ,...
SEPTIC FORIt ...................
HAlL TO: ...........
'Date 19
a. This application mst 1~ conpletely filled ia by typewriter or in ink and anlnitted to the Building Inspector with
3 sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan shooing location of lot and of buildings on In~nlees, relationship to adjoining premises or pablle
streets or areas, and giving a detailed description o£ layout
this al~licatian.
c. The ~ covered by this application p~y ant be c(~,,,~,~ced before issea~e of Building Permit.
d. b'txm app~'oval of this application, the Building Inspector will issue a Building Permit to the applicant. Such
pandit sim11 be kept an the premises available for inspection throughout the ~rk.
e. No building slmll be econpie~ or used in whole or in part for a~y purlx)~ whatever until a Certificate of
Occupancy shall have been granted by the Building Inspector.
~ APPLICATI(~ IS l~lI ~ to the Building Department for the issa~ee of a Building Pemit paranant to the
Buiiding Zose Orainance of the Town of Sonthold~ Suffolk County, ~ York~ and other applicable La~s, Ordinances:or
Reltulations~ for the construction of builiings~ additions or alterations~ or for r~oval or deaolition~ as herein
described. Ton applicant agrees to ca, ply with all applicable la~s, ordinances, building code, ho~sing cede~ and
rng~lations, and to admit antl~rized inspectors on premises and in building for necessary inspections.
(Signature of applicator, or name, if a corporation)
(l~iling address of applicant) .
State x~aettmr applicant is mr, lessee~ agent, architect, engineer, general contractor, electrician, plm~er or builder.
...eo~.~.~ ............. 2'; .......... ~ .......... ~ ....................... '""
~ of ~ of ~,..~..~. ~....~ ....
(an on the tax roll or latest deed)
. ~. //1// /.~.~ , //~/£_.~ NO;~I-FY BUII'DING DEPARTMENT AT
(R~I title of e~----~te o[f~ce~) FOLLOWING ~NSPECTIONS:
,.. ......
UMBING
3. INSULATION
Plt~bers License 1~o .......................... 4. FINAL - CONS'tRUCTIQN MUST
Electricians License t~o ...................... ALL CONST~iUCltON SHALL M~ET
Other lka~e~s License I~ ..................... THE ~E(3UIREM~NTS OF THE N.Y.
' STATE CONST/~OCTION ~ E~EP, GY
]. Location of land on daieb proposed ~ will be done ........................ CO~E~3... ~.. ai~.9~g'~Le.. ~[IB...
..... ............... .... ..............
Bouse h~aber Street ~let
co~ty tax ~, ~o. ~00o s~tlon ....... ~eek .~. ~. .......... rot ....0~. ........
Sulxllvisiun ......................... Filed l~p No ........ Eot .....
2. State ~xlsting use and occupancy of prmfises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ......................
b. Intended use and occupancy .............................................................................
3, Fxm~re et work (check ~hich a licable): ~ I~fihli~ .......... ~lC~ ...... ~.i.~Alrerat~on ...........
(~o ~ ~id ~ filing this a~lieacJ~)
if garage, ~r of car~ .... '~ .................................
6. If I~mi~maa, ~rclal or mi I ~o~im~, 8~ci~ ~ture a~ extent et ead~ ty~ o~ u~ ......................
7, I)i~nai~s o[ ~iating at~Tea, i~ any: ~C ................ ~ar ............... ~p~h .................
I)innn~i~ts of sam 8tn~tx~re ~th alterati~a or ~i~iona: ~onr ............... ~ar ...............
8. Dhi~nsi~m o~ enLire ~ ~s~l~u I~L ................ ~ar ............... ~pLh ..............
9. fii~ of lot: l~nlt .......... ~ ......... ~ar .................... ~pth ....................
...... ~ ....... ~ of Fonmr ~mr ........................................
II. ~ or u~ dlacrict in ~ddl ~r~i~a are ai~L~ ..............................................................
' vtollate
12. ~s Fro~l ~lst~ti~ any ~ing 1~, ordhmtme or regulal:i~: ........................
PI,OT I)IAGRAH
~dmtlmr interior or co~r 1o~.
SS
f~lY OF .......................
a~e ~, j
(C~tractor, agent, c~r~rate of[icer, etc.)
of said (~r or ~mrs, m~l is duly ~thorl~l to I~rfom or h~e [mrforn~ tim ~id ~rk taxi to ~ke a~l file thi~
applicati~m; thaL all statamnts c~mta~[~ in this a~llcati~m are tn~ to the [mst of his kz~l~
Lhat the ~rk will I~ ~rfou~l in
the,~mmmr ~C forth in Lhe al~llcation fil~
Notaw Ptlbli*, State of N~w York
No. 4951364 ,
Qualified in Su~olk ~nty 0
Commission Expires May 2~,