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Home My WebLink About24097-z lrOl~f[ 1~0. 0 TO%VN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2409? 7 ¢oun~ To~ Mo~ ~o. ,000 S.c,,on ...././..~. ....... B,~k ...... /../.. ......... Lo, ~o ...... ~.L ....... .z. pursuant to opplicotion doted .......................... , 19..,~.... and approved by the Building Inspector. Rev. 6~30/80 FOP, ti NO. l TOIiN OF SOUYHOLO BUILDING DEPART~IgNT TOI/N NALL SOUTHOLD, N. Y. TEL: 765-1802' BOARD OF HEALTH ............... 3 SETS OF PLANS ............... SURVEY ........................ CHECK ......................... SEPTIC FOPR4 ................... NOTIFY: 6.[.. NAIL TO: ....... APPLICATION FOR BUILDINg PERtllT INSTRUCTIONS a. ~his application mst be campletely filled in by typcn~iter or ia ink and anlxaitted to the Building Inspector ~ith 3 sets of plans, accurate plot plan to scale. Fee according to ~le. b. Plot plan shoning location of lot and of buildings oil premises, relationship to adjoining presaises or public streets or man, and giving a ~etailed description of lay~t of property ~aist be dr~ra on the diagram x4aich is part of t_his application. c. The x,xn~k covered by this application may not be ecer~need before issu~ee of Building Pemit. d. Upon alto,oval of this application, the Building Inspector ¥r111 issue a Building Pexmlt to the applicant. Seth pannit shall be kept on the pr~fises available for inspection throughout the wrk. e. 1~ building shall be eccupied or used in ~hole or in part for any porpose x0hatewr ontil a C~rtificate of Occupancy shall have been granted by the Building Inspector. APPLICATI~I IS tli~: i to the Building at for tim issuance of a Building Penalt pttran~t to the Building Zone Ordi~ece of the To~ of ~utheld, Suffolk County, Ne~ York, and other applicable La~s, Ordinances:or Regulatians, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. Tee applicant agrees to ec~ply ~ith all applicable Ix, ordinances, building code, housing code, and regntlations, and to admit authorized iasI~Ctors on premises and in building f~/~ecesse~y i/~spections. t (Signature of applicant, or n~e, if a corporation) (flailing address of applicant) ~ State ~anther applicant is oe~er, lessee, agent, architect, eagieeer, g~eeral ~trsct~, el~trici~, pl~r ~ ~il~r. ................ APPROVED AS NOT~ ..................... ........... 'h' ..... ; ............... ..... (~ ~ ~ t~ roll or latest ~) NOTIF~BUILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE If ~lieat is a ~ati~, si~ of ~ly ~i~ offi~r. FOLLOWING iNSPECTIONS: 1. FOUNDATION - TWO REQUIRED ...................... FOR POURED CONCRETE (~ ~ title of ~ate officer) 2. ROUGH = FRAMING & PLUMBING 3. INSU~TION 4. FINAL - CONS3RUCTION MUST ~il~rs Lic~ ~ .......................... BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET Pl~re Lic~ ~ .......................... THE REQUIREMENTS OF THE N.Y. [l~trici~s Li~m ~ ...................... ~TATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR ~r ~s Li~ ~ ..................... DESIGN OB 1. ~tim of 1~ ~ ~i~ ~ ~ ~11 ~ ~ .............................................................. ~ ~r St~t . ~ ~et ./ZS:: ....... ........ .... ai*isi~ ...~.{.~.~,~0 ': ...................... ~q~ Fil~ ~ ~ ................ ~t .~.(.~... (~) a. ~sti~u~~ .................................................... ... ... . · ... ,.. · .... .. · .. · b~ Intended u~ and occupancy ............................. II. 12. 13. 15. ''ri Pat.re~ of ~ork (cl~Ckl~meval~Jddt a.p~lieohle): ~ Ikiillli~l .......... Addition .......... Alteration .......... lIemol i lion ............ Other Work ......... .~.~ ~.~..~ f~'. ........... 9/ .(Description) (~o I~ ~id ~ filing rids a~licati~) If &~lllng, m;~i~r of ~lhntarts . ........... [bd~r of {[~lhng traits on e~ ~r ................ If garage, ttJd~r of cars .... ~ ................................. If I~miness, ~mrcial or mi~l ~on~, sl~ci~ ~ut:ure and extent of eadt ty~ of u~ ...................... Dimensions of ~isCing strictures, if any: ~C ................ ~ar ............... ~l)th ................. l}inensi~s o[ ~m sCn~mre w rh alt'eraCi~s or ~irions: ~eer ............ ~ar ............... 1o~ · ~ of C~tr~ror ............ ] ....................... ~klress ............................... H~ ~ ............... , . locate clearly and dietlnctly f-rm~ propert~y lines. (live street xdmtber interior or corner PI,OT DIAGRAH L1 baildings, xl~ether existing or propoeed, and indicate all eet-lmek dimensions block nuni>er or description according to deed, and r~ow street na~s and indicat~ ............... I>eilql duly ~am, delxmes and says thnt lie is the applicmnt lie ]re Lhe ........... (C~ltractor, asent, cbrporate officer, etc.) of said (~er or ~rs, arxl i8 drily ~thorir~ to i~rfou~ or have l~rfom~ the aaid ~zk mxl to ~ke and file thin statamnta (:~ta~t~ in thin al~l [cation are t:nm Lo the Jmst: of his kt~l~ge a[~ l~[iefl and that the ~)rk will I~ ~rfon~l in the] n~m~mr ~t forth in the a~ticati~ fil~ ~)m to Imfore n~ this I UNDA J; coOPER ! Notary Public, State of New Y°f 4822563, Suffolk, CountY Te?m°~xpires December $1,1~ (Sigmature ef Applicant)