HomeMy WebLinkAbout24125-z FORM NO. :B
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.° 2~t125 Z Dote....~ ............. ~..~.7
Permission is hereby granted to~f~ ~,
~.~.
,o ........ ~...;...~ ....... ~~ ............... ~ ........... ~~.~.>: .........
...~...~ ........ ~:....../...~.....~..~~.
pursuant to applicc~tion dated ..... ~...~..~......~... ................., 19.~...~.., and approved by the
Building inspector.
Rev. 6/30/80
FORN NO.
TOI~N OF SOUTHOLD
BUILDXNG DEPARTN~NT
TOI~ ]]ALL
SOUTHOLD, N.Y. 1197l
TEL.' 765-1802.
BOARD OF HEALTH ...............
3 SETS OF PLANS ...............
SURVEY ........................
CHECK .........................
SEPTIC FORlt
CALL
~.~.P.t.~.~: ...........
'APPLICATION FOR BUILDINg PERHIT
INSTRUCTIONS
"Date ................ ,19 ....
a. 1his application hist be completely filled in by type~iter or in ink and anlnitted to the Building Inspector with
3 sets of plm~s, accurate plot plan to scale. Fee according to schedule.
b. Plot plan sho~ng location of lot and of Imildings on premises, relationship to adjoining premises Or public
~treets or areas, and giving a detailed de~eriptiee of lay~t of property must be dr~n on the dingr~m ~hich is part of
this application.
c. ~he work covered by this application may not be tormented before iss~ee of Building Permit.
d. ~ hi.royal of this applieatiou, the Building Inspector i~ill issue a Building Permit to the applicon. Such
I~nnlt shall be kept on the praises available for inspection throught~t the ~ork.
e. No building shall be ecc~pled or used in ~hole or in part for any imrpose ~hatever until a Certificate of
O~cupan~ shall have been granted by the Building 'Inspector.
APPLICAT[C~I IS 1~[~E4~¥ ~ to the Building Departmeut for the is~u~e of a Buildiug Permit lJ~mmnt to the
Building Zone Ordinance of the To~ of So~thold, Suffolk Cc~D], Ne~ York, and other applicable La~s, Ordln~es or
P~gulations, for the construction of lmildings, additions or alterations, or for r~n~val or d~olitlou, as herein
described. ~he applicator agrees to cc~ply ~rlth all applicable 1~, ordlnm~ces, building code, bonsing code, ~xl
r~gulations, and to ad.it anthori~d inspectors on premises and in Imilding for necessity inspections.
(Sig~atttre of applie~t, or ra~e, if a corporation)
(l~iling address of applicant)
State ~etber applicant ia o~ner, lessee, agent, architect, engineer, general contract~[~~t~t ,or_ builder.
'.:...0..~.~.~ ............................................................ ~~~,"-'~-,~~--
N~ne of o~er Of prelims ..... k~./.~'[.L~:~.~. (...t L 1:. [ ! LTd.~.%~. ............... .N O.TJ FY. ~UILD~NG. D~RAP.~:MF. NT. A~.
(as on the tm~ roll or latest deed) 765-1802 9 AM TO 4 PM FOR THE
If applicant is a corporatlou, signature of duly authorized officer.
(N~eand title 'of corporate officer)
Builders Li. cense No ............... 't .........
Plumbers Lxcanse No .......... .~..~/~. .......
Electricians License No ....... ~ .~J/. [ .~ .......
Offer Traders License Na .....................
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
S. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION & ENERGY
CODES. NOT RE~SPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
1. la:atiee of land on ~hich proposed ~ork will be done ........................................... ...... . .. .. · ..... · .
...~...&..~. ..... P. ttC.~.~% ....................... ~V.~C(.t..'..~.~. ...........................................
14o~se l~d~r Street Ballet
County TaxIqapBuo I000 Section ...... f/...~. .... Block ....... J~. ...... Lot ~ ......
· Filed ~ No Lot
Subdivision .................
2. State existing use and occupancy oi premises and intended use and occupancy oi proposed ceestmct~on:
~. ~asting ~ ~ oc~ ......... .~.~./.~ .....................
· .~ .gl.O. &~ ...................
....-. ..... ....... .............................
3. ff~t.re o~ ~ar~k (check sddch applicable): ~ I~dlding .......... ~i~i~ .......... Mteratioa ..........
~' I (to ~ ~id ~ filing this
If ~rage, t~i~r of ~rs .... ~ .................................
If ]msirena, ~rcial or mi~ ~, s~ci~ ~ure ~ ~teflt of earl, t~ of u~ .... ~.{a ............
6.
7. I)inenai~s off ~isti~ atnm~ea, if any: ~t ................ ~ar ............... ~pUt .................
Dinenai~ of ~m at~b~re ~th alterati~a or ~itiona: ~ont ............... ~ar
8. Dinensi~ off entire ~ ~st~tim: l~mC ................ ~ar ............... ~pUi ..............
I ~t~r of Stories .....................
9. Si~ of I
lot: t~t .......... ~ ......... ~ar .................... ~pth ....................
~I,OT DIAGRAH
~d~tl~r interior or co~r loL
(~m o~,i~ividm~ ut~ing c~traet) ]
(C~ltractor, agellt, ~or~rate officer, etc.)
o ' said ~r or ~rs, taxi Jo duty ~thor~ to ~rfonn or h~e i~rfo~ Lite ~i(I ~rk mgl t:n ~ke a~l file this
al~licatim~; that alt statamnts cmt~t*~ ~n thin alq>licatl<a~ are
that the ~k wilt I~ ~rfon~l in th~ ~ms~r ~t forth in the appl. icati(~
(~igm~ure