HomeMy WebLinkAbout24127-z FOle, lt~ NO. ~
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.° 24121' Z
Permission is hereby granted to: ,/1 /y . ~ ~ y/~ ~ _~_ . .~, / ~// , /y~/ ~ \
....... ~~...~....~~ ( ~/~~~J
to .~7_,,,~. -..==...= ...................... ~- .~.-~;~,,,,,..; ....... :--..-......-: .......
' ................
at premises Iocoted ot ...................................................................... :~ ....................
County Tox Mop No, 1000 Section /'~-'~" Block ~ Lot No. .~..
pursuant to application dated ...~~-.~)... ................... , 19..~...Z and approved by the
Building Inspector.
Buildi/~ Insl:~tor ~'
Rev. 6/30/80
.FORI~ NO. I
BUILDING DRPARTFIENT
SOUTHOLD, N.Y. 11971
TEL: 765-1802 '.
Uisapproved a/c ......................
BOARD OF HEALTH ........... ... .
3 SETS OF PLANS ...............
SURVEY ........................
CIIKCK .........................
SEPTIC FORI4 ...................
NOTIFY:
CALL ....... ~.~..y. ..
HAlL TO: ....................
'APPLICATION FOR BUILDING PERI4IT
INSTRUCTIONS
'Date ................ ,19 ....
a. ~ais application mast be c¢~letely filled in by typewriter or in ink aed sul~itted to the Building Inspector with
3 sets of plans, accurate plot plan to scale. Fee according to schedule.
, b. Plot plan sl~dng.locatlon of lot and of buildings on premises, relationship to adjoining premises or pablie
stn~ets or areas, and giving a detailed description of layout of property mast be dram on the diag~m ~aich is part of
this application.
c. The ~ork covered by this application way not be ccrarencad before issum~e of Building Peemit.
d. Upon ~ppt~,al of this application, the Building Inspector will issue a Building Permit to the applicon, t. Such
pemit shM1 be kept on the praises available for inspection throughout the ~ork.
e. lqo b~ilding shall be occupied or used in xdaole or in part for any pm-pose ~Imtever tmtil a Certificate of
Occupancy shall have been granted by the Building Inspector.
/kPPLI~Clq IS m~I ~ to the Building Uepar~aent for the issuance of a Building Pemlt ptwssant to the
Building Zone Ordlnm~ce of the Toam of 8antbeld, ~uffolk County, Ne~ York, and other applicable Lmm, Ordinasees or
Regulations, for the coustmction of buildings, aklltions or alterations, or for rar~al or 0emolition, as herein
described. ~ applicant agrees to canply with all applicable lm~s, ordinances, building code, housing code, ami
regulations, and to a~it anthorised inspectors on premises aed in building for necessary inspections.
(Siganm~ of ~pplicant, or na~e, if a corporation)
(tlllng addregi~o£~i~t) ' ', '
.... =. ...................................................... ....
(as an the t~ rell or latest deed) NOTIFY BUILDING OEPARTMENT AT
/ff~and title of c~ate officer)
Pl~bers License No ............... .. .. ... ....
Eloctricians License NO .................... ..
Other Trade's License No ............
765-1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION * TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE, N.Y,
STATE CONS'~RUCTION ~& ENERGY*
CODES. NOT RESPONSISLE FOR
DESIGN OR CONSTRUCTION ERRORS
I. Location of land on ~alch proposed x,x~k will be done ...................................... ; .......................
............... . ..............................
County Tax lisp No. 1000 ~ectlon . ./..8..~.-~ ....... Block -~ Lot ~
~ulxtivision ............ Filed 14ap No ....... Lot .......
2. State e~isting use and occupancy of premises aed intended use and occupancy of proposed construction:
a. ~xlsting use and eeonpaocy .................................................................
b. tntended ose aed occupancy ...... .fi..~....~...: ........................ :~;?~.lq~aa¢~ .................
I0.
II.
12.
13.
14.
15.
I~cate clearly atxl distinctly
property lines. Give stree~
~eCher inLerlor or co~r lot.
P;~tnre of ~ork (clmck ~4~lch apphcable): Ne~ lkJilding .......... ~liti~ ...... ~.. Alteration .....
~ (to Im ~id ~t filing this al~licaCi~)
Dhmnsi~ o[ ~i~ri~ ~rnmtu~a, t[ any: ~t ................ ~ar ............... ~pth .................
Diaensima o[ ~m ~tn~t~re ~[th alterations or ~irlon~ Front .............. ~ar.. ..............
~pth .................... t~i~t .................... ~l~r o[ Stories ...... ~ .......
Si~ o[ lor~ ~t .......... ~ ......... ~ar .................... I~pth ............... .....
I~ate o~ hwdmm ............ ~ ....... ~ o[ Fo~ ~r ........................................
~ or u~ district in ~dd~ ~r~i~8 am ~t~
PI.OT DIAGRAH
............ being duly b~x)rn, delx)c, es and v,.uya that he ia the applie, mH.
(C~traeLor, n~genC~ ~orporate officer, etc.)
o[ said ~mr or ~mrs, ami is duty ~thoriv~ to lmrfom or h~e lmr[or.~ the ~id ~[k o[gl Co n~ke ami fil,e this
alq)licati~; thai: ail 9tatemnts c{mt~i~ in this all)lication are tn~ to fl~e I~t of his km~l~e a~
that the ~rk will I~ ~rfon~l in th~ .~lmer ~t forth in the al~l. ical:i~ fil~ tlmr~Lfl~.
~m to Imfom ~m this ~. I