HomeMy WebLinkAbout24185-zFORM NO.$
1OWN OF SOUTHOLD
BUILDING DEPARTMENI'
TOWN I, IAU.
SOUTHOLD, N.Y.
24185 Z
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UN11L FULL
COMPLETION OF THE WORK AUTHORIZED)
Permlsslon Is hereby granted to:
....... ~ ~N~....~.N. ~l...C;.g~.]; ~ I<;..E..Y. .........................................
....... .~.~ ~)...I~;P......H.~..I~ ~...I~ ................................. ..........
....... ~,T,,T,,~ ,T,W,~,~,,,~,,Y,,,~., ~, ~ .~ ~ ....................................
to ~;B~C;.T...,~ E.~I~;~..~.cJ...~f?..P.!-,,7, F~i~...E!~.I~...,. .............................................................................
MATTITUCK
at p~'emlses located at .................. ~..5..5........D..E...E..P.....H...q.L...E;.....D..R. ...................................................................
CountyTax Map No....,,4.7..,3..~..~.~ ...... Section ..1.-'L..5. .............. Block ....~,.0..~ .........Lot No..O,,Q,.~. ................
pursuant to application dated ...~1.~.'('. .................. ~.7. ......................... 19......~..7. ...... and approved by the
Building Inspector.
Fee $ ....... .~. .~. ,. .0. .9. .....
Rev. 6/$0/80
lq)EH NO. I
TO~,4N OF SOUTIIOI,D
BUILDING DEPARTHENT
SOUTIIOLI), N.Y. !1971
'FEI.: 765- 1802
BO^RD OF IIEAI.TII ...............
3 SETS OF PLANS ...............
SURVEY ........................
CItECK .........................
SEPTIC FORH ...................
NOTIFY:
CAI,I ................
HAIl. TO: ....................
APPLICATION FOR BUILDIIqG PEllHIT
l I~STRUCT1 OHS
Date ................ , 19 ....
a. 'Ibis application ramt be co~pletely filled in by tyl~.triter or in ink at~<l submlttc~l to the Iklildiog Inslmctor xoith
3 ~ts of plans, ac~rate plot plan to scale. Fee accordi~ to sch~lute.
b. Plot plan ~ieg l~atim et lot ami of lxdldi~s on praMses, relatlon~ip to ~jolning pranises or ~blic
struts or areas, a~ givi~ a (~tail~l ~ription of la~C et prol~rty ,~]sc lm dr~n on the diagr~ dfich is ~rt of
this al~l icat ion.
c. 'lhe ~rk c(~er~l I~ this application may m)t be c~m~l before isstmime of ~ildlng Pemlr.
d. Ul~n appeal of this application, the l~[l(lin[[ Insl~ct.or ~il[ issue a ~lil(li~ Permit to the appllcant.
~)mir shall be kept m the pr~i~s ~ailable for ins~ctlon thrr~gh~t the ~rk.
e. ~ Imildi~ droll I~ ~]pi~ or um~ in O~ole or in ~art for a~y lX~se M~a[~er until a Certificate of
'~lm~my ~mll have l~n I~an[~ by tie Ikfildlng 'lnsl~Cor.
~FI.I(~TI~ lS l~ffig~ [~E to the Ihildlng lk~r~ent for the issuance of a I~dldlng Pe~n~t la~rsuan[ to the
l~fildlng 7x)~m Or~i~}u~e of the 1'~ of ~tlmld, ~fffolk Cxamty, ~ York, a~ odmr applicable l~s, Ordinates or
~gulations~ [or tl~ camt~tla~ of ladldi~s, ~iti~s or alteratlons~ or for r~al or da~lition, as herein
~scril~l. 'll~ applicant a~8 to ca~91y wlrl~ all al~llcable l~s, ordlna~es~ beilding c~te, h~mir~
re,dati~,s, a,xl Lo mi,dC autlmriz,1 insl~ctors {,, proni~s ami in laJil,l~g for ,~cessary i~i~s~
_ (~h[,~ lng Mdress_0f a~pli~an~
State ~mther al~*licanC is ~r, ]es~e, agent, architect, engi~r, ge*~r21 contractor, electriclan.,~phsdmr.. . or beilder.
........ a.w. c ...................... ....................... ...: ........... · ............ :: .................
If applleanL is a cor[~ration, si~ture of doly au~horiz~l officer. FEE:~ ' '~¢ , ,~:
' NOTI~ BUILDING DEPART~NT
765-1802 9 AM TO 4 PM FOR
1. FOUNDATION - ~0 REQUIRED
FOR' ~URED CONC~E~
2. RO~H - FRAMING & PLUMBING
l~Hd~r~ [,~cen~ ~ .......................... 3. INSU~ON
Ph.d~r~ L;c. en~ ~ .......................... 4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
Elec~ric~mm L]cen~ ~ ...................... ALL CONSTRUCTION SHALL MEET
Otbe~ l'r;~'~ Licen~ ~) ..................... THE REQUIREMENTS OF THE N.Y.
~'~ ~ '~ ~ ~~ t { ~ ~]~. }.~ ~~ ,t '-- ,~ DESIGN OR C~NSTRUCTION ERRORS '
.. c,, .... ..........................
~flxliv~si~, ...................................... ~i]~ ~qp ~ ................ ]~ ...............
(~)
6. Eul. in~tt~l {2>sL ....................~ ... fee .................. ] ..... . ....................
(Io Im l~id ol~ fil~ing lid. al~)lieal-i~m)
Ii: gnilll~e~ ~Mdmr of cnru ......................................
I)ia~n~kxm o~ m~m ~t~J~:tt~re ~lth aller~t x~ or rLI o ~ Fro .... ',.....~. I~ur'. ..............
8. l)i.~m~i(ms'of, enLire I~ c(~mErtl:l:i<xl: I.'rlxll' . ............... I~ar ...... ,: ........ I~pd~ ..............
9. Size of lot: Prtmt .................... I~ilr . ................... I~plh ..i .................
g ....... ~ ......... Will a.st.esa fill tm rot~ed finn ~ronl~¢~.-. YES
15. Is lhi~ I*r~lmt'ty within ~ f~t of a I'idal ~mthu~l? * YI~q ~) [
· 11,' YES, l~llll~l} '1~i~ 'll~)gll~!S l~gl~['l' ~Y I~! IUg~/II~).
I'I.OT I) I'AGRAH J
[~:ate clearly m~l dJ~tiiml:ly nil Inlildii~s. ~lelJler ex 8 :lllg or profx)~l, dl~l i~Mieate all set--I~:k d'n~nalona
~dmth~ inlerkof or co,'lmr lot:.
Ik~ it; Ihe [
appJicnkJon; LhnL nil 8l'alclli~llt8 ¢:ontaha~d in Ihllt applicnt, ior~ life [l~l~ LO the I~il:j of his kixmledge lllKJ
.......... .......,
~)lary l,,b ' J ' ~ ~ 7