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HomeMy WebLinkAbout24218-z24218 ~ ~ORM NO.$ TOWN OF SOUTHOLO BUILDING DEPARTMENT TO~I HALl, ~OUTHO~, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNtiL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ....... H,~B~...~...~E...H.~BD.~ ...................................... ....... Z,~...~UJ~,,,~.~...~ .............................................. ....... ~:~.P. OB~...~.~...~,~..4.~ .................................... at premises located at .................. :..~ ~......~J~..,~.~H.~...~ ................................... ,~.1~[~.~..0,~, ......... CountyTaxMap No.....~.~.~ ...... Section ..~.~. ............. Block ....0.0.~ ......... Lot No. ~.~ ................ pursuant to application dated .,.~,~; ............... ~.~ .............. , .......... 19.....~.~ ...... and approved bythe Building Inspector, Fee $ ........ ~. ~. ,. P.Q ..... Rev, 6/30/80 UCc~/e : 50'-- I" [~ = i~/{O l-l U ,~l ~r tl 1~' , ? TOI4N OF SOUTHOLD ! · ~ ~ 9 , ' ! · BUILDING DEPARTI4ENT SOUTHOLD, N.Y. 11971 ......... ................ Di~ a/e .................................. .............................. , ...... - APPt;~CATJON FOE B~I_~oI_~ FgPa~:T INSTRUCTIONS BOARD OF HEALTH ............... 3 SETS OF PLANS ............... SURVEY ........................ CHECK ......................... SEPTIC FORIt ...~ .... ~ .......... NOTIFY: 14AII. TO: .................... a. Ibis applicatiou ~ast be ccmpletely filled in by typaeriter or in i~ ~ ~itt~ to ~e ~ildi~ In~tor with 3 ~ts of plus, ~ate plot pl~ to ~ale. F~ ~c~i~ to ~le. b. Hot plm ~i~ l~tim of lot ~ of ~ildi~ ~ ~i~s, mlatimi~ip to ~joini~ ~s or ~blic st~ts or ama, ~ givi~ a ~tail~ ~ripti~ of l~t of ~r~ ~t ~ dr~ ~ ~e di~ ~i& is ~rt of ~is ~licati~. c. ~ ~k ~ ~ ~is ~liati~ ~ ~t ~ c~ ~fo~ isle of ~ildi~ Pemit. d. ~ a~al of ~is ~liati~, t~ ~ildi~ I~tor will is~ a ~ildi~ Pe~t to the ~li~t. ~t ~11 ~ ~t ~ ~ ~i~s ~il~le for iu~ti~ ~t ~ ~rk. e. ~ ~ildi~ ~11 ~ ~i~ ~ ~ in ~le ~ in ~r~ for ~ ~ ~at~r ~til a ~ificate of ~ ~all b~ ~ ~m~ ~ ~ ~ildi~ Iu~tor. ~I~ IS ~i ~ to t~ ~ildi~ ~nt for ~ isle of a ~ildi~ Pe~t ~t to ~ildi~ ~ ~i~ of ~ ~ of ~ld, ~ffolk ~, ~ Yo~, ~ o~er ~li~le ~, ~ati~s~ ~ ~ ~st~ti~ of ~ildi~s, ~iti~ ~ alterati~s, or for ~al or ~liti~, ~scri~. ~ ~li~t ~s to ~ly ~a ~1 ~li~le 1~, ~i~es, ~i~ ~, ~i~ c~, (lqailing address of applicant) State ~aetll~/a~ at~licant is oaner, lessee, agent, ~it~t, ~i~r, ~ral c~traetor, electricia, pl~r.~.. ~ilder. ........ ........ ............... .=..: .......... .... .............. ........ ,(an~ ~ t~mI1 ~latest ~) , ~ ,. ~ . ~ ;~ ...... a rati~ si ~e of &l ~ri~ officer ~ ~ ~T ~ ~T ..................................... 1, ~ * ~ RE~IRED (~ ~ title of ~ate oilier) ~~ ~il~rs Lic~ ~ .......................... 4. FINAL - CONSvRUCTION MUST BE ~M~E FOR C.O. ~rs Lic~ ~ .......................... ALL CONSTRUCTION SHALL ~EET El~trici~s Li~ ~ ...................... TH~ R~f~~ '~ {"~ ~! v STATE CONSTRUCiIO~ & ENERGY ~r ~s Li~ ~ ..................... CODES. NOT RESPONSIBLE FCq T~.el~ ~ 1~ ~ ..~l~ ~e~ ..~ ~gll ~ ~ DESIGN OR Cp. NSTRUCTION ERRC)R~ . ,~ ......... ~ ..... ~.~ ......................../m ................................................. / ...... ~.~ .......... ~.~ .... ~, ........ ,..,.~ ............................................................. ~T~p~. ]~ ~ti~ ................ Bl~ .......... ~t ..~ ............ ~ivisi~ ...................................... Fil~ ~ ~ ................ ~ ............... (~) .. ~i~ ~ ~ ~ .. ~4~(~ ~ ....................... ' ........... , ................ ~. ~,t~ ~ ~ ~ ..~l~.Z'.~./.~!~ ............................................. 3. I%tnre e~ t~o~k (dmck ~daid~ a dicable): ~ Ik~ihling .......... /kkhtlon ...~... M~erat~on .......... / If garage, ~aalmr o~ cars .... ~ ................................. 6. I~ I~si~mss, ~rcial or mi~ ~y, s~ci~ ~ture m~ ~tenc of ead~ ~ of u~ ...................... ?. Din~nalam o~ ~is;iq atn~tn[es, if any: ~ ................ ~ar ............... ~p~h ................. Diaunai~s o~ ~m sC~mre w h alterati~s or ~lCmns: l~ont ............... ~ar ............... l~pth .................... l~i~c .................... ~lmr of Stories ............... I~i ............... ~r o~ 8toriea ..................... 9. 5i~ of lot: l~r ' ~ar ~pth ............... ..... ~me of Ar~d~t ............ ~ .................. ~veas .............................. H~ ~ ............... PLOT DIA~RA~ ~ pr~r~y li~s. Gi~ st~ ~ bl~k ~imr or ~acripEi~ according ~o ~, a~ ~l~ street ~s ~l i~icate ~amtlmr interior or ~r lot. I o~ aa~d ~mr or ~mra, m~l ia duty ~thori~ to ~rfonn or h~e I~r[om~ the said ~[k m~l to rake a~l flle this aiqfl [carlo,,; Lhal: all atata~uta ccmt'a~imM in this al~)lication are t:~ to the Imst of his k~ml~lge ~ta~ KAREN O ,JACKSON Nolary Public 8ta e o New No. 4988666 {