HomeMy WebLinkAbout24222-zFORM
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HAU.
SOUTHOLD, N,Y.
24222 Z
BUILDING PERMIT
[THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
I)ate .,..,J.U~,E ............... 2.6 ........................... 19..9.7. ....
Permission Is hereby granted to:
....... ,J. OH~., .D.. ,~ ~Z~AE~P,~Q ........................................
....... klO~l~2'...P,~. ............................................................
~O~THOLD 11911., .............................................
to.....ERECT,, ,A,, ,FENE:E,, AS,, AP. RL.I,E~,, F, OR ...................................................................................
at premises located at ............. ,43,4,7,,5.,,.,MAIN,, RD ................................................ SDUTHO, LD. ...........
CouniyTax Map No.....,47...81~R9. ..... Section ...0.7.5 ............. Block ...DDO.1 ......... Lot No. DI~.~.Q(ll .....
pursuant'to application dated ...~T,..I~ ..... , ........ 18 ........................ 19..... -q~ ...... and approved bythe
Building Inspector,
Fee $ ........ ;~,,5., .0.0 .....
B~Cding Inspectoh~
Rev. 6/30/80
4
FORH NO.
TO$IN OF SOUTHOLD
BUILDING BEPARTHENT
TOIdlq HALL
SOUTHOLD, N.Y. {1971
TEL: 765- 1802 ',
BOARD OF HEALTH ...............
3 SETS OF PLANS ...............
SURVEY .............
CHECK .........................
SEPTIC FORH ...................
NOTIFY:
HAIl, TO: ................... ·
APPLICATION FOR BUILDING PERHIT
INSTRUCTIONS
· Da~e . . ,19
a. This application mast be completely filled in by typ~citer or in ink and submitted to the Building Inspector with
3 sets of plans, accurate plot plan to scale. Fee according to scbe6ule.
b. Flor plan sho~ing location of lot and of buildlngs on premises, relationshlp to adjoining IrC~ises or public
streets or areas, and giving, a detailed description of layout of property mint be dra~n on the diagram which is part of
this appllcation.
c. The ~n~rk covered by this applicatlon v~y ont be ccra~eseed before isanaace of Building Penuit.
d. Upon aov~val of this application, the Building Inspector will issue a Building Permit to the applicant,
pem/t shall be kept on the premises available for inspection throughout the work.
e. I~ building shall be occupied or used in v/aole or in part for any pat-pose v~hatever vntll a Certificate of
Occupancy ~hall have been granted by the Building Inspector.
APPLICATICi~ IS llgea~i ~ to the Building Uepartment for the issuance of a Building Pem/t pursuant to the
Building Zone Ordinance of the 3bwn of Sonthold, Suffolk Coanty, Ne~ York, and other applicable La~, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for r~oval or demolitlon, as herein
deseribed. The applicant agrees to c~ply with all applicable l~s, ordinances, building code, housing code, and
rngulatlo~, and to admit anthorised inspectors on premises and in building for necessary inspections.
(Signature of applicant, or na~e, if a corporation)
...... : ........... 9. .......... ~. ...... ............
(Mailing address of applicant)
State ~bether a~plicaat is o~er, lessee, agent, architect, englseer, goneral eontractor,a.el..ec~[~i~el~a~ ll~r or builder.
..... .......................... : ................ : ............ -----'
(as on the ~mc roll or latest deed) NOTIFY lU{LDIN~ DEFW~AE'NT AT
7~S-!t4~ e AM TO 4 IIM F(XI ~lE
4. FINAL · CONS'~iUCIION MUST
BE COMPLETE ~QW C. Oo
ALL CONSTRUCTION SHALL MEtT
THE REQUIREMENT8 O~ THE N.Y.
STATE CONSTRUCTION& WY
CODES. N~ WESPONSiBLI ~S
DESIGN~CONSmUCTI4~EImOW8
I. L~catlon of land on dnich proposed ~ will be done ..............................................................
~ N~i~r .:, Street
~ivlsJ~ ................ Fil~ ~ ~ ....... ~t .........
2, State ~sti~ ~ ~ ~ of ~s ~ iute~ ~ ~ ~ of ~ c~t~t~:
3. P~ture ef ~ork (check ddch applicable): ~ lkfihling .......... Addition .......... Alteration .......
If ~rage, ~i~r of cars '
6. If [xtsig~sa, ~nmrcia] or mi~l ~oqmr~y, sl~eif~ ~ture m~ ~tenC of each ty~ of u~ ......................
7. I)imnaions of ~iatieg atn~tu[es, if any: lb'one ................ I~ar ............... ~pth .................
Dinenaions o~ aa~ str~t~re ~th alLerations or t~kli~ion0: Front ............... I~ar ...............
8. l)i,ensions of entire r~ coflstru~Clon: t~r~x~t ................ Rear ............... Depth ..............
l~itO~t ....................... ~. ~t~r of Stories .....................
16. ~s of ~r of ~s
· ~ of C~traetor , I
PI.OT DIAGRAH
f~n p~l~r~y lines. Give street and
~dmtber interior or corner
tlA.o
t;z ,o
(C~ltractor, ~gent~ :or.rate officer, etc.)
of naid ~r or ~rs, ar~l is duly ~thori~ to I~rfom or h~e I~rforn~ the ~id ~rk m~l to ~ke a~l file this
apl)l icaCion; Lhat ali stat~nL9 c~b ti~ in this alq)] ication are the Lo U~e
that the ~rk ~iH I~ ~rfon~l in tl.: seetmr ~C forth in the appHcati~n~
~ to ~foreme this ~ ,
' HELENE O HOi ]gmal~re of Al~ti~t)
.
Notaw Public, State ,f New York /~, g~,~e c
No, 495138~ I
~m, delx)ses and says that he is the appl. lcsnt