HomeMy WebLinkAbout24266-zTO%VN OF $OUTI4OLD
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? 24266 Z ~.~...~..
Permission is hereby granted to:
........................................... ............... ........... .....................
at premises located at~.....Z~.~..~..~.~...~.~.....'~...~.....~
Coun~ To× Mop No. ~00 S~,~.~ ...... ~,~ ..... Z ............ ~o,,o. ~
pu~uan, ,o application~t~ ...~..........~ .................. , 19~.~ and op~r~v~'~ the
Building Inspector. ~ ~
Rev. 6/30/80
I I:l ) I il*l '1') ' I)ATI.'
I
[,
E~llr~
ARrayed
]r
FORH lqO. I ~
TO!4H OF SOUTI1OI,D
TO~IN ltALL
SOUTHOLD, I~I.Y. 11971
.BOARD OF tlE^LTII ...............
-/~ SETS OF P?????????~g ...............
SURVEY
~' cnEcl( ........... ,' t: ...........
SEPTIC FORN ..... ~ . .; ..........
NOTIFY:
CALl ...................
HAll. TO: ....................
Dote ................ , 19 ....
INSTRUCTIONS
n. 'lhls appllcotlon .ust be o~pletely [i1 Itel in by tyl~,~rlter or in ink ~1 ~Jl~ltt~ to the ~fildln8 ln~clor whh
3 ~ts or plans, ~c~rate plot plan Lo scale. F~ acco,llng to schedule.
b. Plot plan ~ing l~ad~ of tot ~ oE t~fildlngs ~ ~ises. ~latlonslfip to ~jolning pr~ni~s or ~bl lc
struts or are~s, taxi gDJ~ ~ ~tail~ ~scrlption o[ t~l: o[ pretty mint 1~ dr~ ~ the dio~n ~dch is ~qrt of
this a~l icatlon.
c. '1t~ ~rk c~r~ 1F this a~llcatlm ~ ~t t~ c~l l~fore issue of ~ildi~ Pem~t.
d. U~ ~al o~ this ~llcadon, the ~ildlng lns~ctor wiH ism~ a ~dldi~g Pem~t to the a~l
~mlt ~all I~ kept m tl~ ~i~s ~itable For ins~etlm (h~mt the x~rk.
e. ~ Ix~iMi~ ~mll t~ ~pi~ or uP~ b~ ~ole or in l~qrt for a~ ~r~ ~at~r xmtll a (~rt[fic~te of
(~o~y shah h~ l~en ~t~l I~ tl~ Mildi~ Ios~tor.
A~A(~TI~ IS I~s~s~ ~ to the ~ildi~ l~rt~nt For the ismn~e of ~ ~ildi~ Permit ~m~t' to the
~fildl~ Fz~ O~lJ~mm:e of tl~ T~ of ~tt~ld, ~[folk ~mty, ~ York, ~1 other a~llcable l~s, O~im~es or
~hti~s, for tl~ ~st~tion of hdldi~s, aMitlms or ~lternti~s, or lot r~l or d~lltlon, ~s herelu
descri~, '11~ ~ffplleont s~es to c~ly with ~tl ~llcnble l~s, ordi,m~e~, Ixdldlng c~rM, I~slng c~le,
re~d~tlms, ~ to ~hlt ~tlmrlz~t ink. tars m ~i~s ~M in Imildlng for ~ess~
... ........
(Si~h~e of ~llca. t, ~ n~, if ~ cor~rntlon)
(~itlng ~klress of
Slale d~ether applicant is owoer, leshake, agent, architect, engineer, Renern] contractor, electne~at, p]lJ~r or IRdlder.
...... .Qmae: ..... · ...................................................................................................
oe .......................................
(os m the t~x roll or latest d~)
1~ ~pplifont ~s ~ c%~ra~, ~i~ al ~ly m~tl~r~z~ officer.
(~oM title of co~offlc~)
'1.
I0.
II.
12.
14.
fi(i, i)rol~lly line.s. Giv~ ul:l~.~,,l: alxl
l~l~lir ............ 10~li~al ...! .......... I~,~fl ilion ............ Olher 14oik
I~d,,~,t ~l <~t ..... ~.../~.~ ~ DD.O... ~,~ ..............................................
If ,L~llins, tt,,l~r of ,L~l'lin;~[ unil~ .... '~ ...... li,,t~r of {~llinfl unil.~, c~ eac fh~r ...~ ...........
If IxmJi~:m, (~n,elcial or initial ~:eUl~l[~y, 6l~eif~ I~llllr{l m~l ~xLeol: of each Lyf of Line
I)in~nM~m of exi~rinfi ~tn~:rurba, if any: I~nmt. l~ar I~pth
lkqllh ........ ~ ............ I~ll~)L .................... ~llt~ of firoFifi~i ...............
' · 5
~till Iol I~ resr~d .......... ~ ......... ~ill exceaa fill I~ rc~l~ed frown pr~ni~e~:
PI.OT I)]AGRAH
%,,
................ ~?c:,'./. /2~· [.6~,~.~; "
(hhll,~: Ol individual .sil~nJni~ CoIILF;']C.L)
.............. IxH nk~ duly
· . R AS NO
NSPECTIuw~;:
1. FOUNDATION.. ~0 REQUIRED
FOR POUEED CONCRETE
2. ROUGH . FRAMING ~ PLUM~ING
3. ~NSULATION
4, FU~JAL .. CONSTRUCTION MUST
BE COMPLETE FOR
ALL CONSTRUCTION SHALL
THE ~EOIJIREMENTS OF THE N.~
STATE CONSTRU~'~ON & ENERGY
CODFJfi, N~ ~ESPoNSIBLE FOR
~JO~ OR CONSTRuCTIoN ERRORs
nplfl icnkion; Ihal. ,IIi titilLolDolll:8 (:%).Lahx~( iii this al)pi ical ioll'ar(~. I lllO [0 the I~uit oi: lli~i klxx4edSe m~l Ix)l ief; nlxl
Ih~iL Ill ~nk will I~ I~ri:onl~l iii Ih(} lll~lilll~r ~tel: fo[th [n Ihe appl 'chi loll fjio(I [hercwilh.
(,~ihnal'ule of ^ppi icanl:)