The URL can be used to link to this page

Home My WebLink About23954-z FO.,Mr 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) Date Permission is hereby granted to: ..................... ....,~~.....~.×~.....~..~ .... , ~o...~~.....~.. ........ ~,,~.~_ ...... ./..~...~ ....... ....~..../...~.~ .......... ,~./..~. ....... pursuant to application dated ........ ~~~ ................. 19~...~., and approved by the / Building Inspector. R~,~. 6/30/80 FORM NO. I TOIT/I OF SOUTI101,D BOIl,DING DE PARTI~IENT TO'dN {IA1,L SOUTIIOLD, N.Y. I 197 TEl.: 765- lB02 Di.qaporoved a/c .................................. BOARD OF IlEAl,TI{ ............... 3 SETS OF PLANS ............... SURVEY ........................ CHECK ......................... SEPTIC FORH ................... NOT] FY: CALl ................... HAll. TO.' .................... APPLICATION FOR BUILDIHC, PERHIT INSTRUCTIONS a. Tlds application ntmt be completely filled in lry lypc~,nciter or in ink m~l md~aitted to O~e ~dldi~ Insurer wi 3 ~ts of plus, ac~ate plot pl~ to ~ale. F~ accordi~ to sch~hde. b. Plot pl~ ~i~ l~ti~ of lot ~1 o[ ~dldi~ ~ ~i~s, ~lati~Mdp to ~joinln8 ~i~s or ~1 str~ts or areas, ~ 8ivi~ a ~tail~ ~riptlm o[ l~t o~ ~rty mst ~ drmm ~ ~e di~ ~dd~ is ~rt of O~is a~] icati~. c. ~ ~rk ~ ~ ~is ~licati~ ~ ~t be ~1 before ism~e of ~iildi~ Pemlt. dt ~ ~al of Ods ~]icaki~, the ~ildi~ lns~ctor will is~'a ~dldi~ ~mit to the ~licant. ~{~.Mmll ~ ~pt ~ t}~ ~i~s ~i]~le for {ns~ti~ th~a¢~t the ~rk. e. ~ ~ildi~ ~mlI ~ ~{~ or u~ in ~le or in ~rt for ~W ~ ~at~r ~tll a ~rtlflcate ~I~H~ IS tm;10;{ll ~E to t.{~ ~dldi~ l~rt~nt for the isle of a ~ildi~ Pe~it ~rmmnt ~dl.di~ ?~ ~i~e of fl~ T~ of ~O~ld, ~ffolk C~ty, ~v %rk, a~l other a~licable I~, ~i~es or ~lati~s, for t~ ~t~ti~ of ~ildi~s, ~Miti~s or alterati[m9, ~ for ~1 or {~liti~,~s lmrein ¢~ri~. ~ a~li~t a~s to ~ty w[~ all ~licable 1~, o~i~es, ~ildi~ ~e, I~mln~c~le, (Si~t.re of a~licanC, or ~, if a ~ratlon) .... State-A~etber applic~qnt is ou,~r, lessee, agent, arcidtect, eng, lneer, ~mral ~traetor, electrician, pl&r or ~dlde ....... ..................................................................... aP aVED. NO m: ........ If a~llcm~t is a ~rati~, si~at~ of ¢~ly m;tl~riz~ officer. 765-1802 9 AM TO 4 PM FOR THE (Nane a~xl title of corporate o[[icer) Builders Licen~qe No..X,k~ ................... lt~abers License lip..__~ ................ Electricians License No ...... ..~ ......... OLl~tr Tr~qde's License No...... ~.~ ...... 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 CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS I. l~cation of lar~l on ~,Idd~ prcgo.~d work will be done .............................................................. ........ . . . . .... ..... /. .. . ....... .... ......... ......... ~ivlsi~ ...................................... ~il.I aap m ................ lac ............... (~) a. F~isti~ t,~ ~ ~ ..~.'~ ...................................................... b. ~nte~l .~ ~ ~ ...... ~~ ........................................................... '1. i~;~lt~e of v. ulk (cl~:x:k Mdd~ apt)licill)le); Nc~ lhdhli~l .......... &~tition .......... Alteration .......... t~l~,ir ............ ~ma~ ............. l~ml ition ............ Other la,rk ..~~ ................ fl. Est i,~t~l C~r .. ....... f~ .............................................. 7. Ili.~mimm o~ ~i~th~ ~rr~turen, it any: Fr~a~t ................ l~ar ............... ~p[h ................. l~i~,t ......................... ~ad~r of Stories ...................... l)is~zmi~a of sa~ ~tnmtme with alrerati~am or ~kliti~ms: Frotl~ ............... l~ar ............... I~pth .................... I~i~t .................... ~l~r o~ Stories ............... I~il~r ......................... ~l~r t}~ Slot lea ..................... 9. Si~ of lot: 15trot .................... I~ar .................... I~pth .................... I0. I~te off h,r~m~ ..................... ~ o~ For.er {~r ........................................ 11. 2xa~ or u~ district Jn~,id~ pt~ai~8 aresitmt~t ............................................................. ~ o~ ArdHt~t .................................... ~lress .............................. ~m~ ~ .......... 15. Is thi~ pmi~rty within ~ f~t of a ti~l ~mtla~l¢ ~ YI~ .......... ~ .......... Pl,O'r DIAGSA~ l~ate clearly md dizritmtly all I~ildi~s, O~etlmr exls[ing or pro~ml, m~ i,alieate ail ~t-l~k din~nsion~ ,~1'^'11~ [Xi' lxl'2d Y(]i~,K, .................... t~ is the ........... ~.;)~ F ......... J.[... ,.; ;hday ~ ..... t;2. ~ ...... C~tRE L Gt.~ Note~ Pubfic. Stere ~f New York Qualified in Suffe k Coun~ Commi~ion Expiras Oscember 8, 19 (hily s~)~n, (lelX),~s a[~l s~lys [hal he is Lhe appl ic~.iL (Sig[uHme o1: ^ppi i(:ant)