HomeMy WebLinkAbout24001-z IPO~M' NO. J
TOWH OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N°. 2tOB1 Z
Date ..................... , 19
Building Inspector.
Rev. 6/30/80
o~
BLDG. DEPT.
...... ~.OWN OF SOUT~O, D~__.
FORH NO.
TOWN OF SOBTUOI,O
BUII.DING DEPARTHENT
TOWN BALI.
SOUTIIOI,D, N.Y. 1197 I
TEL: 765- 1802
INSTRUCTIONS
BO^RI) OF IIE^[,'{'I! ...............
3 SETS OF FI.fiNS ...............
SURVEY ........................
GIIECK .........................
SEPTIC FORH ...................
HOTIFY:
c^,.,..'9~ Y-.?.~aZ ....
~^11, TO: ..................
a. 2~is application ntmt he co. lately filled in by typewriter or in ink and sulraitted to tl~e ~Hldi~ Irish[or
3~[s of plus, ~rare plot plm~ to ~ale. F~ accordi~ to ~]ale.
b. Plot plan fl~i~ l~tion of loc ~ of ~ildi~ ~ ~i~s, relationship Co ~joini~ pr~i~s or ~]ic
struts or areas, ~ givi~ a &tail~ ~ription of last of pro~rty ~st ~ dr~ ~ the di~r~ ~id~ is ~rt o
this applicati~.
c. ~ ~ ~r~ ~ ~is a~licati~ ~ ~t he c~ed ~fore issue of ~ildi~ Pe~t.
d. U~ a~al o~ fl~is a~licati~, the hfildi~ lnsi~ctor will is~ a ~ildi~ Pe~t to the a~licant. ~d
~mit ~mll ~ ~pt ~ tim ~i~s ~ail~le for ins~ti~ th~{~t tim ~rk.
e. ~ ~ildi~ ~mll ~ ~o~i~ or u~ in ~le or in ~rt for ~ ~ ~mt~er ~til a ~rtificate of
~co~ ~mtl h~ ~n ~ant~ t~ the ~ildi~ Ins~tor.
~I~TI~ IS IE~ ~ to tim ~ildi~g I~rt~nt for the issue of a ~ildi~ Permit ~r~t to the
~ildi~ ~m O~i~ of ~m T~ of ~lttmld, ~fffolk C~ml~, ~ York, a~ other ~lic~)le I~s, ~i~es or
~lati~s, for ~m ~st~tim o[ Imitdi~gs, m~iti~s or alterati~a, or for r~al or ~liti~, aa I~reiu
~ril~. ~ a~li~t ~s ~o ~ly vifl~ all a~licable l~s, ordinates, ~ildi~ ~e, I~mi~ c~, a~
~lations, a~ to m~it ~O~ri~ ins~tors t~ pr~,i~s aed in I~dlding for ~ces~ ins~ti~{s.
/[S~mture of appllcant, or ~, ii a cor~ratioO
State ~tl~r a~li~t is ~r, les~, ~mnt, ard~it~t, engi~r, ge~ral c~tractor, electrician, plier or ~ih
..... .....................................................
( ' atest d~)
If als~lic~t is a co.ratio, si~mture of duly m~tl~ri~l officer.
(K~ne and title off corporate o~ficer)
Builders License No ..........................
Pl~l~rs License I~o ..........................
Electricians License No ......................
Otl~r ~'s I,i~ ~ .....................
... ~. ~..~<.~z ~.~ .... ~..x ..... </. g'.~:C~. .............................................
I~ ~r St~t l~nleL
C~y w ~ ~. ~ ~i~ ..J.l~. ........ ~,~ ...~ ........... ,~ ..Y.~. ..........
~ivisi~ ...................................... Fil~ gnp ~) ................ lot ...............
(~)
2. State existi~ ~ ~ ~{pa~ of pr~d~s ~ inte~xl~ u~ axxl ~co~y of ~o~l c~st~tion:
b. ~.~ ~ ~ ~ ..... ~..~. x...tTe:~ .... ~.~.~. ~ .~.~
/
3. N. lt.,e of ~lk (dv~ck Mi[dr al~piicallle): I'L'w l~lihlin8 .......... &kliti~ .......... hlte~at i(m ..........
6. 11; Ix~6hmas. ~m~rcial or mi~l ~:CUlm~y, ~l~Cil~ tmture m~l extent of ea~ tyl~ of u~ ......................
7. Di.~nai~m of ~iating at'n~tmes, iF any: ttr~.~t ................ l~ar . .............. [~pth .................
l~ldh .................... l~i0d; .................... ~ml~r of Stories ...............
8. I)i..Nmi~m of entire ~ ~mtn~[icnl: Ft'~xlt ................ l~ar ............... I~pth ..............
PI.OT DIAGRAM
ltx:ate clearly and disl:incl:ly ~11 buildi~qIa, ~mt[var existing or proposed, and i~Miee[e all set-back dimenMon~
~;~n~ p.'~[x-~rty lines. Give ~l:r~eL and block ~i)er oc de~crip[itm according to dc~M, ~nd shcw ~rreer m~nes m~l indic~
ut tmld (~a~..r or ~!r.% m~l i.s duly authorizc~l to I~rRnm or have l~rtoH~M Ih~ said ~tk m~l to n~&e m~l file Ihi¢~
lh;lL the ~)tk ~i Il I~ I~rffout~l iLll Ihe fi~un~r ~t. forth ill the appl leal:leu fil~l
~),,, lo[~1~ I'o~'e ,,~ tla~thiSo~ ~~ ~9~.~
, N~ublic. Stere of New York /
' Qualified in SutfOk Cou~ .~ [¢
~mission E~ires Decem~t ~, ~--