HomeMy WebLinkAbout24010-z lrO]~,M NO. J
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 24010 7
Permission is hereby granted/;~/~to:~,
......... /...~...~...~. .,~...~.: ...................
..~Z.:.,....~. .,4~. .~..~,.~ ~ /...~...~?.. .........
...... .
Building Inspector.
Rev. 6/30/80
i !
[ BLD~ DEPT.
FORM NO. I
TOWN OF SOUTIIOI,D
BUILDING DEPAWPMENT
TOWN DALI.
SOUTIIOI,I), N.Y. I ]97 I
TEl.: 765-1802
Disapproved ~/c ..................................
INSTRUCTIONS
BOARI) OF llEAI.Ttl ...............
3 SETS OF PLANS ...............
SURVEY
CHECK .........................
SEPTIC FORM ...................
NOTIFY:
cA,,L ~. = ~.7 ....
MAI1, TO: ...................
Date ................ ,19...
a. Tills applicaticm nttst b~ completely filled |n by typewriter or in ink ar~l st/n|tted to tim Building Inspector
21 sets of plans, accurate plot plan to scale. Fee acconlhxg to schednle.
b. Plot plan showing location of lot and of Ixdldings on premises, relationship to adjoining premises or l~t)lic
streets or areas, and giving a detailed description of lsyont of property must be_ drawn on the diagram ~hich is part o
this application.
c. Tim work covered by this application my not be corrne{}ced before issuance of Building Pemit.
d. Upon approval of this application, the {kfilding Inspector will issue a Building Pemlt to the applicant. Sue
pemit simll be kept on tie premises available for inspection thrcughmt the work.
e. No hfildlng simll be occupied or used in wl~ole or in part for any t~rpose v/mtever until a Certificate of
Occupancy stmI1 Imve been granted by the Building Inspector.
APPLICAT[(II 1S IEREBY ~ to tim Ikdlding Department for tbe isstmoce of a Building Permit la~rsum~t to the
Building Zone Ordirumce of the Tcvm of Sonttmld, ~d:folk County, NO~ York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for r~nuval or deraulition, as bereln
described. 'lhe applicant agrees to cc~ly with ail applicable laws, ordinances, building cude, I~aslng code, and
(Signature oF appl icant, or ~ne, i~ a corperatio~0
State whetber applicant ~---~?~essee, agent, architect, engineer, general contractor, electrician, plmber or lmi!
Rane
Of
of
premises
I[ at~plicant is a corporation, signature of duly ~mtlx)rized offficer.
(Name and title of corporate officer)
Phm/)ers l,icense No. ........................
Electricians License No .....................,
No ..................... ¥.
bocation of land on which propesed work will be done .......
Douse lqud~r Street llamlet
~,t~ T~ ~p No. ,~o .~t~,....~....L~... ,,~..~ ............ ,~ .... ~. ~ 3
~iuislm ...................................... Fil~ ~ap NO ................ ]~t ...............
(~)
State ~sti~g ~ ~ ~y o~ pmni~s ~ inter~ use taxi ~cu~ of pm~ cmst~tion:
~. ~i~ing u~ ~ ~-~ .. ~c~w~%.. ~.a.~ .................................................
b. ~,,t~ ~ ~ ~ .. ~(~. ~Z~.~ ............................................
~t i~])
4. E~Li,~L~I (~SC .. ~. ~ ~ ............ ~c~ ..............................................
1, I)inetmi~m of ~ist h~ ~t~t~tt;re~, i~ aH~ Ft{~l ................ I~ar ............... ~pth .................
Ik~i~ ......................... ~;tl~r o~ Storie~ ......................
I~l}lh .................... l~i~ .................... ~tt~r of Storie~ ...............
I~i~)t . ..... ~.l. ~li~r of Stories
9. Si~ of lot~ l~lt .................... I~ar . ................... I~pth ....................
II. Yx~m or u~ district in ~id~ pio~li~s a~e ait~t~l ...........................................................
12. [k~a prol~l ~g~mll~ti~ ~iolate any ~dn8 lira, otdi~me or iegul~itn~: .... ~.
13. ~ill lot I~ regr~l ....... ~.; ......... ~ill ~:e~a Jill I~ r~l~ fron pr~ni~al YES
15. la thi~ pmlmxt~ ~ithin ~0 f~t of a ti{hi ~tlat~l~ ~ YI~ .......... ~ ..........
PI.OT Il [^(;IIAH
I~x:ate clearly taxi distinctly all buildif~gs, whether exiating or i)rolx)~l, m~l i~xlicate all set-I~k di,~nai~
lie is tile .............................. ~..~..G/.~g.~ ...........................................................
Ihill the ~)tk will I~ i~rh)mtnl Ju the n~nlt~r ~L fo¢lh itl the al}pill:al, loll fil~l ttmr~lU~.
MNDA J. COOPER
Nota~ Publi~ State of N~Y~
4822563, Suffolk Cou~
Expire~ Decem~ 31,
(sigautlule of Ai,plicanl)