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Home My WebLink About23380-zFORM · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOU'[HOLD, N.Y. BUILDING PERMIT N~ 23380 Z (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) oo,~.....~...~ ................. ~.....~ Permission Is hereby granted?.~;~,// ...... ~.,..~ ....... ~/.. .................................. CounlyTaxMapNo. 1000 Section ....... ..~...~...~,. Block .......... ~ ........... Lot No. ...,.~..~ ............ pursuant fo application dated ....... ~.Z..~'. .............. l g..~..~...., and approved bythe Building Inspec~r.~,,''''~ Rev, 6/30/80 '~ "+-"'~ BOAIH) OF IIEAI,TII ............... ~ SIJRYEY ........................ BU T CIIECK ......................... SEPTIC FORIq ................... SOUTIIOL1), N.Y. I t971 F~ni ~ ~ ~ ~ ~ ~AIL TO: .................... .................................... ~ APPff~ TIONI.~C/A FOE BUll.DING PERHIT Date ................ ,19 .... INSTRUCTIONS . '. · ~ ,A,~V~ :; c. ......... o. Hus o~hcat~ flu~t 1~ cm~l~tely f~ll~ m by tyl~.~ter or mmk a~l ~l~ttt~ to the ~nld~t~ Ins~ctor ruth 3 ~ts of pl~s, ~curak~ plp~ p~an to a:ale. F~ acco~ to b. flor plao M~ l~a~ o~ lot mfl of la~ld~s ~ pram~s, rela~mnsh~p [o ~l.lomlng pr~s or l~bllc struts or areas, a~l glvit~ a ¢~tailM ¢~scriptim~ of l~*t of ~o~rty ,~lst I~ dram ~ the dia~ ~dd~ is ~rt o~ Ods applicati~. c. 'H~e ~)rk c~l I~ this a~licati~ v~y ~t I~ cm~l I~fore is~m~e of ~ilding Pemit. d. U~l a~al of this a~licati~, the l~ildlng Ins~ctor will is~ a l~ildi~ Pemlt to the a~licaot. Such ~rmit ~mll I~ kept ~ tl~ ~ni~s available for ias~ctia~ th~O~t the x~rk. e. ~ Ixdldi~ Mmll lm ~mpi~ or n~ in ~le or in ~rt for any plr~ ~mt~er ~tll a ~rtificate of ~c~y Mini. 1 have I~n ~ant~l 1~ tl~ ~ildlng Insurer. ~,IC~'I'I~ IS 1~ k~ to tl~ lkfildi~B I~l~rOmnt for the ismm~e of a ~ilding Pennlt ~nt to the ~ildi~ ~m O~i~o O~ tim ,'1'~ of ~tlmld, ~fffolk (~, ~ York, a~ other applicable ~s, ~i~es or ~gmlati~s, for tle'~stnrtim o[ Ixdldi~s, ~kllti~s or aIterati~m, or for m~al or d~lltim~, as I~reln ~ril~..'lira &~llmt a~s to ~ly with all a~llcable l~s, ordi~mes, Indlding ~, Imsi~ c~le, m~ re. latins, md to mhdt m~tl~rlz~l ins~tora ~ pranises taxi i .... (8i~ture o~ ~icam~r ~ i~a cor~rati~) State ~ether applicant is rmner, lensee, agent, arddtect, engineer, general contractor, dectrician, pluni~er or lafihler. lqa~e of o~er of prem .............................. (as tm the tax roll or latent deed) I1~ applicant is a corlx~ratlon, slgnatnre of duly autboriz~ed officer. (Ram at~ title of corporate officer) !Milders License Il) .......................... Plmtmrs IAcenne Ho .......................... Electricians License bio ...................... Other Traders License ~l ..................... I. It)catlon of land on ~hid, prolx~ ~s~d/jwork w~}l be donel,) ~: ................................................ ........ ¢...o..O. ........ .......................................... ........ 3. ............ ..t..7 .......... Sulxlivlsion ...................................... Filed ~l~ ~) ................ /Dot ............... 2. State existing use oral ocm~paocy of premises arv. l inte~x]e<l use and ocmqxa[~y o[ Vcoposed construction: a. Existing use and ocm~pat~cy ............................................................................. b. Inter,led rose and occu[mney ............................................................................. ~ I (l~n(:ri ~ti~) 6. Eal. i,u~t~l (k~at: . .~... fee (ro Im fid tm fi lin~l II*i~ al~licati~) 5. 1 f ~k~lliaql, ~dmr of (~11 ing units ............ t~,d~r o1: ¢~lllnl~ t]nlra ¢~ each ~r ................ 6. If Ixmi~maa, t~mercial or mi~d i~qm~y, almcif~ ~ml.ure m~l eaten~ of each~ tyl~ o~ uae ...................... ............... ; I~pth 7. I)[,en~Htxm off ealatin8 atrtmttn-ea, i~ a,y: Yr(~H . I~ar ...... , .......................... Ik~il~t ......................... ~dmv of 8toriea ...................... D'ae,allms of aa~ stnmture with alteratJlms or ~klitiona: Front .......... ~ ..... I~ar ............... 9. 8i~ o~ IoL: I~[~s~ .................... I~ar . ................... I~plh .... ~ ................ lO. I~de of 15~rcha~ ..................... ~n off Fon~er (~r ................. ~ ....................... II. ?~ or u~ district in ~id~ pranl~a are atcuat~l I 13. IJill lot I~ teBrm~d .................... ~ill e~'.eaa fill Im ro~ml frown pr~nlaeo.: YES 16. ~na o~ {~r of p~ni~a ........................... ~Mreaa .............. i ............... H~ ~ ............. · ~e of ardHtect ..................................... ~klreas~ .............. i ................ Hm~m ~ ............ ~ of (kmtracror ........................... ~klraaa ' ........ Hm~m ~. P3. la this p~lm~ty ~ithin ~l) f~l. of a tirol ~t:la~l'l ~ ~F~ .......... ~)'~ ..... VI.OT I)IAORAH I~mate clearly m~l dlst:i~x:tly all laHIdi~l~a, ~mlher ealsl:in8 or prolxmed, a ~ ~M'ca~e all aet-lmck I:xtx~) i)rolmrl'y li~es. Give ,L~l: m~l bhx:k ~,dmr or ¢~acril)ti¢~ acco,lin8 Lo (~[, mM ~t~ sLree~ ~,ea taxi i~licat'e ~d~ether interior or cor~r lot. AP OVED AS NOTED. ._, , / 7~5-180~' 9 AM TO 4, 'PM FOil THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. aES,ONam'" FO. --- ' .... ~. ................... (i~,1~; of i]~lividual .iipdu8 contract) I Ik., i, the ....................................................... I .......................... i of ~mid (x~s~r or t~x*.ra, taxi i~ d. ly author izc~l Lo I~S fo.. or have i~rl'or.~d Ihe 8aid ~)~k taxi Lo .[fl(e taxi file thin IhaL the ~)rk will I~ I~rFotnL~l in tho n~l[a~er ~et: l:oHh i. Ihe appllcat, ion I:iled II~rc~lLlt. Commission Expires December 8,