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Home My WebLink About23276-zFORM NO.$ TOWN OF $OUTHOLD BUILDING DEPABTMENT TOWN HAU. SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ......... :,,,,..r.... ........................................ N~ 23276 Z Permission is hereby granted tc~ - (~ /' / ..... ~.~.~..~~.~ ........ ...... /...~.~.~.~....£~. ..~c:~:~..~.../.~....~(,.%.:~...:...~ ~ .. ~ . . . .~. . . ~. ~.~. ? .~. . . . .~' , , ,~¢~. . . . .. . ~. . . ~/p ~ ~/~ . . . ~. ~ ....... CountyTaxMap No. 1000 Section ........ .~.....~........ Block ............ ~ ....... Lot No. ....~....?...~.,..( ......... pursuant to application dated ............ ~..~...,,~... ....... ../.~.. ............ 19..~.)..~....., and approved bythe Bulldlng Inspector, Fee ......................... Rev. 6/30/80 O' FORM NO. I TOWN OF SOUTDOLD BUILDING DEPARTHENT TOWN HALL SOUTBOLD, N.Y. 11971 TEL: 765-1802 BOARD OF HEALTH ............... 3 SETS OF PLANS ............... SURVEY ........................ CHECK ......................... SEPTIC FORM ................... DisappravM a c ............................... ..... - ·: AP/L CATION FOR BUILDING PERMIT NOTIFY: CALL NAIL TO:~ .................. 'Date 19 INSTRUCTIONS a. llds application nest be completely fillM in by typ~rriter or in ink and anl~ittM to the l~dlding Inspector *rio 3 sets of plans, accurate plot plan to scale. Fee accur~ing to sd~odule. b. Plot plan showing location of lot and of beildings on premises, relationship to Mjoiaing preraisea or public streets or areas, and giving a detailM ¢leacription of layout of property mst be drawn on tie dingran ~daich is part of this application. c. lbe ~rk covered by this ppphcat on may not he ec,aaeacM before isstmace of Building Permit. d. Upon ,m~to~al of this application, the Duilding Inspector will issue a Building Permit to the applicant. Such permit shall be kept on tie premises available for iospactim thri~hmt the work. e. No building shall be occupiM or tkqM in ;,~ole or in part for mrj purpose daatever un~il a Certifi~ate.o£ Occupancy shall have been grantM by the Building Inspector. APPLICATIf}I IS l~ul~l~l[ MblE to the Building Departnent for the ismmace of a Building Permit pormmnt to the Building Zone Ordinance of the To~n of Sonthold, Suffolk County, Ne~ York, and other applicable La~s, Ordinances or Rngulatlons, for tl~ construction of builtlings, additions or alterations, or for vanoval or demolition, as Isareln deacribM. The applicant agrees to cc~ply with all applicable la~m~ ordinances, building code, housing code, ami regulations, and to admit anthorizJ_~l inspectors on prendses m~l in bui¢~r ~ irmpections-. ~/Z~2 ~JS/~ . ....... (~gnature ~f applicant, or n~e, if a corporation) :a ................... (Mailing a&lrese of applicant) State vi}ether applicant is o~ser, lessee, agent, architect, engineer, general contractor, electrician, plmber or huilder. Ow~.f4k ........................... Nmue of ~,mer o ses ............................................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorir~.l officer. and tltle of corporate officer) Builders License No ..... Plumbers License No ...... glactrieians License NO ...................... Other Tra4e's License NO. · · I. Locatio~ of land on ~aich propased ~ork will be 4ane ..................................................... '. g irk ........... lm li~her Street Uanle t Connty TaxMapNo. 1000 Section ..~..~. .......... Block ...~ ............ Lot .... [.~.[/ ....... Sulxlivislon Film Map No . Lot .............. 2. State erast~ng tkse end accupeocy of promses and mtende4 use taxi occupancy.5)fc~]~t/,.Sonstmet, a. Existing use and occupancy ... f~.ldf-~&[ ......................... ~,--?"~-,/L--*'-~%,-,i-, .............. b. Intencl~l use and occupancy ... :~..;...~.rr t ~ .,.~-: ....................... s.- ,> -~ · .'~.~ · -,-x · · -t * ............... pro[tarry lineB. (Jive etreet and block interior or comer lac, Oin~n~i~m o~ sam ~tnmture with~alrera~i~s er ~itJofls: Front ............... I~ar ............... PI.OT DIAGIIA~ ~xd~r or ~scripticm accordin~ Co ~ed, a~ ~c~ nCree~ ~s a~l i~licaCe AP~,R0.,VJ~D AS NOTED FEE: ~B 765-1802 9 AM ~ 4~THE ~ FOLLOWING iNSPECTIONS: 1. FOUNDATION . ~0 REQUIRED FOR POURED CONCRETE 2. ROUGH - FRA~NG & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST ~E COMPLETE FOR C,O, ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE STATE CONSTRUCTION & ENERGY C09ES, N~ RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS ..... Imifql (I,ly ~)rll, (lelx)~s taxi says that he ia the al)i)l|cmd: Ik~ ic, Ihe ' (Cx~ntractor, ngent, co,Ix)rate of~fli::er~ etc.) apl)iication; that ~lll sLalomnt8 eonta r~l in Ihis alq)li(:ation are Lnm LO tim Impel. of hi~ klx~lc~l~[e taxi IxH ief~ alx] I , IhaL the ~)rk ~ill I~ I~rfon~l in Lhe ~mm~r ~C I~rlh Jr) tile appl ica :mn filc~l tlmr~i~. .~)rn Lo before u~. this NOTARY PUBUO, ~ 0f N~ Ymk No. 4971~7 ~ 9 (Silp~t:m'e of 4~1)1 leant)