HomeMy WebLinkAbout18542-z POEM NO. f
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)
No 8 5 4 ~ Z Date ..~.~:<«.....,1.4.....,... , 19?~q.
Permission is hereby granted to:
:..................:y.~.. ~..~.q..~~...... .
.
.
ct premises lacated at .a:~~D...$....
Caunty Tax Map No 1000 Sections ~ .fig. S. .p. Block CQ 1c. Lot No ~R.
pursuant to opplication dated . S~l...'4,Q,J.A.-r~!'f~-lw, ~S 19..9 and approved by the
6uildmg I/n~spect/or
Fee ati? ~..f . .
e~ .
Building Inspector
Rev 6/30/80
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4 APPLICANT
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8UlE'PCLE COUNTY HEALTH D ARTNENT ~ ,53~ J-
DATi'"1MLQR09 ~9]j R. n. REa. #S-S~-~o J s%~~
of
The aevsge di 9i.oeel EY.d rater supply rE/ti vs
feoil Ltiee for this lDC..tlon lrovi boea 0 i
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~'Qj ,N~f~~~ j-' " ` ~0 ~ NOTIFY BUILDING DEPARTMENT AT
~C,~ tiss d'.` [ Bhh 765-1602 9 AM 70 A PM FGR THE
\ L~,' FOLLOWING INSPECTIONS
y 1 FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
\ r' ~`~ss. 2. ROUGH • FRAMING & PLUMBING
3. INSULATION
\ \ 4 FINAL - CONSTRUCTION MU
BE COMPLETE FOR C.C
s`''ow, ALL CONSTRUCTION SHA MEET
~ THE REQUIREMENTS OF E N.VS
~2 ~`"s STATE CONSTRUCTION RGY
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F~ COOES. NOT RES NSI FOR
~ DESIGN OR CON UCTI RRORS
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NONbNENT \V'
SUBO/VJSpN MAP F/CED /N TNEOFf/CE
Of 7NE CL£RKOF SL1rfOLK COUNTYON
NAR / J, /97J AS F/LEND JRT2
NtVIS10N5 YOUNG & YOUNG
40u US TRANDER AbENUE RHERHEAD NEW YORK
ALOEN W YOf1N4 NOW4R0 W VOl1NG
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2r.. ~ `v SURVEY fOR N
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o`r;~es maN ni ouARANTFLn In
~A,P cSaa93 CUTCHOGUE THE T/TLECUARANTEE CO
/fc 4ND fuNE`~+ +'p9`ir , , TOWN OF
r `r Sllff P (r) ti Y ~"rJ'~lfth'1t~[U, 7~p-tfnv7~.. -
r,r „ -r r, scnLE /rL: 50• DATE SEPT/6,/976 ~N~76 7Bd
BOARD OF HEALTH
0 3 SETS DF PLANS•.
FORM NO. t SURVEY .
SEF ~t TOWV OF SOUTHOLD CHECK • • • •
i ~ BUILDING DEPARTMENT SEPTIC FORC( „
TOWN HALL NOTIFY
, ~OUTHOLD,N.Y.11971 CALL
D TEL.: 7G5.1802 ~ ~ ~6 ~p• .
MAIL T 0 : ^""~y,Cl
E:cammed .~.-_~t-.t~~~.?-.t2, 19 1
Approved (f, 19 Permit No. ~ $ S~.
Disapproveda~c
(Budding Inspector)
APPLICATION FOR BUILDING PERMIT
Date 19
INSTRUCTIONS
a. T}tis application must be completely filled rn by typewriter or rn ink and submitted to the Budding Inspector, with
sets of plans, accurate plot plan to scale. Fee accord[ng to schedule.
b. Plot plan showing location of lot and of buildings on premises, relat[onshrp to ad~ommg premises or public stree
or areas, and givurg a detazled description of layout of property must be drawn on the diagram which rs part of this appl
cation.
c. The work covered by this application may not be commenced before issuance of Buildut~ Permit.
d. Upon approval of this application, the Bu[ld[ng Inspector will issued a Buildutg Permit to the applicant. Such perm
shall be kept on the premises available for uispection throughout the work.
e. No building shall be occupied or used rn whole or [n part for any purpose whatever until a Certificate of Occupanc
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to ti
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances
Regulations, for the construction of buildings, additions or alterations, or for removal or demolitron, as herein descnbe~
The applicant agrees to comply w[th all applicable laws, ordinances, budding code, housing code, and regulations, and t
admit authonzed inspectors on premises and in building for nece ary inspections.
.:~~..~11;~1.1.C~,~~"
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde,
Name of aivner of premises ~~~4-.~ g:.~.r:~ ~ . .
(as on the tax roll ar latest deed)
If applicant is a corporation, signature of duly authorized officer.
.
(Name and title of corporate officer)
ALL COL[TRACTOR'S MUST BE SUFFOLK COUNTY LICENSED
Builder's License No. ....4:'~"- : . . .
Plumber's License No .
Electrician's License No . .
OI}icr Trade's License No . .
I. Location of land on w}iich proposed work will be done ~
~ S..
House Number - Street Hanilet
County Ta+c bfap No. 1000 Section ~ , Block Lot , , , , , , , , , , • • ,
Subdivision Filed Dlap No. Lot...............
(Nmnc)
State existing use and occupancy of premises and intended use and occupancy of proposed construction•
a. Exis[ing use and occupancy .
b. Intended use and occupancy