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Home My WebLink About23476-ZTOWN OF Sou'r'~OLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT N9 (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 23476 Z D~,e ........ ~ ...................... , ,~.~.~. ~u.~ Tox Mo~ No. ,000 S.c,,on .......... ./-.~. '~',~'~ ...... ~ ........ ,.o, No..../...Z ............. pur~uont 'to opplicotion doted ........... ~ ....... ~.. ................ , 19 ..~..~.... and opproved by th, Building ~~ Fee $../..~...~ ..... Buddin In.q~ector / Rev. 6/30/80 FORN NO. I TOWN OF SOUTIIOLD BUILDING DEPARTNENT TOI4N IIALL SOUTIIOLD, N.Y. I 197 I ~i~wvro~/~/e .................................. ...................................... INSTRUCTIONS BOARD OF IIEALTII ............... 3 SETS OF PI.ANS ............... SURYEY ........................ CIIECK ......................... SEPTIC FOIOI ................... NOTI FY: HAIl. TO: .................... a. Tids ~plication mint be conpletely filled in by typewriter or in ink ~ ~fl~itt~ to fl~ ~dldi~ Ins~ctor ~ith 3-~ts of plus, ~ate plot pl~ to ~le. F~ ~rdi~ to ~le. b. Plot pl~ ~i~ l~ati~ of lot ~ of ~ildi~s ~ ~i~s, relation~ip to ~joining' p~i~s or ~lic struts or areas, ~ givi~ a ~tail~ ~riptian of l~t of ~rty ~t ~ dr~ ~ t~ di~ M~i~ is ~rt of this ~licati~. c. ~ m~ mr~ ~ this a~lication ~ ~t ~ ~1 hefore issue of ~ildi~ Pemit. d. U~ amn~al of fids a~licati~, fl~ ~ildi~ In~etor will is~ a ~ildi~ ~mit to the ~lic~t. ~mit ~mll ~ ~pt ~ ~ ~i~s ~ilable for ins~ti~ thm~t tim ~rk. e. ~ ~ildi~ ~11 ~ ~i~ or ~ in ~le or in ~rt for ~ ~ ~at~r ~tll a ~rtlfi~te of ~ ~mll h~ ~n ~t~ ~ ~ ~ildi~ I~tor. ~1~ IS 1~ ~ to t~ ~ildi~ ~r~nt for rhe isle of a ~ildi~ Pe~t ~ to the ~ildi~ ~ ~i~e of ~ T~ of ~O~ld. ~folk ~ty, ~ Yo~, a~ off,er a~lic~le ~s~ ~i~es or ~dati~, for t~ ~st~tim of ~ildi~s, ~itims or alterati~s, or for r~al or ~liti<, ~ t~rein ~ri~. ~ ~limt ~s to ~ly with all a~llcable l~s, o~i~tmes, ~ildi~ ~ ~i~ ~lati~s, ~ to ~it ~t~ri~ in~tors ~ ~i~s ~ io l~filding ~r z~es~ in~tims. ..... ................. (Si~mre o[ a~lleant, or ~, if a co.ratio) (mili~ ~rese o[ a~lic~t) State ~$aether applicant is o~ner, lessee, agent, arddtect, engineer, general contractor, eleetrlclan, plt,nber or I~ailder. .............................~d .ee:..~.~ ~. ........................................................................ ~ of o~,~r of ,~s. ~//.,.,,.o,...,~,,,/..;g.,~,,.¢'~././.q..'.~:.. ............................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly al:thorised officer. (N~ and title of corporate officer) Plumbers I.icense No .......................... MAY -9 {996 '?! BLDG. DEPT. Electricians License No ...................... TOWN OF SOUTHOLD Other Trade's License No ..................... I. l~0c. ation of land on ~hid~ proposed ~,~rk ~dll be done .............................................................. ..................................~..~.:.~....~.,~. ~ ......... .(ge.~:&. ~...~. .......... ~q~ .............. ~ /~'>/: ................ Hcose Number Street ltaml et ~,-~ Ta. ~ ~. ,~ ~t~on .. Z.5..'. ........ .l~..~. ............ ~t ./..7. ............ Subdivision ...................................... Filed Hap rb ................ lot ............... 2. State existing use and occupancy of premises and intended use and ocmq',aocy of proptxsed construction: a. Existing use and occupancy ~r' .~ ~,. L.t~ ~ ana oc~y ....... ..~....~.. .................................................... i. I~;~l.~e ol ~k (d~:k ~itJ~ ~plflicnhle): I~ I~dlding .~ ...... ~kliti~l .......... Altera~io~ .......... l~l~ir ............ ~1 ............. i~li)l JLJOII ...[ ........ ()lilflr IJ)lk ............................... 5. If ,~llin8, ~,l~r of ~lli~ stairs ~(~.~ .... ti~i~r of ~g~llin8 ~mil:s ~ each flor ................ fi. If I~siness, ~mmrcial or Ini~l ~1[~1~, 8~ci~ i~[u~e alii exten~ of each tyl~ og u~ ...................... 1. l)in~nsiom of ~isling strictures, ig rely: Fr(~lt~ ........... I~ar ............... l~pth ................. I~iJst ......................... ~t~r of Stories ...................... I~pth .................... I~ijst .................... ~d~r of Stories ............... I~i~dJl ......................... Rider of Sl:orie. ..................... 12. I~ prol~)~l (x~l~:tial violate any wxling 1~, ordif~e or regulatj~: ..~0 ................... 13. Dill Io[ Im regra~ ..... ~ ............ ~ill e~:ess fill tm ~ off Ardiit~t .................................... ~lress .............................. ~m ~ ............ 15~ la thi~ p~lm[[y within ~1 ~ o~ a ti~hd ~mrla~l? ~ Yl~ .......... ~1 .~ ..... I'I.OT I)IAGRAH lzacate clearly a~l distinctly ~11 I~lJldi~s, ~J~lher exisl:in§ or proposed, msl i~llicote all s~t-lmk dimensions prol~rl'y li~es, give stn~t mil blo~:k ~d~er or description according t'o deed, ar~l sim street r~ms ar~l indicnt'e interior or corner Jot. /Y (Nm~a of i~livithml signing eom tact) AP,PRO, V..E AS NOTED 765-1802 9 AM TO 4 PM FOR THE FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION Ik~ i:~ Ihe .... ~'' ~ ............................................. 4:' ~r-tI~AL .... CONS-T~UCTION. -MUST ( /C~lr~tor~ nge.t, corlx, rate o[fi,:er, el,:.) B~ COmPk~g FO" said Ihat the ~)rk will Im Imrfot~l~l in the ,~uJner ~t forth i. the applical:ion fi~~ RESPONSIBLE FOR ~nl to I~fo~e Ibis / / CLAIRE L GLEW NotBry Public, State of New York No. 4879505 Qualified in Suffolk County Commission Expires December B, (Sigi~nlm:e of ^Pltiica"t)