HomeMy WebLinkAbout23856-ZTOWN 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)
Permission is hereby granted~o: /
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. ~.~.~ &
........... o..~.....~...~.~..~. ............
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County Tax Mop No. 1000 Section ............ &.~.... Block ......... ~.. .........Lot No..../..~.. ...............
pursuont tO application dated ........................................ ~.. ......... , 19...~.&., and approved by the
Building Inspector.
d~ng ~i;~ ...........
Rev. 6/30/80
F()RH NO. !
'l'OI4R OF SOUTIIOLD
BUILDING DE PARTflENT
'l'O~R IIALL
SOUTIIOLD, N.Y. 1197J
TEL: 765-1802
Di r~pproved a/c ..................................
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^F~.~CA'rlON FOR BUII.I)ING PERHIT
INS'FRUCTIONS
BOARI) OF IIE^WFH ...............
3 SETS OF PLANS ...............
SIIRVEY ........................
CIIECK .........................
SI?.PTI C FORH ...................
NOTIFY:
CALl ...................
flAIL TO: ....................
a. 'lhis appllcatio~ mint be conpletely filled in hy typewriter or in ink ar~l ~l~aitt~ to tl~ l~,ilditg 'hml~ctor wi~
3 ~ta of plans, at.rate plot pl~ to ~ale. F~ acconli~ to
b. Plot plan ~i~ l~ati~ of lot ~ of ~dldi~s ~ pr~i~s, relationship to ~joiaing l)r~i~s or ~dflic
struts or areas, ~ givi~ a ~tail~ ~scripti~ of last of ~o~rty ,=mt 1~ dr~m ~ tl~ dia~ ~fiO~ is Imrt of
this a~licati~.
c. ~m ~rk c~ I~ this a~licati~ v~ t~t I~ ~<~1 {~fore issue of ~:ildi~ Pemit.
d. U~ ~al of this a~licati~, t}~ ~ilding Ins~ctor will is~ a l~ilding Ferule to the aHfllcant. ~h
~dt Mmll I~ kept ~ tl~ ~ni~s ~ailnble for ins~cti~ thr~Ol~t tim x~rk.
e. ~ I~mildi~ ~mll I~ ~ompi~l or till itl ~le or
(~a~y rJmll h~e ~n gr~t~l I~ tl~ ~dldi{g hm~tor.
A['H.I(~TI~ IS IE~ ~ to tl~ ~mildi~ ~rt~nt for the is~{~e of a h~ilding Pemit ~mr~mant to the
lkmildi~ 7~ O~i}m~e of Om T~} of ~tl~ld, ~fffolk C~nty, ~* Yo~, m~ other a~licM)le ~s, Ordi~s or
~Bati~s, for tl~ ~stn<ti~ of Infihli~s, m~iti¢ms or alterati~a, or for ~al or ~lition, as I~rein
{b~ril~l. 'B~ a~llc~t ag~s to co~ly ~ith all a~licable
remlati~m, ami to ~it ~,tl~iz~ ins~tors ~ ~ises a~l in--or
... v.~ ~ ............... ~..- ..........~5-
(Si~ture of al~llcant, or ~,
(~ail i~ ~ress of a~licant)
State ~mtl~r applic~at ia ~r, les~, a~st, archit~t, engiz~r, ge~ral c~tractor, electrician, pillar or lasihler.
............ ~.~.~ .o=&~. ...............................................................................................
I~are of tmner of premises .. R3.0~O~r:O~..~., .~JA~k~e(3...~..W. ......................................................
(as en the tax roil or latest deed)
I f applicant is a corporaticn~, signature of Chdy a~tlg)riz~ed officer.
title of corporate officer)
I~dlders License No ..........................
Pltsd~ers License No ................. .. ........
Electriclan$ License lla ....................... '
Other Trade's License No .....................
Ik~use I~d)er Street ll~nlet
..... ...... .... ........ ...// ..........
~:~livisi~ ...................................... Fil~ gap ~ ................ l~t ...............
2. Slate existi~ u~ ~ ~y of pr~i~s ar~ inte~x~l u~ a~l ~ol~y of ~o~ c~mt~cti~:
..... ..........................
b.
Intem~]
I~l~i r ............ I~al ............. I~r)] i ~ lo. ..... x ...... OI her* [~)~ ..................................
~ ~ ~[~r ipti~)
4. Esl i.vlied (~1: ~. ? .................. fee ..............................................
IEil~iL ......................... ~,~l~r o~ ~lori~s ......................
I~q~lh .................... I~il~ .................... ~i~l~r ~f Sl~ri~ ...............
IEil~H: ......................... D~t~e o~ Slorie~ .....................
9. Size ()[ lot: I~i~iL .................... l~a[ .................... I~pll~ ....................
II. 7~a~ or .~ di~t:rict i~ dd{t~ p~o.isea are ~it~mt*l ..... 1.~ .........................................
II. ~ill lot I~ tel~r~l .................... ~ill e~ceso fill I~ r~l~l fr~n pt~nises: YES
~ ()~ Ar(~Hieet .................................... ~lres, .............................. 1~ D) ...............
15. I~t Ihi~ i)~l~rty uilhill ~X) fMt o~ a ti<L~l t~tlaixl? * Yl~i .......... ~) ...~. ....
~lF YES. ~lllll]l)'IU~ 'II~I~II~L~ I~IHI'I' t~Y Ig~ I~lll~l).
I'I.OT DTAGRAH
Ten:ale clearly a[~d distinctly all I~Hldil~s. ~l~ether exisl:inp~ or pro~l, al~l il~lica~e all se~-I~:k
f.~. i)rol~ity lilts. (;i~ st~t aixl bilk a,il~r or t~scripti(~ acco[dii~g ~o ~l.,m~l d~ sLreeL lu,~es aixl i~licate
~ ~ C(~F,",:~'TF~C~iON SHALL ~EET
T ~: REOU~P4ENTS OF THE N.Y,
S F, c;~E CONSTRUCTION ~ ENERGY
CODES, NOT RESPONSIDLE FOR
~;I'A'~E iX~ ~ ~(~K, DESIGN OR CONSTRUCTION ERRORS
IIIINI~ (I~ .... ~ ........
(N;,~ <)~ i~xllvi(h~H sil~ni.g tin,tract)
nppl it.rio.; tirol: (ill stat~,e.t~ c~.tailx~d i. this ;ll~licat i<)..re t~ to the I~t:
Ihnl the ~rk .ill le lerl:o[u~l iii Ille ii~lnl~]r ~et [o[Ih iii Ihe applical:io~ [iici II~r~ith.
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