The URL can be used to link to this page

Home My WebLink About23920-Z /Om.m* NO. et TOWN OF SOUTHOLD BUiLDiNG D£PARTM[HT TOWN HALL SOUTHOLD, N. Y. BUILDING PEIU~IT (THIS PEPJ~AIT MUST BE KEPT ON THE PREMISES UNTIL FULL CON~PLETION OF THE WORK AUTHORIZED) N.° 23920 Z Date ......... ~.?.. ............................... , 19....~.7 County Tax Mop No. 1000 Section ...... .~.,. ........... Block ..... ~... ............ Lot No ......Z'..~...'.....~.. ..... pursuant to application dated ........... ./.~..~...~.~ ............................... , 19..~.~,., and approved by the Building Inspector. Rev. 6/30/80 FORH NO. I TO~/N OF SOUTHOLD BUILDING DEPARTHENT TO~/N HALL SOUTBOLD, N.Y. 11971 TEL: 765-1802 ~OARb OF HE^I/FI{ ............... 3 SETS OF PLANS ............... SURVEY ........................ CIIECK ......................... SEPTIC FORH ................... NOTIFY: ~. I~A I l, TO: .................... APPLICATION FOR BUILDING PERPIIT INSTRUCTIONS 1Date ................ ,19 .... a. This ~pplieati~a ~ast be completely filled in by typewriter or in 3. ~ts of pl~, ~te plot pl~ to ~le. F~ ~i~ to ~fle. b. Plot pl~ ~ l~ti~ of lot ~ of ~ildi~ ~ ~s, ~lati~ip to ~joini~ p~i~s or ~lie st~ts or ~, ~ givi~ a ~t~l~ ~ri~i~ of l~t of p~y ~t ~ ~ ~ ~ di~ ~i~ is ~ of ~is ~li~tim. c. ~ m~ ~ ~ ~is ~li~ti~ ~ mt ~ ~m~ ~fo~ isle of ~ildi~ ~t. d. ~ a~al of ~is ~li~ti~, ~ ~ildi~ I~tor ~11 is~ a ~ildi~ ~t to ~t ~11 ~ ~ ~ ~ ~s ~il~le for i~ti~ ~t e. ~ ~ildi~ ~11 ~ ~i~ or ~ in ~le or ia ~rt for ~ ~ ~tmr mtil a ~rtificate of ~ ~1 ~ ~n ~t~ ~ ~ ~ildi~ Im~tor. ~I~ I~ ~ ~ to t~ ~ildi~ ~mnt for ~ isle of a ~ildi~ ~t ~t to the ~ildi~ ~ ~i~ of ~ Tm of ~ld, ~ffolk ~, ~ Yo~, ~ oflmr ~li~le ~, ~i~s or ~lati~, :~r ~ mt~ti~ of ~ildi~, ~iti~ or alterati~, or for ~al or ~liti~, m ~rein &~ri~. ~ ~limt ~s to ~ly ~ all ~li~le 1~, o~i~es, ~ildi~ r~lati~, ~ to ~it m~ri~ i~t~s ~ ~s ~ in ~ildi~ for ~s~ i~ti~. (~ili~ ~ress o~ ~lic~r) State Ohetber applicant is oacer, lessee, agent, architect, engineer, general contractor, electrician, pit,bet or builder. .- of mr of ............................. (as co the tax roll or latest deed) If applicant is a corporation, signam of duly anthorlzed officer. (l~m and title of corporate officer) Builders License Bu...~.~.~.~ ....... Pl~nhers License No .......................... Electricians License No ...................... Other Trade's License No ..................... ,. ~ti. o~ l~ co ~ich ~ .~.in be ~...Fm.~.v;.~.~...&~ ......... .q.~..~...~..e;...~ ....... ..~..~ ..... ..~.~.q&. ............................................................................................. Oamty t~. I~ ~ti~ ..'2~ .......... BI~ ...~. .......... ~t ...(.~{..~ .... ~ivisi~ .... ~..p .................... Fil~ ~ ~ ................ ~t ............... (~) 2. State ~isti~ m ~ ~ of ~s ~ inte~ m ~ ~ of ~ mtmti~: ~. ~ ~ ~ ~ .... ~',1.& ...... ~.~.~ ....................................... 3. Fz~ture of ~ork (d~ck O~id~ applicable): ~ Suihling .......... Addition .......... Alteration .......... I~ffli r ............ ~al ............. I~1 itim .... ~ ..... Otl~r ~ .................................. ~mriptim) 6. Esti~mt~l ~st .~ ............. [~ .............................................. (to I~ ~icl {m filing this a~li~tlm) 5. 1[ &~lli~, a,~r of ~lling units ..~ ....... ,i,,t~r of ,~,ling ,mits on cad, flmr ..(.~ff... If gnrnge, s~r of cars ........ [ ............................. 6. 1[ I~,si~ss, ~reial or mi~l mo~, ~ci[y m~ture m~l extent of ead~ ~ of um ...................... V 7. l)i~mnsi~m of ~isti~ stnr~ms, if m~y: mt ............ ~ar ...... /.. ...... ~pth ...: ............. ..... ......... · ...... ..... ................ Oi~nsi~s of ~m stnr~re ~ith alteratims or ~itions: Fret ............... ~ar ............... ~pth .................... I~i~t .................... l~d~r of Stories ............... 8. Oin~nsions of entire ~ cmst~tia~: Fret ................ ~ar ............... ~pfl~ .............. I~i~t ......................... l~r o~ Stories ..................... I0. [hte of t~,rcham ..................... g~ of For~r ~r ...~.~ ............................. I I. I~ or u~ district in ~*id~ ~i~s am si~t~ .............................................................. 12. ~s propel c~st~tim violate any z~ing 1~, o~li~re or re~flatlm: ........................ 16. ~s of (~r of ~m* ~ of A~Ht~t .................................... ~ress .............................. H~ ~ ............... 15. ls this p~rty within ~ PI.OT IH^GRAM It)cate clearly and distinctly all I~tdl{lings, st~ether existing or proposed, and iallcate ali set-back dimenslo~s frnm property lines. Give street and block a~ber or description according to deed, and sl~x, street ms and indicate ~hether interior or corner lot. APPROVED AS NOTED FEE: ,.ff. ~OTI~ BUIL~ING O£PABT~NT AT 765-18r12 9 AM TO 4 PM FOR THE FOLLOWING iNSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR ~URED CONCRETE 2, ROUGH - ~AMING & PLUMBING INSU~ON 4. FINAL - CONSTRUCTION MUST BE COMP~ FOR C.O, ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF ~E N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR ~NSTRUCTION ERRORS .m,x)rn, delx)ses and s~ys Llmt he is the appl i(~ant I~ is the ....~.~..~...~.~ nl~,ent, corporate o[~icer, etc.) of ~aid c~nx, r or ~rs, nrKI is ~dy ~thori~l to l~rfonn or II~ I~rFor~ I.l~ ~id.m[k taxi to rake taxi file thi~ alqd icati~m; that nil st*temnts c~tnlt~l Ihnt the ~)rk will I~ ~rFon~l ia the mm~r ~m to I~for~ ~ this .......... d~y o[ ...; . .~?.19. . I ' L , Note~ Pubtic, S*~ -