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Home My WebLink About24558-ZFOOld 140.3 TOWN OF SOUTHOLD BUILDtNG DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 24558 BUILDING PERMIT ~HISPERMITMUSTBEKEPTONTHEPREMISESUN~LFULL COMPL~ONOFTHEW~)RKAUTHORIZE~ Da~ ...... ~M~.....~ .......................... ~...~Z... Z Perml~lon Is hereby granted to: ........ ~..~..~..,¥~.~ .................... ........ ~..~.,...z~...~ .......................................... ........ ~A~...~.~Z.~ ........................................ to.....~i~O~...~N..~.~.~..,~Z~...gAJ~,A~..A~...~...~ ................................ at premises Io~ated at .............. .2..~§..0..5,........~.,.~......~.. ................................................ .c.p...T.g. Sg. gp..~ ........ CounlyTax Map No ...... .4.~.3..8...8..g...... Section .....J:0..8. ............ Block ..... ..O..O.g..3. ........ Lot No...O.k..J: ............... pursuant to application dated .....~...O..V..~..~...~..~...~......1...4; ........................ 19 ...... ..g.~ ..... and approved bythe Building Ir~pectof. Fee $ ......... .]: ,5..:. ,0, ,C). .... Rev. 6/30/80 Di rmppr~r~ed n/e .................................. FORt{ NO. I TOI4N OF SOUTHOLD BUII.DING DE PARTlVIENT TO~N I1ALL SOUTIIOLD, N.Y. 11971 TEl.: 765-1802 BOARD OF 'BEALT[I ..... ; ......... 3. SETS OF PLANS ......... ' ...... SURVEY ~ , ...................... CIIECK.. ~ ...................... SEPTIC FORH ................... NOTIFY ~ CALL .................. HAIl. TO: .................... APPLICATION FOR BUll,DING PERHIT INSTRUCTIONS 'Date ................ ,19 .... a. lhis application Rust be conpletely filled in by t~nvriter or in ink ar~l submitted to 3 sets of plans, sceorate plot plan to scale. Fee according to sclmdule. b. Plot plan sho~ing location of lot and of tnmildings on premieea, relationship to adjoining premises or tad)lie streets or arena, and §lying a detailed description of layont of property mast be dr~ o~ tim diagran sddd~ in part of thin al~lication. c. Tim ~ork cover~l by thin application may not be coaraeoced before iasuance of Building P~rmit. d. Upon approval of this application, the Building lnapector will issue a Building Pemlt to the applicant. Such permit aball be kept on the premlsea available for inspeetlon thrcn~gi~at tim x~ork. e. No Ixdlding shall be occupied or used in ~hole or in pert for mW purpose xohatever ~mti! a Certlficnte of Occx;pancy aball have been granted by the Ikdldi~ Inspector. AI'PLICATICIt IS Ill;l~ HAtE~ to the Duildlng Department for the issuance of a Building' Permit parstmnt to the l~dlding Zola Ordinanc~ of the Tom~ of ~thold, Suffolk County, ~ York, nnd otl~erTap~lieable l~a, Ordirmnees or Regulationa, for the.eotmtruetion of tnfildlnga, ~klitiona or alterations, or for ren°val~6r dewolttion, aa Imrein descril)ed, t~he apphcant agreea to oanply with all applicable lmes, ordinaneea, building~ cede, ~housing code, ned regulatlona, m~l to admit authorized inspectora on premises and in building for n~ceasary inspections. .... .......... (Nailing addreea of applicant) State vdmther applicant ia ~r, lea.see, agent, architect, engineer,' general contractor, electrician. Plt~l~r or builde .............................................................................. t Il o atest deed) If applicant is a corporation, signature of duly m~thoriz~ officer. ~-~ I ~ ~ 4 ~ ~ THE (k~ne and title of corporate officer) l~dlders License No .......................... Pl~nbers License Ro .......................... Electriclana Licer~ NO ...................... Other Trade'a License NO ..................... 4. FINAL - CON~rlII.I(WION MUST BE:~= ~ C.O. A~ CON~R~ION SHALL MEET THE RE~UIB~NT5 OF THE N.Y. ~A~' ~NS~U~ION ~ ENERGY COD~S; ~ESPONalBLE FOR ~D~E$1GN qB CONSTRUCTION ERRORS I. I~cation of laed on ~aidl proposed ~ork will be ~... · I~ ~r St~t ' ~;, l~e~ ...... ~fl~i i i Fil~ ~p ~ I~t (~) 2. State existi~ ~ ~ ~y of ~ims a~ inte~ ~ a~ ~ o~ ~ c~st~ti~: a. FMsti,~ t~ ~ ~ ~ ~ ............................ Dinenai~m of $~ stnmture ~ith alterati~m or ~iti~s: Fr~t ............... ~ar ............... I~pth .................. ,. I~i~t .................... K~d~r of Stories ............... fl. I)inenai~m of entire ~ ~at~tia~: l~xmt ................ l~8r ............... ~pth .............. I~i~t ......................... Ka~lmr of Bto~iea ..................... II. ~e or u~ district in ~ddl pr~i~8 are ait~t~ .............................................................. ~ of Arddt~t ........... i; ....................... ~reaa .............................. H~ ~ ............... 15. Nate of Contractor ....... 2 ........................... /~klreaa ............................... II~ne No ............... this property within 300 feet of a tidal ~atland? ~ YlkS .......... ~ .......... ~IF YES, l~Crlll31J) ~ TRU8'II~ l~ll. IFr HAY BI~ RE(~LIIIRffJ). ' PI.OT DIAGRAI4 l~cate clearly and distinctly ail buildings, ~lmtlmr exial;ing or proposed, and ir~{icete ail act-back dimensions fr~,u property lines. Give stteetland block ntm{tmr or description according to deed, m~l ~1~ street raima taxi indicate ~dmtlmr interior or corner lot. .. .................,,g I~ is the ................... Q.~ ................................................................... (C~tractor, agent, cor~rate officer, etc.) oE said ~er or ~ers, m~l ia duly ~thori~ to ~rfonn or h~e [mrforn~ the enid ~rk at~l to nn~ and file this application; that all state.nra Contai~ in this nl~fiication are tn~ to fl~e trust of his hK~lslge sift I~lief~ and that the ~rk will I~ [~rfon~l in' tim ~nner ~c forth'in fl~e alii ication fil~l [Imr~ifll. ~rn to I~fore n~ fids ~ ....... .....- ' - ~01~72~ .4; '~ ~x4ont, delx~aes a,xl mays that he is the appl icant