HomeMy WebLinkAbout15234-Z !~0~.~ NO. 0
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
15234 Z
Permission is hereby granted to:
~-~.~.~,~....~ .....~...:.~:......~.~..~:.~.~. ....
,o
t p oc cl at ................. ~.:.....-:~....'..t~.,...~/.....'~,~-~...~. .......... ';~T~:~..~.~ ...... , .......................
County Tax Map No, 1000 Section ...... ..~....~...~. ...... Block ....... ..~..1 ......... Lot No......~'...J ...............
,.,rsuon, to ,,p~co,~on dot,~ ...(~.~...Z..~. ............ , Jg.~.~.. ond o,,rov,~ by ,he
Building Inspector.
Building Inspector
Rev. 6/30/80
FIELD INSFECTION COMMENTS
FOUNDATION (1st)
FOUNDATION (2nd)
2.
ROUGH FRAME &
FLUMBING
INSULATION FERN. Y.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
'FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y. 11971
TEL.: 765-1802
Examined .~-~..-~....~....~.., 19~.~.
Approved .~.~.9~,~ . .k~.. 9., 19 .~.(*. Permit No. t ~.~..~..~. ~
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
BLDG. DEPT.
TOWN OF SOUTHOLD
Received ........... ,19...
Date ... ~./.e..~.., ./.~ .... , 19 .Sug.,
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy
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 the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections.
(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 builder.
...~..~N~ze..~.,e..~.~..~..~.~.~ r...~. ~r~...~.,.~:~.,~...~.t~..~. ~.r..~...~.r.,~ .~...t-.) .............
Name of owner of premises .... ~..~.~.~..../-!.~..~.~ .....................................................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No....~..~. ! .~ .................
Plumber's ~icense No..~..Qa.r.4! I.I ......
Electricians License No. '~'4~'¢..~A°.~..
Other Trade's License No ......................
1. Location of land on which proposed work will be done Ol~p ~t'e~,.~ ~,~,e ~
............................................
.... .~t.TM. ............ ~ . .~..-.-r.~.*..~h...: ......
House Number Street Hamlet
County Tax Map No. 1000 Section ..... .~..~. ......... Block ..... ./. ........... Lot...~..]. ..............
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .... .~.,4f.¢~-f. 77...~.~ 7- ...............................................
b. Intended use and occupancy ...... ..~ff.A~..~.~...~...~'..~..~. t..t-..F.. ~..~t..~. ~.c!.~..~. ...........................
JUL '~
RODERIC~K VAN T.,.T~J.YL. P.C.
LICENSED LAND SURVEYORS
GREENPORT NEW YORK
SUF FO ,EP- I:n'UEPT,
H.S. NO.
:is the applicant's responsi.b, il!ty to
~aintain adequate sanitary .o~s~ance
etween alt water supply an(] sewage !
I~posal factlitiee.
STATEMENT OF INTENT
THE WATER SUPI~_Y AND SEWAGE DISPOSAL
SYSTEMS FOR THIS RESIDENCE WILL
CONFORM TO THE STANDARDS OF THE
SUFFOLK ~PT. OF HEA,~:~I-I SERVICES.
APP~./A NT '
SUFFOLK COUNTY DEPT. OF HEALTH
SERVICES - FOR APPROVAL OF
CONSTRUCTION 0~.~
DATE: 04 1986,
SUFFOLK CO TAX MAP DESI~N.A.TJ~:
DIST. SECT BLOCK PCL
OWNERS ADDRESS:
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