HomeMy WebLinkAbout14596-Z~'iELD INS~ECTION
1.
~'OUNDATION (.1st)
DATE
COMMENTS
'OUNDATION (2nd)
~OUGH FRAME &
PLUMBING
~iNSULATION
PER N. Y.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS:
I~OB,~ NO. ·
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PER~IT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
at premises Iocoted ot ............................................
County Tax Mop No. lO00 Section .... ~:~..~..~. ........ Block ....... ~ ............. Lot No ...... -~. ...............
pursuant ,o application doted ..~~....~. .................... lO~...~..., ond approved by the
Building Inspector.
Building Insgector
Rev. 6/30/80
Examined .~O~.e~..~...., 19~. .(°.
'FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
PgOUTHOLD, N.Y. 11971
TEL.: 765-1802
Approved . .~. ~'%...~-'..., 19~.~.. Permit No.}..q.~..q. .~..-~..
Disapproved a/c .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
BLDG. DEPT.
~ OF $OU'I~OLD
Received ........... ,19...
INSTRUCTIONS
a. Tins application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
sets of plans, accurate plot plan to scale· Fee according to schedule·
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of tins appli-
cation.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy
shall have been granted by the Bui_lq~g Inspector.
APPLICATION IS HERF:~I~Y ~lFE.~ ~lhe Bufldiag Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance~[~ T~'~&~l~' ~h~c~folk County, New York, and other applicable Laws, Ordinances or
Regulations, for the.~dou ~ r~i~ns or alterations, or for removal or demolition, as herein described.
The applica~l.t._a[~o~[~ ~[~aws, ordinances, building code, housing code, and regulations, and to
admit autho~ii~l~14t'ec~'s~r~h~ [~'l building for necessar~"fllspections.
'o c ,, rox,, ..... '
q~_~~_ ,~q~l~q~ ~ ~ignature of applicant, or name, if a cor~t;ia~;o'n') ....
~ ~ (Mailin~address o f applicant)
State whether applic~is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder.
.... .O.:.o.~e~ ......................................................... ~ ...... .~..,...n97~.. .........
'(a; on't'h'e t'a}t roll o~iti'~ie$~t .... ~;5;" ' ' ~} '~i'L ......
If applicant is a corporation, signature of duly authorized officer. , r ~,~. ~::~iO>,'~TMF~NT AT
· :, Z .~ ~.rjR THE
(Name and title of corporate officer)
Builder's License No ......
Plumber s L~cense No.
Electrician's License No .......................
Other Trade's License No.
1. Location of land on which proposed work will be done ..................................................
Hot'se Numl~r .......... Sir;;; .............. Hamlet
o,nt No. 1000 Section ..... Block ..... l ........... Lot....¢. ..............
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
State existing use and occupancy of premises and inten~d use and occupancyof prqposed construction:
Existing
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