HomeMy WebLinkAbout24354-Z f®�
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG,
[ ] FOUNDATION 2ND [ ] INSYJ. MON
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FRAMING / STRAPPING NAL
[ ] FIREPLACE &71,MNEY [ ] FIRE SAFETY INSPECTION
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DATE ` INSPECTOR
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BOARD OF HEALTH
. . • . . • . • . • .FORM NO. 1 3 SETS OF PLANS
ff I TOWN OF SOUTHOLD SURVEY
( 1997 { BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . .
.- TOWN HALL SEPTIC FORM . . . . . . . . . . . . . . . . . . .
_ x j SOUTHOLD, N.Y. 11971
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TEL: 765-1802 NOTIFY:
VN r "s t'Ziri 9CALLExanine .... 1:... 19! 7 MAIL. TO: . . . . . . . . . . . . . . . . . . . .
Approvc�c ..�Y..... 19!I. Permit No. a, ................................
Disapprovea/c .. ....................................
.. ............. ...... ....
(Building Inspector)
LICATION FOR BUILDING PERMIT jh Q
Date. . . . . . . . . . . . 19. !.7
INSTRUCTIONS
a. 'this application mist 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.
h. 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 mist be drawn on the diagram which is part of
this application.
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 issue a Building Permit to the applicant. Such
permit stall 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 lave been granted by the Building Inspector.
APPI.ICNrI(N IS ICREBY HNE to the Building Department for the issuance of a Building Permit pursuant to the
Building ?.one 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.
?%3Tt Q.-.M�.
3T •
(Signature of.applicant, if corporation)
. 1.x'15.....: Qq. ...��,.�.
(Mailing address of applicant)
State whether-applicant-fs owner, lessee, agent, architect, engineer, general contractor, electrician, pluniber or builder.
..... ..aw N.R......................... ................. ............................................
Nine of owner of premises .. �:I,.��'rA....O ig......K.,L. T NgE'(l. ...........................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorizf�Eir,
........................N iA ............................ AWZ�47*•��9: 3. iJ11�I
Mre and title of corporate officer) MU
Builders License No. .......... Jt ..........
Plumbers License No. ...........NIN .........
Electricians License No. :........ .......
Oder Trade's License No. ..........Vik.......
1. Io-cation of land on which proposed work will be done..............................................................
2 5
,.2 ......................:S .W a?:Q..�R............_...............:.... .;�{-(v�........................
House Nmber Street Hand
et
('.aunty Tax Ma No. 1000 Section
...0': ` f....... Block ......9.1�7...... Iot ...Q.�Q.....
Subdivision a&W Pb... ............. Filed Map No. .57-5..... Lot .3....Z .
(Nam)
2. State existing use and occupancyofpremises and intended use and occupancy of proposed construction:
a. Existing use aid occupancy .TK\�( ---,P �... y �............................
b. Intended use and occupancy ............... b?........�`114- ...AhAVk-a". -ems.....
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FORK NO. f
TOWN 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)
-- Z(.,::p
N 24354 Z Date ... ......... .........;1/...... ................,
Permission is hereby gran d t
........../2. . . .. .. ...w.......... ......... :.......
..............P..<. .. .. ... ......... .................................
to ............... . ..... ....r..�...�... z�� ...fir . .. . . . .. ... ....:
...... .. .......... . . .. . ...? .... ... ...... . . .. ..... .........
... ... ...... �. ..�.
.......... .. . . `... ...�:!. .. .
......... ....... ........... . .... ... ....: ..... ............... .................................
at premises located at .. . .�....... ..
County Tax Map No. 1000 Section ........ .... Block ........ ./.......... Lot No. 6�.�................
pursuant to application dated ........... .. .........
//.................. 19,/...7, and approved by the
Building Inspector.
Fee $. `..
........ .. ..J..... ........ ................
Building Inspector
Rev. 6/30/80