.
,.,...
BUILDING PERMIT
RESIDENTIAL PROPERTY
DEPARTMENT
OF
ASSESSMENT
NASSAU
COUNTY
240 Old
Country
Road, Mineola, NY 11501
NBHD# (ASSESSOR
USE
ONLY)
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;;;;....
__
.+,
________________________
__.
0
SECTION
BLOCK LOT
(S)
SCH
DIST# PERMIT#
SPECIFIC
ZONING
DESIGNATION
(')
t-------t--------------t----------------+------t------------------t--------------------------1%
0
0
t-----""t::'~~:"::'="'~~~~~------------------
.....
~~":":::~----------~------------------------"'"'r
Location of
N.E.S
.W.
SIDE
OF
{OR
CORNER
OF}
N.E.S.
W.
SIDE
OF
0
b.::B=ul~ld=mg~=====-------------
------------------+---------~~~~~-------------------------t
~
ADDRESS
OF
PROPERTY
NAME
OF
BUSINESS
-
0
Check one
t=:~~-=-~=---------------------------==-----t---------t:~=-=~==-:-:=-:-:=~---------------------1~
CITY,
TOWN,
VILLAGE
ZIP
CONTACT
PERSON/OWNER
..,_
___________________
___________
_,. D OWNER
ESTIMATED COST OF CONSTRUCTION:
OR
ADDRESS
0 LESSEE
CITY,
STATE,
ZIP
"'
WORK MUST BEGIN BY
~~,,--------------------------------t
m
PRINCIPLE
TYPE
OF
(')
·
..
CONSTRUCTION
__________________________________ _.
:::!
0
z
PERMIT EXP DATE
D
STEEL
LOT SIZE S.F.
D
MASONRY
# BLDGS
ON
LOT
D
FRAME
DETAILED
DESCRIPT.ION
OF
WORK (PLEASE PRINT CLEARLY)
IF YOU WISH TO GROUP OR APPORTION LOTS
PLEASE
CALL
516-571 -1500 FOR FURTHER INFORMATION
m
*INCLUDING, BUT NOT LIMITED TO: LOCATION,
TYPE
AND DIMENSIONS
OF
IMPROVEMENT r
i-----------------------------------------------------------------------------
....
0
PERMIT
TYPE·
CHECK
ALL
ITEMS THAT APPLY
0 NEW BUILDING
0ADDITION
(CHANGE
IN
S.F.)
0 DEMOLITION
OALTERATION
(NO
CHANGE
IN
S.
F.)
0 MAINTAIN (PRE-EXISTING)
0 RECONSTRUCTION-
0 DECK, TERRACE, PORCH, CARPORT
0DORMERS
OOTHER
___________
__
0 FIRE DAMAGE
0 GARAGE/ OUT BUILDING
OHVAC
0PLUMBING
0 RELOCATION
0 REPLACEMENT
0 SWIMMING POOL
0TENNIS
COURT
0 CHANGE
IN
USE
PROPOSED TOTAL PLUMBING FIXTURES
DOES RESIDENCE HAVE
THE FOLLOWING
FINISHEDATIIC YES 0
NO
0
BASEMENT FINISH
1/4 D 1/2 D 3/4 D
FULL
D
(')
"
FLOOR/FIXTURE
BASEMENT 1ST FLOOR
2NDFLOOR
3RD FLOOR
BATHROOM SINK
1----------------------------------------------------------------------------------------~
~
TOILET
'"
-----------------------------------------------------------------------------------------~-
BATHTUB 0
,__
__________________________________________________
--+----------------------------------~::u
STALL SHOWER
-----------------------------------------------------+----------------------------------~m
BIDET r
----------------------------------------------------------------------------------------~o
KITCHEN SINK
(i)
---------------------+---------------+-----------------1------------------+-----------------~~
WET BAR
NUMBER OF EXISTING AND PROPOSED BATHS
NUMBER
OF
EXISTING FULL BATHS NUMBER
OF
PROPOSED FULL BATHS
NUMBER
OF
EXISTING HALF BATHS NUMBER
OF
PROPOSED HALF BATHS
HALF
BATH
EQUALS TWO FIXTURES, FULL BATH EQUALS THREE OR MORE FIXTURES
C:
-------------------------
----------------------~
o
~----~
o
~------------------------------11~
NEW C/O NEEDED YES
NO
-,
VARIANCE OBTAINED
YES
0
NO
0
~
CONSTRUCTION/RENOVATION
IN
EXCESS
OF
50% YES 0
NO
0
SURVEY ENCLOSED YES 0
NO
0
'!.';.'
>41~:J'-{'.:1.~~-~!~~;<i!~~·~
~.
DATE
OF
GRANTING
OF
PERMIT
Signature
of
Applicant/Contact Person - Sign & Print
SEPARATE APPLICATION
SHALL
BE
MADE FOR EACH BUILDING
FIELD REPORT ON REVERSE
Rav
08/11
Address
of
Applicant/Contact Person
Telephone
