.
,-
BUILDING PERMIT
RESIDENTIAL PROPERTY
DEPARTMENT OF ASSESSMENT
NASSAU COUNTY
240
Old
Country
Road,
Mineola,
NY 11501
NBHD# (ASSESSOR
USE
ONLY)
~
~~~~~~~"'!""!'~~--------1
z
DATE
REC'D (ASSESSOR USE ONLY)
.,_
____
..,..
____________
_,.;.T~OW~N-·-C-ITY~·-V-IL~LA;;.;,;.G~E~O-F~:::::;;;m;;;;;;~;;;;;;;;;;;;;;;;;;:;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;....
__
-+---------------------------1
th
SECTION
BLOCK LOT
(S)
SCH
DIST# PERMIT#
SPECIFIC
ZONING
DESIGNATION
(')
1-------1--------------1--------'-~-----+------+------------------+-----~--;_;..;..;.;;...;.;~,;;..;;...:;.;...;.;;.;.;...
____
.... :c
0
0
t------+.-:-~!'!!'"':'.="~~~~~-----------
......
----
....
~~~~------------------------------------1r
Location of
N.E.S
.
W.
SIDE
OF
(OR
CORNER
OF)
N.E
.
S.W
.
SIDE
OF
0
t=:B~ul~ld~lng~~~=-:--------------------------------+---------"P!"!'~~~~------------------------
.....
~
ADDRESS
OF
PROPERTY
NAME
OF
BUSINESS
-
0
Check one
~~,.,.,.,,.,.,.,,.,.~-=---------------------------'"'"""':-----t---------+,..,,._~"""=~.,.,,,,.....,..,.,,-----------------------1-t
CITY,
TOWN,
VILLAGE
ZIP
CONTACT
PERSON/OWNER
~-=-
......
----..._~~
....
......,...,..,..._..----------10
OWNER
ESTIMATED COST OF CONSTRUCTION:
OR
ADDRESS
0 LESSEE
CITY,
STATE,
ZIP
"'
WORK MUST BEGIN BY
PRINCIPLE
TYPE
OF
·
..
-PH-O-NE--------------------------------41~
CONSTRUCTION
:::!
=
EMA-,-IL
--------------------------------11
0
z
PERMIT EXP DATE
0
STEEL
LOT SIZE S.F.
0
MASONRY
# BLDGS
ON
LOT
0
FRAME
IF YOU WISH TO GROUP OR APPORTION LOTS
PLEASE
CALL
516-571-1500 FOR FURTHER INFORMATION
DETAILED DESCRIPTION
OF
WORK (PLEASE PRINT CLEARLY)
m
*INCLUDING, BUT NOT LIMITED TO: LOCATION,
TYPE
AND DIMENSIONS
OF
IMPROVEMENT r
.,_
__________________________
..._
______________________________________________________
.... o
(')
"
1--------------------------------------------------------------------------------------~
PERMIT
TYPE·
CHECK
ALL
ITEMS THAT APPLY
0 NEW BUILDING
0ADDITION
(CHANGE
IN
S.F.)
0 DEMOLITION
0ALTERATION
(NO CHANGE
IN
S.F.)
0 MAINTAIN (PRE-EXISTING)
. -
0 RECONSTRUCTION
0 DECK, TERRACE, PORCH, CARPORT
0DORMERS
00THER
__________
_
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
1-------------------
...
r
~
CENTRAL AIR
YES 0
NO
0
---------------------------
!!J
FINISHEDATTIC 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
~
~-------------------1----------------1----------------+-----------------+------------------t
llt:
BATHTUB 0
'---------------------+----------------+----------------+-----------------+-----------------~::u
STALL SHOWER
~---------------...------------------------------------------------------------------~m
BIDET r
--------------------+---------------+----------------+----------------~----------------~o
KITCHEN SINK
(i)
-----------------------------------------------------------------------------------------~§
WET BAR
NUMBER OF EXISTING AND PROPOSED BATHS
NUMBER
OF
EXISTING FULL BATHS NUMBER OF
PR
OPOS
ED
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:
------------------------------------------
........
------
........
--------------------------~Z
NEW C/O NEEDED YES 0
NO
0
=i
VARIANCE OBTAINED
YES
0
NO
0 lit:
CONSTRUCTION/RENOVATION
IN
EXCESS
OF
50% YES 0
NO
0
SURVEY ENCLOSED YES 0
NO
0
g
DATE OF GRANTING OF PERMIT
--
------------------------------
----------~"'
Signature
of
Applicant/Contact Person - Sign & Print
SEPARATE APPLICATION SHALL BE
MADE FOR EACH BUILDING
FIELD REPORT ON REVERSE
Rev
08/11
Address
of
Applicant/Contact Person
Telephone
