HomeMy WebLinkAbout24645-zFORM NO.~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HAIl
SOUTHOLD, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Permission Is hereby granted to:
........ ~.E~.~....~...~!.~;~.~!...~!P.~.Y.~ ~ .................................
...... ,.~...E~.~,~.~....P.I~.~P~;..... .............................................
........ ~i~.~..T.Y..V.~, LJ, E. ,. ~Y....~. ~,.7.. P .~ ...................................
to .....E:.~E.C.T...~...E~.[~E~...,T ~.. ~,~B....~,~B~.. ~E~...~ .P.~, ~ ~ D...E.~B ...................................................
at premises located at ................... .:LT...5.......C...L..E..~.R..~.~..E.~...~.~.~. ................................ ~.~ILJ.~.I~ ...........
CountyTaxMap No. 4?~E~B~ Section 07O Block O00E~ Lot No. 040
pursuant to application dated ....0.. ~.N.U.~. I~.Y. .......... ,7. ........................ 19 ...... ~,~ ..... and approved bythe
Building Inspector.
Fee $ ........ .3;,, .5, .:, .0..0.,,,,,
l~ilding Inspec~r
Rev. 6/30/80
OF
$OUT|IOI,D
BUII,1)ING DEI'AETHEflT
TEL: 765- 1802
l)i~a~ a/c ..................................
..................................
BOARD OF IIEAI,'|'II ...............
3 SETS OF PLANS ...............
SURVEY ........................
CIIECK .........................
SEPTIC FORH ...................
CaLL . .2q~:~. (~..
APPLICATION FOR BUILDING PERHIT
] N,qTRUCTIONS
a. 'Ibis aplRic;it~i(~£ht~fftTbe'c~letfily iS lc4 ih by cyF:4vffiter oF in inlCntxl sul~ffted to
3 ~ts o[ plans, aco~rate plot plan to scale. F~ accordi~ to sd~ule.
b. Plot plan fl~ing l~tlm of lot at~l of l~ilding8 {~ praises, relationship to ~joining pr~nisen or
,trots or areas, n~l glvir~ a ~htail~ {hscrlpti~ of iaya;t of pretty ,~mt 1~ dr~ ~ the diagran ~id~ is I~art of
this a[qfl icnti~.
c. 'lhe ~rk c~r~ by this: al~llcaci~ v~ t~t I~ c~ lmfore iamm~e of Adldi~ Peunlt.
d. UI~ a~n~al of thiff.a~llcati~, tl~ ]kfildlng lna~ctor will is~ a ~ildltg Petmlt to
l~nnit ~ml'[ I~ kept'~ the p~ni~a ~ailable for ins~cti~ thr~t the ~rk.
e. ~ Ixdlding ~mll 1~ ~pi~ or o~ in ~ole or ia lmrt for a~ ~r~se ~mt~er until a (~rtlfical:e
(kcaq~a~my shall h~ Iron grant~l by tim ~dldi~ Trisector.
~Fl~.I(~l]~ lS 1~1~ ~ to tl~ l~ildlog ~lmrt~ot for the is~qnce of a l~ildlng Pemlt ~trmuu~t t.O the
I~dlding ~m Onli~m~e of tl~ T~ of ~z*tl~ld, ~fffolk ~mty, ~q York, atd other applicable l~s, Ordi,~ea or
~gulat~s, for tl~ c~tz~i~ of ~dldi~gs, ~Mitit~s or alteratltms, or for r~wal or d~lltion, as het~in
descril~l. 3he applicant a~s to c(~ply ~ith nH a~lJcable 1~, ordbmnces, ~dldi~
rel~fiati~m, at~l to at,it ~tlmrir~l Jnsl~tors ~ p~nlms at~l in ~i. ldlng for ~ces~ary
(Sig~mture of applicant, or nam, if a corlx~ratic~O
(~la~hr~ ~(klress of app]lcant)
Ji.P LqtOYEIP ED ~SN OTED
................................................ : .................... ./~W~ ,~ vo..~.~:. ~ . .....
{os o~ the tax mil or lateat d~l) 7a~-1~ ~ ~ ~ 4 ~ ~ THE
If applicant is a cor~ration, $i~at~re of d~fly i~lti~)ri~al officor. ~ F~D~ ' ~
P~iil(lers l.icense No...~.J..~-. ..................
Ph]~i~ers License No ........................
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N,Y.
STATE CONSTRUCTION & ENERGY
Etectricians Licen~ No../~,.[~,. ............. CODES, NOT
RESPONSIBLE
FOR
Lice,,. ..............
[buse l~fl~er Street et
2. SLate exiating u~ taxi ~os~q~ of l~ni~s a~xl int'eml~l use a{xl tmmq~qncy of p~ ccmstmctlon:
~. ,~,,,,,,, ,:~- ~, ~,,~,~, .... >.~.~...~.~...~?.~t.~. ...............
(1o I~ Imid on fill.fl thin
PI,OT I)IA()IJAH
~.~.l~!inL~ (Mly f,'~x~r., (leix~aea el~l ~a¥[s Lhnt I)e i.q the ~)pl)llc::)nt
((k~trneLor, fll~en~, corlx)rnt:e ol [i(:er, etc.)
o~o