HomeMy WebLinkAbout24232-zFORM NO.3
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
Sou*r HOt. D, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Dote ......,7~' ................. .Q ........................... 19..@.7. ....
Permission Is hereby granted to:
....... .~.~,A~T,~.. ~,.. ,T..[ ~... A~ ~).~I~.~. ..............................
....... .~7.,55...G;8~:D..~,~rJ~ ........................................
....... ~T.I.TU~CK..NY...1.1.9,5.2., ................................. .,..
to.....E~I~CT...A...~-,t,ICE..AC...At:?RLT.~])..EOR ...................................................................................
at premises Iocoted at ................ ;~.?.SR.....G[:~z~L~D.._&.~.E ..........................................................................
CounlyTax Map No......4.'Z. 3~Stg. ..... Section .L;LD?. ............. Block ....EIQ0.;L ......... Lot No. 0.0.5...Q0.2 .....
pursuant to application dated ...~.ULY .................. 1 ......................... 19.....R~ ...... and approved b/the
Building Inspector.
Fee $ ........ 85,- O.O .....
Rev. 6/30/80
S~PTIC, WAT'E/:l
WELL LOCATION
AS PER OTHERS,
ARE, NOT GUARA~
.(
FORH NO. I
TOWN O1" SOUTIIOLI)
BU1 I,') lNG I}E PARTMLr NT
TOlIN IIAI.I.
APPI,I(:ATION I"OP, BUII.I)ING PEftHIT
l NSTRUCI'IONS
BOAIH) OF IIEAI,TII ...............
] SETS OF PLANS ...............
SURVEY ........................
CIIECK .........................
SFA:'T] C FORH ...................
CAI.1 ...................
MAIl. TO: ....................
n. 'lids applicaticai re,st Im colt)letely filled irs by tyl~riter or in init al~l sula, itt~l to the I~filding 1,mlmclor
3 ~ts of plans, accurate plot plan to ramie. F~ accordi~ iD schechde.
b. Plol: phm tigrisB I~ati~s of loc ami of Ixdldings on pre~nises, relationship rD mi, Dining prenises or lxll~l/e
slr~t~; or areas, ar~l givir~ a (~l:ail~l (~scril)ti~{ of la~x]t of ptx)l~rty ~mt I~ dr~m on the diagrm~ al{ich is II{ri: ol'
this application.
c. 'lhe work c~reered by this alii,cation way [K)I. be ccxm~rv.:ed before issumme of lkdlding Pemir.
d. Ilium ai~)rl~al off this application, the hdhlinR Insl~eCor will iss~ a Ik~ildin{[ Pemil to the applicanl..
Ix*rmit droll I~ kept m tim pr~i~s available for ins~cti~ thrcx~a: the ~rk.
e. ~) Ixlihling ,frail Im ~cupi~l or u~l in ~d~ole or in ~rl for any lan-~ Omtever until a (~rtifieare of
(ktCUlUl~my ~O~all have Immn grant~t by tim Ikdhling Inslmctor.
~PIl.If~'l~(g IS I[~fl~ b~ rD the I~ildinR ~lmrttmnt for tim iss,mme of a thdlding Permit. i~rs~mot to the
l[dlding 7xam Ordi~mm:e of tl~ 'l'~a~ of ~tlmld, ~ff~olk
l~gulal ,ms, for tl~ c~stn~:tiol of I~ildlrBs, ~kllti~m or alterations, or for ro~al or d~olition, as herein
{kmcril~dl. '11~ applicant agr~s rD co*lily with all aplfl icahle Imps, ordlma~:es, ladlding c~le. I~ming c~le,
regolar[{ms, m~l to mtMr autlmriz~l ins~etors ~a~ pmM~s m~l iD I~dlding for mces~ ins~ctions.
~lch
(Si,limtt,re of al~)~icant, or re,m, if a corporal'ion)
(['~dlinl; ~ldress o1: applicant)
...o ......................................................................
(aS (Xl Ihe tax roll or Iai. esl: dc~l) N{~IF~ BUILDIN~ ~E~ AT
al,id ,cant is a COrlnration, sig~mlure of duly aull~)z-iz~l officer. 705-1~ $
.........................................................
(~,~e ami title of COrlX)rate officer) ~. ~
4. FINAL - gO~VRU~
IMi Iders l,icemm ~ .......................... BE GOM~ FO~ ~.0.
Ph~t~r~ Licen~ ~o .......................... AL~ ~ONgTRU~TION
THE REOUi~E~ENT$ OF TH~ N.Y.
Electriciam~ I.icen~ ~) ...................... ~TATE ~ONST~UgTIO~
CODES. NOT RESPONSIBLE FOR
o,,~ .,.,-~.~?~ ,.~,:.,~ ~, ..................... ¢~ ~ ~ =~,~ o~ co~s,~?~ =~o~s
... r~k ................
~ltxliviMon ...................................... Filc~l ~hp ~> ................ l~t ...............
(~m)
a. Exisl lng u~ m~l {~cl,[~r~y ..............................................................................
~,,. ,,,,,~,~, ,,~, ,-, .~,.,,~..~ ~.~ ~. ~ c.~m~m,~. ........................................
~)I,OT l) l
'
'A'II~ IHr LN~V YIHII(,
. i
....... ~ ..... ,,,,, ,,~ ..~.~.(s..~. ,~...
~otaw Public, ~tate of K~;w YOrK
No. 52-8125850, Suffol~ CougW
Term Expires October 31~
(It,ly ;~)m, (l(!lXm(!~t oiH rmyr; theft, he ltl Ihe iq)pi