HomeMy WebLinkAbout23890-z IFO'n'ae NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PEPu~(T MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
D~te ........ ~ /: ,~..~Z
N.° 2~890 Z .-- .... =... .................... ,
/
hereby granted to -
Permission
is
.........................
...~.~...~~:....~.zz~
~~..~..~.~~~~...-~.~~ ~~ ...............
~,~,~,~ ...... ~ ......... ~.~..~ .............................
pursuont to oppl'cotion d,,tea ................~...~. ...................... , Jg..~.., and opproved by the
Building Inspector.
Building Inspectoy
Rev. 6130/80
i ¢/,: STOI~Y
Fr~. HO
9o,44
(SS'~)
~5.0
.. %
FORM NO, I
'I'O~N OF SOUTIIOLI}
RUILDING I)EPAR'rHENT
SOlITI1Ol,ll~ RoY . 1197 I
BOARD OF IIEAI,TII ...............
,?3 SETS OF PLANS ...............
/SURYEY ........................
CI1ECK
SEPTIC FORH ...................
a. 'lhla alldication uust Im co~pletely [itled in by typewriter or in ink and m~lJaltted to the ]ktildlu8 Inslector will
3 ~ts of plans, ack,rate plot plm~ to scale.
b. Plot- plan ~i~ l~ati~ of lot a~ of I~ildi~s ~ ~i~a, ~elatlonshlp to ~.]oining pr~i~s or ~a~llc
~ ptr~ts or areas, a~ glvi~ a t~tail~ ~seriptim o~ last of ~-o~rky ~,~mt 1~ dram a~ the dla~ ~1ct~ is ~rt of
t.lda a~llcati~.
c. ~e ~k c~ I~ this a~licat:i~ ray ~t l~ c~l I~fore ismm~e of A~ilding Permit.
d. U~ ~al of this applicati~, the Mildin~ Insl~ctor will is~ a Afildiog l'enait to the appllcm~t. ~ch
l~mlt Mmll ~ kept ~ tl~ p~i~s ~ilable for ins~cti~ thra~t the ~rk.
e; ~ I~tildi~ ~mll 1~ ~a~pi~l or u~ in ~le or ia Dart for a~ ~se ~mt~er until a ¢~rtlficate of
(~:~a~y ramtt h~e I~n grm~t~l I~ tim Adldlng los~tor.
APHA~TI~ 18 1~1~1~ ~ to tl~ A~ildlog I~r~nt for the is~a~e of a ~ilding Pe~it ~:rmmnt to the
l~ildi~ r~e O~i~e of ~m Ta~ of ~tl~ld, ~ffolk C~nty, ~ York, m~ other applicable ~a, O~li~es or
~lOflati~s, for tl~ ~mkn~ti~ of l~itdi~s, ~iti~s or alterations, or for ~al or ¢~lltion, as herein
&scril~l. 'lira applic~t agr~s to co~ly with
re,latices, ai~ to ~nit a~tl~rlzml ins~ctors ~ ~ises a~l in l~il.di~ for ~ecea~ in~ti~s.
(Si~mt~re o[ applicant, or m~, ii a cor~rati~O
(~ailh~ ~dress o[ applicant)
State Mmther applicant is o~ner, lessee, agent, ard~iteet, engiz~zer, §eneral c~tracCor~ electrician, plmtmr or Ixlihler.
..O~.Oa~ ..........................................................................................................
~,~ o~ ~ o~ p~i~,. ~.l.~a~...~a~ ..............................................................
(as ~ tie tax mil or latest de~)
If a~licsnk is a co,ratio, si~mtu~ o[ ~ly a~tl~rlz~l o[~icer.
..... .~.~. .............................................
(~ a~ title o[ co~mra~e
Plt~d~ers Liceose Ro .......... t ...... ' .........
!
Electriciass License ~ ..... i~ ...............
Oliver l¥ade's I,icense ~ .... .~ ...............
~. ~m, ti~, ,,~ ~a~ m ~o~ m~m~ ~rk ~m ~ ~.~.Q.~ ..... ~ ............................
..... ..................... ...................... ...............
Ik~me ~r Strut l~le~
(~mty Tax ~,p ~. I~ ~ti~, ...~ ......... Bilk .. ......... lot ...........
Mlxllvisi~m ...................................... Fil~l ~p ~.' ............... lot ...............
(~)
2. State existing u~ a~ ~D~ o~ prmi~s ~ inte~l use a~xl
a. gxist, it~ o~ a~ ~ .. I..~ ..........................................................
~,. ~,t¢,~k~* ,,~ ~ ,~,,~y ...~&~ ................................................................
I..
I
, APPR~ED
76~-180~ B A~ TO ~ ~ FOR TH~
FOLLOWING INSPE~IOND:
L 6OLJ~OATJON ~O REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSU~TION
FINAL OON~TRU~ION
BE COMPLETE ~R ~.0.
ALL CONSTRUCTION 8NALL MEET
THE REQUIRE~ENT~ OF ~E N.~
s~,r~ CONS~UCTION & ENERGY
COOES, NOT RES~ONB~LE FOR
DESIGN O~ CON~U~ION ERROR~
(C(~llrn(:tor~ ~llelll:. (:(!rlx~rJHe of Elect, et(:.)
eppl i(:m. io~H t.h/)l: ell atatelenttl (:ontaJ~d in t Ilia al)pi l(:aLion nre l l'~ Lo Ihe I~al; oF hi*~ kin~lc~ll~(~ aixl I~1 iefj m,I
I ; .
Ih;iL Lhe ~)rk will I~ i~rl:m,ed in [ilo illgllll~E BE~ forth il1 the nppl l(Itil. Jon riled H~rc~iLh.
JOYCE M. WILKINS j
NoteW Publi;, State of New
No. 4952246, Su~lk ~u~,
Term ~plr~ J~ne 1~ 1~
(Si[~.ah,'e ()f Appl ieeal.)