HomeMy WebLinkAbout23331-zFORM NO.$
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HAU.
$OUTHOLD, N,Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Date ~ ~/,-,2D
............. .......................................... ,
N? 23331 Z
Permission Is hereby granted to:
r
at premises located at ........ ~ .......... ..~. ~....'~--~r/~......~....--~...
.................................................................
Coun~yZax Map No. 1000 Sectlon....~..~ ........ Block .......... ..~...~.. ....... Lot No. ....~...~ ...............
pursuant to application dated ......... ~.'~..~..~ .......... ..z','~..~.....¢~... ..... 19...,~...,~...... and approved bythe
Building Inspector.
7/ BcJtl~Jlng Inspector
Rev. 6/30/80
TOWI'~ OF SO f"' OLD
PORH k'{O. I
TO%qN OF SOIJTIIOI,D
B0 ILI)IIqG I)F,P AR'fI~IRlqT
'1'O1~ k'l llALI,
SOU'FIlOI.D, N.Y. 1197 I
'FEI.: 765- 1802
0isapp~ovnd a/c ..................................
BOARD OF IlF. AI.TII ...............
3 SE'r8 OF PLANS ...............
SOR~/EY ........................
CI1ECK .........................
SgPTIG FORH ...................
l~O'i'l FY:
.... ZA.zt'.:/.3.¢..o.
HAll. TO: ....................
APPLICATION FOR BIJ£LDING PERHI'F
INSTRUCTIONS
a. 'lhis app]icati~ mist be conpletely filled in I~J typcn.;riter or in ink o~1 ~lnitt~ to fl~e ~xildi~ Ins~ctor ~ith
3 ~ts of plans~ accurate plot plnn to ~ale. F~ accordiag Lo
b. Plot pisa ~i~ l~ti~ of lot aM of hdldi~s ~ ~nises, ~lationshlp to ~joining praises or ~blic
sl.r~ta or areas, a~gl givi~ a ¢htail~l ~ripti~ o[ la~t of ~rty mst I~ dr~ ~ the diagr~ ~id~ is ~rt of
this al~d icati~m.
c. 11~ ~rk ~r~ I~ this a~] icati~ v~y ~t Im coa~:~ I~fore is~t<e of ~dldi~g Permit.
d. II~ n~al of tala aH~llcati(nb tim hdldi~ 'Insl~ctor will ia~ a ~fildlng ~it to the a~licant. ~ch
~mit ~atl Im kept ~ tim p~i~s ~ailoble for ins~cti~ th~O~t the ~rk.
e. ~ Ixdlding ~all I~ ~pi~l or u~ in ~ole or in ~rt for a~W ~lr~ ~at~r
~H.IC~I'I~ IS IE~lff ~ to tim ~ildi~ l~lmrt~nt for the is~a~e of a lkfilding Pe~it
~ildit~ ~ O~hm~e of tim '1'~ of ~tl~ld, ~fffolk ~ry, ~¢ York, a~ other a~lJcab]e l~a, O~tit~es or
~lati~s, for tim ~st~ti~ of Imiidi~s, ~iti~s or alterati~s, or for ~al or t~ol itlon, as lmrein
{~ri~l. 'lira applicant a~s ~o c~ply with all a~llcable 1~, ordi~es,~ilding ~, I~}sing c~, aM
~gulati~s, and to ~it m~tl~rlzml ins~rors ~ p~i~s and in I~d)di~~for ~cgs~ins~yi~s-
(~ur~of a~licant, or ~, if a coq~ratt~)
.
~taLe ~tl~r a~licm~t is ¢~r, les~, agent, arddt~t, et~gn~r, ge~ral c~tractor, electrician, pl~i~r or I~ilder.
................. .oa .......................... ............................................................
(as ~the ~x roll or I ~1)
If al¥1icant is a coq~rati(~, sig~ata~ of (h~ly ~tl~rlrml officer.
and title of corporate officer)
Builders License No ..........................
Phs~bers License NO ..........................
Electricians License NO ......................
Other 'lYnde~s l.icease No .....................
I. location ol~ land on ~ddch propo~.l ~x)rk will be dose ..............................................................
Nouse ~l~r ~ Strut I~det
(~)
2. State ~istirg u~ a~ ~y of l)r~d~s and int.e~l use taxi ~[m~y of
b. ltnte{~ded ose atxl oecopaney .............................................................................
PI,OT I)l A(;IIA~
FEE: ,
"OTIFY BUILDIN~ OEPART~E.T
~0~ POU~ED
3. INSU~TIO~
BE CO~',PLE'['~ FOR C,O. i
AI.L CC}~STRUCTION SHALL ME~T
T~,: '~r'OiH~(ME~rS OF THE N,Y.
~X.,Z:t~,~[ LM tJ:),',',~ST~UCTIONJ ERRORS
((X l; lICt r, JlJ~(~ll~, cbrlx)r.~lte orfJr, er~ el(:.)
JOYCE M. WILKINS
Notary Public, State of New Y~t
No. 4952246, Suffolk County ,
Term Expirea June 12, 1gU/Ti