HomeMy WebLinkAbout23355-zFORM NO.3
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Date ...........................
23355 Z
Permission is hereby grante.d to:
..........
to ..~~....'..~T.~.~.. ~. ~~.: ......................
........................ , .......................... .~.. .~/.~ ......................................................
CountyJax Map No. lO00 Seotlon ...... Z.,~....~. Block ......./ .............. LotNo, ~' ~
pursuant to application dated ......... ~-...~.~....~... ,~.. ......... 19...~....~..,..., and approved bythe
Building Inspe~/.~---~
~ee ~..~.~.. .............
Rev. 6/30/80
/"'~'" Building Inspector
PAUL ~ MAUI~EEN h,1. G~I PPA
~zK-i--ir iTU C~
VORH I~()~ I
T()~H ()t~ ,qOUTUOI,I)
I~U I1,1) I H(~ I)lt, V A RTtlF, tH'
TO~JH UAl,I,
fiOUTIIOI,I)~ fl.Y. 11971
TIll,: 765- 1802
I HS'I'IIIIC'I* [ OH S
IIOAIU) ()F IIF,^I,TII ...............
3 ,qlt'l'g O1;' PI.AH!; ...............
(I UltVlt. Y ........................
CIII~CK .........................
~gl?'l'l C FOItfl ...................
N(/'rl tTy t
.pole ............... ,19...
, n. 'lhin .ppi ic.tlc~* ,m.t Im cc~q~lelely filled ht by I'YlX~.~rit. er or in ink m*l mflx.ltted Lo the Ik~lhling l*~l~clor ~ith
3 .et. of plo,m, nccurnte l~lot plou Lo .cole. F.e oecording lo
IJtJ~ nl~d lenth.~.
~:. 'lhe ~rk c~ner~l by Ihin ~Jl~)l ienti~u* ~,~ty ~)t Im c~m~:ed Imf.re i.mm~:e o[ Ik~iJdi~)g l'ermlt.
imf,niL ~mll Im ~el)t I~J tim l~nl~, or.il.Ill, for i~l.lmeti~ tht~x~K~t the
(~m~lm~.:y .I.]11 hove Ix~en grnnted by tim I~silding lnnlmctor.
AFI'I,I(~'I'I(B I~ IHilGillY }~ Lo tim I~lil(IJng I~lmCtu~,;t for the i..umme of n ~lil{lJl~ Pe[mlt Ix;rmmnL to the
denc~il~.l. 'tim Olqdleont ~gr~ I.o ccx,~)ly ~ith nil npplic~lfle I~0, ordinmme., I~JIIding
[~guhll Item, n(xl to ~},llt militarized i.slme{or. ~ I~r~.l~en m.I Jn I~dldiug lot
(SJ~pmture Of nl~l[~nut, or nm~, ii a eorlxn'ntion)
............. :z.h ......... 0 ............. ~. ........
to. oq'~ !he I~ roll or Iht. eot deed)
(t~ m.I title o[ corlx)role officer)
l~Jihlern l.i~:eo.e 1'1o ..........................
I'h~dmrtt l,icenne Ho ..........................
lilectrlclmto I,lcen~e I~.) ......................
Otlmr 'lYric'0 I,iee[me I~) .....................
I~x:nt|o~t of ln,.I o~1 '~ldch p~lm.ed ~trk ,ail 1 Im ~o ~e.: ................ r ............. ! .......................
~,lxl{u{s{~ ...................................... Flied ~,p ti) ................ li)t ............... (~,~)
I)l,OT
~Ar:III(H' llll(~.l'J()r ()[' i:()rlv~r
DATE: ~ B.R # ______.__
F ·
r L~iUlLDiNG DEPAR~
765-1802 9 AM TO 4 PM FOR THE
FOLLowING INSPECTIONS:
1, fiOU~DATJoN '~0 REQUIRED
FOR POLJR~D CONCRETE
3. ' FRAMING 8t PLUMBING
INSULATION
4, FINAL C
ONgTRLIOTiON MUST
ALL CONSTrUCTiON 8HALL MEET
THE REQUIREMENTS OF THE N.~
STATE CONSTRuct/ON & ENERGY
COOEs, NOT RESPONSIBLE FOR
OESIGN OR CONST~UCT!ON
................... day .ge...
NOTARY PUBLIC~tate of
No. 4725089, ~uffolk Coup/
Term ExRir~ May 31,