HomeMy WebLinkAbout23400-zFO~M NO.3
TOWN OF $OUTHOLD
BUILDING DEPAgTMENT
TOWN HALL
SOUTHOLD, N.Y.
N~
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Date ............ ~..~.../. ..........................
23400 Z
Permission Is hereby granted to:
................
pursuant to application dated ......... ~,,../....~... ......... 19.Z) .~... ..... and approved by the
Building Inspect'
~ee~.,~.'. .........
'~' "~'~'"' ............... Building In'~'-'~~
Rev,
6/30/80
,I
t~ORH NO. ! ~
TONN OF SOUTHOLD
BUILDING DEFARTHENT
TOWN HALl,
· $OUTIIOLD ~ N.Y. J197J
TEL: 765- IS02
INSTRUCTIONS
3 SETS OF PLANS ,,, ....... I ....
SURVE~ ~.~lll...*~,..,'.,.,..~.-
CilECK .~,, ....................
SEPTIC FORH ~., ................
MAIL TO: ..... ., ........... ...
a. 1his ~lication ~u~t l~ cc~letely lille4 in 1~ ~iter or in ink ~ ~tt~
3 ~t, of plus, ~ate plot pl~ m ~e. F~ ~i~ to ~le.
b. Hot pl~ ~ l~ti~ o[ lot ~ o[ ~ildi~ ~ ~s, ~lati~ip to ~joini~ ~i~s ~ ~llc
st~ts ~ a~as, ~ givi~ a ~t~l~ ~ri~i~ of l~t of ~r~ ~t W ~ ~ ~ di~ ~dd~ is ~rC of
Offs ~li~ti~.
~ri~. ~ ~li~t ~0 to ~ly ~ all ~li~ble 1~, ~i~s~
-.- - t ....
State ~tl~r ~llm~ ~~, ~t, o~d~-,~l~r,'" ' ~ral ~tr~t~ el~trici~, pl~r
.... .~IC. ....................................................................................................
.......................
(~ ~ title o[ m~te ofilmr)
Iluilders License I~ ..........................
Plumbers Licer~e No ..........................
Electricians License No ......................
Otlmr Trad~'s License ~ .....................
I. Location o[ 1.nd on ~tdch i,~ovosed -.,,ork will ~ ~ ..............................................................
I~ ~r St~t ~let
(~)
I0.
II.
12.
I).
I~.
15.
Nature of ~ork (ctmck Mdch aPPlicable)~ ~a lksildi~ .......... ~iti~ .......... Atterati~ ..........
~a pro~ ~tn~tt~ v/olote ~y ~i~ i~, ordl~e ar regularly: ..~ .......
............... ~ ........ , .... ~ ~ ...............
PLOT D~AGRA~
· q'rATl~ OF NK{~{ YORK,
COIIII'rY OF
(l~{ie of i~divi&ml ot.gnl~
· ApPRO,V~D AS NOTED
DATE: -- B,R # ........
FEE: __ BY:
NOTIFY BUILDING D~P~RTMENT A'I:
765o1802 9 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1, t:OUNDATION ~ TWO REQIJIRED
FOR POURED CONCRETE
2, I:~OUGH ~ F~AfQUNG &
BE COMPLE]E FOF¢ C,O.
~L,E CONSTRLJCHON SHALL MEET
~I~IE RESUIREMEN'I'S OF THE
(~.6~E~,. ~CJ~ RESPOI~SIBLE FOR
lis ii ilia .... ......,, ., , , ? -'
(C~tra~tdr, agent, 9oroorata officer, e~c.) ~ ~ ~ ' ' ' , '
of said ~r or ~mra~ ~l ia ~ly'~tl~rt~ tO Imrfom or I~e ~rfo~ tim eaid ~ ~ ~o ~ ~ file
a~licati~; tlmt all star--Ca ~ tn this a~licaci~ are Cam to tim Imat of Ida ~l~e ~ ~liefi
~rn ~o Imfot~ m ~da
........ .~,-~;./~C,5., &~ oc ,,~ ......... ~9. , ..... ,.. _/
.... ; :,,:; .....