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Home My WebLink About23408-zFORM NO.3 TOWN OF $OUTHOLD BUILDING DEPARTMENt* TOWN HAl/ SOUTHOLD, N.Y. N£ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 23408 Z Date .......... ..~...~...~... .................... 19...~,..~... pursuant to application dated .................. ~..,.~....~.., 19...~..~,..., and approved by the Building Inspector. Rev. 6/30/80 FORH HI). ! 'FO~N OF SOUTIIOI.D BUILDING DEPAP,'ITIE NT TOUN llAl,l. SOIFI'III)L1), N.Y. 1197 I TEl.: BOARI) OF IIF, ALTI! 3 SBT8 OF PI.AN,q ........ , ...... SURVEY ........................ c.~c~..%~P.... ~ .............. SEPTIC FOIIH ................... NOT t FY: HA I 1, TO: .................... Diaal~roved a/c .................................. (1! (li~8 1 nal}ector) A1PPI.I~{~I'ION FOR BUll.DING PERHIT ~..q~.~k ....... a. 'lhls al~llcatio~ mint I~ co~l)letely filled in by tyl~qriter or in ink ar~l ~tl~nltt~'to the ~fildiU~In~ctor 3 ~ts off plans, ~curate plot plan to r~ale. F~ accordi~ to sd~hfle. '-' ..... b. Pink plau ~in8 lcx:atics~ of lot mM of Ix;ildings (m praises, relat ica,ship to edjoinin8 pr~i~s or ~1~1)1 str~ts or arena, ned 81vh~ a ~tail~l (~scriptiat o[ la~t of prolmrty ,nst t~ drnm m the dia~ ~,{d, is I~art of this a~licati~. c. lhe ~rk amrM I~ this a~llcati¢a~ p~ s,~t I~ cm~t~l Imf ore isa~a~e o~ ~filding Pe~it. d. UI~ algal o~ this atqfilcatlcm, tl~e lhJildin8 lnslmctor will ism~ a I~ildh~ Pemlt to the appllcm~t. ~ch ~tmlt ~mll Im kept ~ tl~ pr~l~s available for lnsl~CtlCa~ thrca~f~a~t the e. ~ lafildi~ ~mll Im ~mqfied or u~d in ~mle or in flirt for a~ ~tr~)se ~mt~r ~tll a ~rtlflcate of (~cx~a~ ~mlt have I~n granted by IJm ~tildln8 lns~ctor. ' At~A(~'l'l~ 18 I~[~IIY ~ll~ to tl~ Ik~lldlt~ l~l~rt~nt for the ismm~e o¢ a ~ilding Permit ~trmmnt to the lk~ihli~ F~ Onli~e of tim 'l'~m off ~tlwld, ~fffolk C~mty, ~ York, ned oO~er applicable l~s, ~8tdati~m, ~or tl~ ~mtn~ti~ of lafildi~s, mhllkhms or alteratltms, or for ~al or ¢~lltlon, as I~relu t~scril~l. '11~ appllcat~t agr~s to co~tfiy with al1 aloft icoble I~s, ordhmt~es, lalilding c~, i~si6g'cede~ reDfiakk~s, at~ to alalt m~tl~rt~l hml~ctors tm praMses a~ in Isdldln8 For tecessary ...... ......... ................. (Sigt~l:ore--~of a~>l icant~or ~, if a corwraki~O ........ ......... (f~ I h~ ~kh'ess of Ol~l~cant)0 State ~{mther npplicnnt ia o~a~er, lessee, agent, archiLect, en§i~+eer, ger~eral, contractor, electric{an, ifluai}er or I~dlder. ............... ~tO.~E..' ........................................................................................... .... S .......... (as a~ tim tax roll or lnt'ebt deed) If nl~licnnt is a corporatia~ sig~mtare o£ duly nul. horiz~ed officer. (N~,,e a~l title o1~ corlvorate of£icer) ll~ilders l.iceO.se ~} .......................... lqt~t~era l,leetme Ro .......................... Electrtelnna License ~ Otler ~a~s Licen~ ~ ..................... I, l~ati~ o[ lam a~ d~id~ pwl~ ~k ~i[l I~ tk~te .............................................................. ....... .g. ~.~5.O ............... ~ ~...R~ ........... ~o...~ ........ a~,ty ~'~ mp ~. ~ ~co~, J2~..$.q ...... m<~ ................ ~ ................ ~1~ ms~ F~led ~t'~p ~} ................ l~t ............... (~.,e) 2. State existing u~ taxi ~ca~Da~y of pr~i~s m~l inte~l use m~l ~oq~y of pro~ c~st~c~ion: b. ,,,t~ ~ ~,~ ~,~,,~y ...,~3...~.~ n ......................................................... '1. I~,lt,~ of ~.k (dm(:l~ whid~ al~l)llL'.hl~)t ~k.~ II~ihli,,l:~ .......... ~Milio,~ ......... ~ll~rn~ion .......... I~q.,ir ............ I~,~al ............. I~,x~l ilion ... ()lher I&~,k ...~..~ ..... (l~cr I pt i ~) ,,. ............. .... .......................... 5. 1 f ,~11 i-I~, ,.,l~r o~ ,~11 i.8 unlto ............ Ii,dmr o1~ &mi I In~ u,dl. ~ ~och fl(mr ................ If ~ural~e, I~l~r of (:m. ...................................... Il. I)h,~.mi(.m ()[ entire i~ C(Xlalrlx:l'J<sl: Fx(x)L ................ I~lr . ......... ~ .... I~l~tll .............. I~ll~d: ........................ ~ l&,~lm~ of [ilorie, ..................... 9, ~ii~ oF 1o1:: FII~IL .................... l~ut' . ................... I~plh ..... ~ .............. IlL I~ll:e of IMrcha~e ..................... ~,~ of FoH~r (~r ........................................ II. 7~ or u~e cll~Lrl~C In ~tl~]~ l.O.l~e~ are~ituol~l .............................................................. 13. ~Jll lot Im ~ellrlx~d .................... 1, Ihi~ I.Ol~rly vllhln ~) feel o[: *IF YEti, ~MII[~I)'1~ '11~11~I I]~I}IIT ~Y I~[ PI.OT I) T^OII^H l*×:ate cleorly n,xl di~;l, ltmlly nil I~dldhq;~, ~Jmther e. lorln8 or prolxmed, m. ~Jmther h~terlor or cDr,mr loC. lr~licat'e all se~-Imck dh,~nslon~ a:~l nhcm nLreel: n~.es m~l h~li(:ate APPJOVED AS NOTEQ __ D~TE: ~B.R #~ 17&S-~802 g AM f F~LLOWING INSPE~IONS. IlJ FOUNDATION . ~O REQUIRED FINAL ' CONSTRUcTION MUST JBE COMPL~E FOR C.O, ~ALL CONSTRU~ION SHA~ ME~ THE REQUIREMENT~ ~ ~E N.~ STATE CONSTRU~ION & ENERGY CODES. DESIGN OR .... O~.K.~'.O~. ..... 0.. ..................... I)<!i,8 duly ~rn. delx):l.a, (H~,~,) of hxlivldmH .ilpd,,8 r. oht,ocl J ~ in the ............. ~ .............................................. ' .......................... (ix ~Lr~ L r, ~l~<,}L, corlx)rnte orfh:er, el:<:.) o¢ ~,mid (~v~r or (~x~ru, mKI J~ duly m~thorlz~l [o I~rfc,m or hove leri'(mmed the ,ri:hi ~qq)lic(~Liom,; [I.H. ul I..Lnt[~t)l. <:()nLnl~)d i. lid. nlq)l,l(~at[o,) m-e L)'lm I.o the Ira.l:) 1~)rn Lo I~fore .~ Ihln