HomeMy WebLinkAbout23416-zFORM NO.3
TO~I~ 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)
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Counh/ Tax Map No. 1000 Secflon.~.,,~..~..~....... Block ........... ~ ..... LotNo ~'~" ~
pursuant to application dated .......... ~....~.~_.,,~,, 1 ...'.~.'.'.'.~.~..., a~d' ~i~'~';~
Building Inspector_, . ~
Rev. 6/30/80
i.O~OHiOOS ~0 NAAO£ ~
'J.d~la '~)a'la ~,
'I'll l! CT 10 lq ,q
a. 'lhis applicntiotl .iJst be ca~1>lelely filled in I~y tylx~riter or in ink ai~l mhnitt~ to the ~iildii~ lns~ctor x;ilh
3 ~l.s oF plnas. ~olrat'e plot platl to scale, lr~ accord{ag I-o schedule.
b. l'lot plnn M~Jl~ l(x:nti(~x of Jot al~J of I~dldit~s ~ pre.ises, Jelniiol~ship to ~l_joining pr~ni~s or IX~blic
str~rB or areaa~ a~ I}ivi~ a cbtaJl~l ~seripti~l of last of Prol~rty ~ust I~ (Ireful ~] the ~liagra, ~id~
this ~il~l ication.
~l. IIl~ a~r~a[ of this alq)lication, the Ihil(lJn~ lnSl~CLor ¥~{ll isst~ a IbJldh~g Pemit to die ~ippllca~l[.
[mimit Mlall 1~ kepi: ~l tl~ pr~ni~s available fi)r inal~d i~l thr(q~alL Lhe
e. ~ JxsJhlJs~ ~lall I~ ~{aqJi~l o~ till i. M~le or in l~lrt: for alW i~rl~se ~lalever taldl a (~rtificate of
(k:(mFatx:y ~al[ have J~n grn.t~l by I]~ IktiJdin8 I~lSl~dor.
AI~,I{~'I'I~ IS I~[~I~Y ~ to tl~ l~dldh~ l~lmd]~nl' for the ismia~<e of a I~dhli.g l'ennit ~rsamn~ [o Ihe
I~jldil~ ~a~ ()~lirm~e of lira 'l'~a~ o~ ~Ll~ld, ~ffoJk (k~ty, ~; ~otk, a~xl oLher npplicM)le I~s, O~Jilm~es or
l~gulati(~s, for lira ~stn~Li~, of Ixdldh~Es, mKlitia~s or alterations, or for rsa~a[ or de~litim~,
~scdl~l. 'lira applkant ngr~s to ca,er wJtl~ all al~l{cable l~s, ordJlmi<es, la~Jlding c~Je, I~slng c~le,
regulati(.it;, a~ to ~hlt atiLl~)ri~l insl~(lt'ors al preuises alii in I~i~litll~ for ~cessn[y J~s~tJ~s.
(Sig~ure of applic:ant, or lk~m, if a corlmraLio~O
Stat e sd~etlmr iq~plkant ia (~.a~r, lessee, al;e.I, archlted, et~llii~er, ger~ral e(~st tacLor, electrician, I)ltnt~r or lad hler.
~,x~ ,,f ~r of ,,r~nl~ ...~'.~...~(~:~ ...............................................................
(as ~t Ihe til~ roll or Iai'esl: de~l)
If all)licaist is a coqx)rati~h si~nl:t.~ o[ dt,ly aut.horiz~l officer.
(N.~,~. atxl title of corporale officer)
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~ota~ public, grate of N~Yo~
No. 4879505
Qualified in Suffolk CounW
Commission Expires Decembe~ 8, 19