HomeMy WebLinkAbout23562-zTOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALt.
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
cOMPLETICN OF THE WORK AUTHORIZED)
Permission is hereby granted, to: / . /~ .~ ~.~ ,~ ,
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~ ~.~,..~~_~...~..:~.~..~..~k~
~, p~ ~ ~ ~t ....................... [ ............................................. ~..~ .................................
............................................................. ~...~f~., ...................................
~.~ r~. ~ ~o. ,000 ~,o. ........ ~ ..... ~,~ .......... 3. ....... ~ ~o ...... .~..~ ......
pu~uont to opplicotion dot~ ........................ ~.~,.~., 19...~ond opp~ ~ ~e
Building Insp~tor.
Rev. 6/30/80
a. 'lifts appl ication ramt be ccmplel'ely £illed in by tyt~iter or in ink
3 ~ts off plus, ~m~rate plot plan to ~le. F~ acco~is~ to ~hahde.
b. Plo~ plm, ~i~ l~ati~ of lot a~ of Indldlr~s ~ pr~i~s, relationship to ~jolni~ praises or ~blic
~tr~ts or areas, ~ givi~ a ~tail~l ~bscripti~ of l~t of ~Olmrty ~st I~ (lr~ ~ the dia~ ~dch is ~rt of
thia a~l icati~.
d. ~ a~al o[ [his a~l~ca[ion~ ~l~ I~lil~ng l~l~c[or ~ill ls~ a ~ll~hg ~ ~o [he a~lican~. ~cll
~it shall tm kept a~ tl~ ~i~s ~ilable for ins~cti~ thr~t~t the
e. ~ lnfildi~ ~mll Im ~i~ or u~l in ~mle or in ~rt for mW D~
AH~J~TI~ IS t~BY ~E to t~ ~Hldit~ ~rt~nt for the issue of a ~ildlt~ Pe~it D~r~nt to the
~dldi~ ~ O~Ii~m~ of ~m T~ of ~(l~l(l, ~fffolk C~ty, ~ York, ~ other a~licMfle l~s, O~im~es or
~dati~s, for tim ~stn~ti~ of hlildb~s, ~iti~s or alterati(ms, or for ~al or ~litlon, as tmre]n
re, flatWare, at~l to ~it: ~tl~rlr~] Jns~tors ¢~ p~i~s m~l in
(Si~ture o[ al~lir~n~ ~ ~ if a corl~rati~)
State whether applicant ia ~ner, leshake., agent, architect, engineer, general co~tractor, electrician, phnt~er or Ndldet
(a.~ on the tax roll or latest deed)
If applicant is a corporation, .~ignature of ~hdy auttK)rized officer.
(Name m~l title of corporate officer)
~,,,~r, ,.~ce~ ~,. ~O~.C--Or..<< ~.v~C ~ "~%a~ C ~
Plmt~r~ l.tcet~ ~ ..........................
El~triei~s Licen~ ~ ......................
Otlmr ~Tmb's I,icen~ ~ .....................
1. l~ati~ of laal m ~id~ ~x~ml ~rk ~ill Im ~km ..............................................................
........ ........ ........................................
1~ ~flmr Strut Ik~nlet
~.,~ ~ ~,. ,~ ~,(~ .... a.~ ...... ,,~ .... ~ .......... ~t ..~.~. .......
~l~ivlsia~ ...................................... Filal ~q~ E~ ................ l~t ...............
(~)
2. State existi~ u~ ~ ~:y of pr~i~s a~l inte~l u~ m~l ~cx~y of ~1 c~mtmc/i~:
a. ~isth~ u~ aM ~ .............................................................................