HomeMy WebLinkAbout23588-z 1~o~' No. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 23588 Z
County Tax Map No. 1000 Section ......... ~...~..... Block ..........~.. ...... Lot No...../....C~... .............
pursuant to application dated .................. ...~...~..../. .......... ,19..~..~ and approved by the
Building Inspector.
Rev. 6/30/80
-.-J
APPI~
hhng |llSlX~( [O1 )
'J'IOH I~OR BUll,DINg PI'~RHIT
] HSTBIJ£;TIO~$
BO^IH} OF lll;.^l,'l'll ...............
.~J3 SETS Ol~ PLANS
SEPTIC FORH ...................
HOT l FY:
m.,. ?.-. .....
HAI I. TO: ....................
Date ................ , 19 ....
a. 'lhis al~)lJ(:atic~ hi,St I)e cc=l~)letely filled in by tyl~l~rlter or in ink a~.l md~nitt~ to the ~dlding lns~ctor ~ilh
3 ~gs of [)lmm, accurate plot piao to ~:ale. F~ ac:cordisg to sd~lule.
b. Plot plan ~,~iig l~atio~ of lot m~l of I~,ildi~s c~ pronises, relationship to ~joining proni~s or D,blic
str~et~ or areas, a~ 8ivi~ a ~tail~l (~cripti~ off la~x~t of l~o~rty nnst
1118
c. 'lhe ~mrk cmer~l I~ Ihi~ a~ticatio* ~my sg~t Im colllEl~:~l Imfore ismm~e of Iklilding Permit.
d. I1[~ nl~al of this alSfllcatim~, the Ikiilding Inslmctor will ismm a I~ilding Permit to the a0~'lJeanl:. ~wh
l~n:dt shall Im kept (m tl~ p~nisea a~ailable for ins~eti~ I.hF(ll~l(IltI the
e. ~ NHlding flmll Im cmcupi~l or u~d in ~lole or in lmrt for a~ D~r~se sdsatever ~mtil a C~rtificate
(~31l~ql~ry flmll h~me linen granted by tim lkdldlng Instructor.
AI~].I(~'I'I(~ IS I~iBY }~IE to tim l~fildii~g ~lmrtu~nt for the ismm~'.e off a IMildlt~ Pemit Dirmmnt Io the
lkdldi~g ~ Onli~m~ o~ the Tc~s off ~thold~ ~ffolk Cxzmty, ~4 Yotlc, m~l other al~lleable l~s, O~li~t~es or
I~gulati~m, For lira c~mtnmti~ <ff IzHldings, ~kliti~8 or alterations, or for r~val or <~lition, as lmrein
~scril~l. 'lhe applicant agr~s to cm~fly with all nl~ilicnble l~s, ordinm~2e8, l~dldlr~ c~ I.~ing
re~laticnm, m~ to ~luil: m~tl~ri~l hmlmctor, tm pronlses mxl in I~fildlng For ~mces~ary inslmcti~ms.
(Sigr~lture of applicant, or na~e, il: a corlx~ratlon)
,I
(Hal I ins ~klreas of al~)l leant)
State sd,etl~r al~ticant is ~r, less~, agent, architect, engi,~r, ge,~rat ,-o:,tract~P~,~0T~r or I,:ilger.
FOLLOWING INSPE~IONS:
If al~licant is a corlx~tal:i(x~, si~ml~x~ of duly authoriz~l officer. 1, FOUNDATION ~OREQUIRED
FOR POURED CONCR~E
......................................................... 2. ROUGH - F~MiNG & PLUMBING
4, FINAL - CON~RU~ION MUST
BE COMPL~E ~R C.O.
l~il~r~ 1,icen~ ~) .......................... A~ CONSTRUC~ON S~ ME~
Ph~,Imrs Licen~ Ro .......................... THE REQUIREME~ OF ~E N.~
STATE CONS~U~ON & ENERGY
Elec~rieimm l,lcen~ ...................... CODES. N~ RES~NSlB~ FO~
OHmr '[~'~ License ~ ..................... DESIGN OR~N~O~
......
lkmse ~sdmr Str~, [ Ol~n'let
~d~livisi~m ...................................... l?il~l ~lp Il) ................ lz~t ...............
(~)
2. Stale exisl ins u~ mxl c~:(mlm~x:y of in~nises ar~l inte[xl~l use a[xl ~:(:u[~uey of pro~s~l consLructioll:
a. Existing u~m a~l (mcnqm[<y .......... ~../. ~Z.~ .................................................
I'I,OT I)
clearly m~l dlel:irx:tly
((~nd I ~]~:tor, nl~mit., J~ol IX)J nte of rJ(:~l', eLe.)
J~r~X)t[I lO I)qlolt~' ISJ] thit;
......... (~,,,, ,~ ..¥.~...
C~iRE L GL~
N~e~ Pubtic, State of New York
No. 4879505
- Qualified in Suffolk CounW
~mission Expires December 8, 19~
(81[pmlm'e of AIq,I