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FORtl NO. I TOWN OF $OUTIlOI.I) BIJ[ 1.1) 1NfJ DEP^P,]~{F, NT TOWN IIAI.I, SOUTI1OI,I], N.Y. 11971 T~I,: 765- li302 IIOARI) OF IIEAI,TII ............... SETS OF PLANS ............... SURVF.¥ ..... ~ , · ~ ............... CIIF~GK ......................... $1';t~T] rd FORH ................... .~; ........ :-~ ..... ~ (Ikdhll.p, In.hi _ulo ) APPLICATION Fi)t{ I{UII.I)]NC. PF, RHIT · 1).te ..... ! N.q'rlt OCT I O~l.g n. 'lhio nRdlcnOo- rm~nt lmc. onp]etely Hll. ed in I~ tyl~.~riter or in ink nwl m~l~ltt~ to tim ~dlding lnn~ctor vith ~etn of pla.n, ncolrnte Plot pl~ to .cnle. Fee occo.llng to .cl,~Jle. h. Plot plan rJ~i~ l~ntim o~ lot .~ o~ hdldingn ~ pr~i.en, ~elati~ship to ~jolnt.8 p~ine9 or IX,bi reeLn or oren., md Bivi,~ n s~tall~ ~scriptt~ o~ la~t'o~ ~rty ~mt 1~ drmm ~ the-d[~ ~dch {n d. UI~ n{~l. of thin n~licnt{~, the lhHd[~ Inn~ctor .i11. inm~ n ~[hli.g ~mlt to the nl~llc.-t. Al'lq.l(~'l'l(~ i~ IE$~I~ ~BI.E to tl~ Ik, ild{.~ l~l~nrtnunt for t{,~ ismm~e o~ n ~,{lding Pemlt ~ltmm-t to the (Slg~nt.r'e o[ n~licnnt, or ~am, ii n nte ~O,er n~,llcm~L {~ ~.~Je~:~,~. architect, ehgb~er. ~rnl c~tr~ctor, electrlcin., ~ (n~ '~ tim. ta~ mil pr Intent d~l) b. l./er~l~l ur~ nwl occm~pm~cy t~'~p,,ir . ........... II,u~[xvnl.. ............ I~,~lit;Io~l ............ Oilier I.k~H( ............... .....":. .............. 'i' II: ~k~lll[,l~, ,.J,l~r ~ ~k~llJi~fl t,dl'~ ............ li.J)cr t)l: ~k~llll~ t.dt'a (~, erich [:ltx~' . ............... I ~ i~l~lle, ,xJli~r (l~' tara ................. . ..................... Ik:~l~lll: ......................... F[llJ~L' O~ 8L()rlefl ...................... ik:l)lh .................... I~l~l[ .................... ~[~l~r ~)~ ~l()rie. ............... Ik:i[~)( ......................... ~l~r ()~ lt[()rla, ..................... y. fii~ ()~ 14)il I~l(~lC .................... I~lll' . ................... I~llllI .................... Il. t~tll liJl: I~ ~eltr~l .................... [~lll e~:efla' fill 1~ ru~i~ed ~rl~ i,'o.iuehi YI[~ l~) ........ ........................... Nklre~a ............................... I1~,~ I~ .......... I'~. Iii Ihlo I,'~)lxtr'l:y ullhhl ~ feel o( fl Ljdal I~Lllll~j'l k Yl~i .......... ~) .......... a Il~ YEti. 3[xjlI%~J) '10~ '1111~;11~ [q[l~ll'l' %~Y 1~[ IM~JIIQ[I). APPROVED AS NOTED 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1 FOUNDATION . TWO REQUIRED FOR POURED CONCRETE 2. ROUGH . FRAMI~ '& PLUMSING 3. INSUL431ON 4. FINAL - CON$1'~UCTION MUST BE COMPLETE FOR C.O. ALL CON~FRUC'FION SHAM. MEET THE REQUIREMENTS OF TNE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS ,~;I'A'II". (X" I'll'.t4 (IAJHI¥ ()1,' . ......................................................... I~il~lj 4l[IJy f~jl'll Ihul lh~ ~lll( ~;ill ~ I~cl:().t~l itl Ihe llljiit~[' fle~ /'()rlh ill the ill)pi Jl:fll:i()ll [lied ?.".'k ...... . ...: ............. No. ~, S~k ~u~ T~ ~lr~ June 1~ 1~