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Home My WebLink About23329-ZFORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. N-~ 23329 Z BUILDING PERMIT [THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ~ ~ .... ~..~.~ ,./..~.~ ........... : ....... ......... ~.z~.....~~~.~..~ .......... ~.~~~..~..:..~...J.~.~.? ~ ,o...~.,.~..(~.~.~....~....~~~..~ ............. ~ ....... ~f~..:~.~~.....~ .......................................................................... Coun~,ToxMopNo. ,000 Sec,on .............. - "--~~ ........ ~.. .......... Lotto...~../. ................ pursuant to application dated ............. ~..~Lf....~......../..~,.. ...... 19..~...~. ..... and approved Building Inspector. ~ee~../~.~... Rev. 6/30/80 FORH NO. I 'I'O~N OF SOUTIIOI,D Bill I.I)! NG I)I[P^WI'HENT T()I~N IIAI,I, ,~OU'HIOI.I), N.Y. 1197 I TEL: 765- 1802 BOARI) OF IlEAl?HI ............... SETS OF PLANS ............... ~SURYEY ........................ --CI1ECK ......................... SEPTIC FORtl ................... CAI,I ................... HA1 I. TO: .................... a. 'lhi. al~)licntioo n.m[ be C(~l)letely [illed in by tylx~riter or in ink m~l md~.itt~l Lo the lkdldi~ ]ns~ctor ~alth ] ~t. of plans, acolrate plot ph)n to ~ale. Fc~ according Io b. Plot plan ~i~ l~ti~ of lot a~ of ~,ildi~a ~ pr~i~s, mlati{~ip to ~joining praises or ~filic str~Ls or areas, m~l Bivit~ a ~tail~ ~ripti~t o[ la~t of prol~rty :mst I~ dr~ ~ the di~r~ ~ticJ~ is ~r~ of Ihi. alq)l icati~. c. ~1~ ~}~k ~r~l I~ this n~}licatil~ nny ~}t ~ ct~um~ I~fore is~m~e of lhdhling Permit. d. lJl~ a~al of this n~llcati~, tl~ I~dldi~ql hml~ctor will is~ a Ihdlding ~Tmit lo the applicant. ~lch i~tmit r~mll I~ kept ~ tl~ p~i~s ~ailable for ins~cti~ th~t tim ~rk. e. ~} I~filding ~mll I~ ~pi~l or u~ in ~u>le or in i~rt for (~ll~mg:y ~tall h~e I~n grant~l by tl~ I~tlhling ~q.IC~TI~ I~ Ill,Iff ~g to tl~ ~ihli~ l~lmrt~ut for the ismm~e of a ~ildit~ Pe~it [~r~nt to the II~ildi~ ~ Ordi~e of tim T~m of ~ll~ld, ~lffolk ~u~ty, ~ Yotk, a~ otlmr a~lic~}le l~s, Onli~es or ~;lati{m8, for tl~ ~st~ti~ of N;ildie~s, ~kliri~s or alterati~8, or for ~al or {~1 ilion, aa I~rein {~ril~]. '11~ applicanC agr~h to c~ly with all a~licable ...... (~ili~ ~lress of a~licant) State xd~etl~er alq}licant is csmer, lessee, a§ent, ardfitect, engineer, general ccs~Lractor, electrician, pludmr or IRfilder. .......................................................................... (as ex} tim tax roll or latest d~l) IF aHA icant is a c~qg}rati~, si~tu~ of ~hdy ~tlg}rir~l officer. (l~m n,~l title of corporate officer) Builders License I~ .......................... Plm~ers 1.1cerise Ho .......................... Electricians License 1~o ...................... Other 'rr~le'B l.icense tlo ..................... I,x:ation of lm~l cs~ ~dch proposed ~)rk will I>e tlofle .............................................................. ). iq.'dl~e o1: ~x~k ((:l~ck ~hi(J~ iq~l~lJc~ilHe): 14u~ I~,ihli,q~ ..~... ..... ~blitio. .......... Allernl io~l .......... I~l~lir . ........... I~l ............. I~.~litio~ .... ~. ..... Other T~),k .................................. ~. Est J.f~t~l (~sl: ......... . ............ Fee .............................................. 5. I~ ~llhq~ ~yt~r ~ i~llJ~q~ iiilil~ ............ Itnti~r ~l~ ~h~llhq~ ~uHIn I~ ench ~l~x~r ................ 7. IlJ.~n~it~ls ~l~ exisl:in~ nLr~tx,tes, i[ mvy: Fr*x~t ................ I~.r ............... l~pth ................. IEi~L ......................... ~ni~r ~ Stl~rien ...................... I~l~lh .................... I~il~t .................... ~ler ~tf ~l~>~J~ ............... I~il~d: ......................... ~l~r ezf ~lorJe~ ..................... I(). I~le of I~nr~:ha~ ..................... ~ ~f Ir~r (Xa~r ........................................ II. 7zv~ or t~ district Jnd~id~ [~,i~e aren~tont~l .............................................................. 13. ~[11 ]c~t I~ ~el~rm~l .................... 14. ~n o~ (~r of j~r~n{~8 ........................... ~khen~ .............................. l~ ~ ............... ~ or A~Htect .................................... ~khenn .............................. I~ I~ ............... ~n~e of Cxxtlractor ..... ~ ............................. ~khes~ ............................... 11t~r~ ~) ............... I~. Is Ihie p~l~rl:y ~ilhin ~ ~t of n tidal ~tlm~17 ~ YIL~ .......... ~) .......... *ilr YK~, ~XflllX~ ~ '11~11~ I~I~IT ~Y I~l.o*r I) IA(;I~AH lzx:~le clearly m~l dJnti~mLly nil I~Hldh~n, (%XINIY (X~ ....................... LINDA J. COOPER N.°,tary.. ~P~blie, State of NeW Isrm EXpires December