HomeMy WebLinkAbout24507-ZTOWN OF $OUTHOLD
BUILDING OEPAI~MENI'
TOWN HALL
$OUTHOLD, N.Y.
'2/i 50 '?
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNtiL FULL
COMPLEtiON OF THE WORK AUTHORIZED)
Z
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L~31e .......... ~ ...... ~ ............... ; .......................................
PermisSion Is hereby granted to;
ANN D & OR. HffMBI_O
ACKIi~RI.Y POND i A
SOLJ THOL. D ~ NY .
...... 2220 ACKERLY PD LA SOUTH/PEC
aT premises iOCaTea aT ...............................................................................................................................
CounlyTaxMap No. 47588<9 Section 06<9 Block 0005 Lot No, 00<9.002
pursuant to application dated OCTOBER <9 19..,.,.?.7. ...... and approved by,he
Building Inspector.
92 · 40
Fee $ .........................
Rev. 6/30/80
// f~i~dl~g ,nspector
FORH NO.
TO~N OF SOOTI'IOLD
BU'ILDIN¢
TOWN HALL
SOUTIt0I,I~ N.Y. 1197l
TEL-' 765-1802
~NS'I'RUCTIONS
BOARD OF HEALTH ...............
3 SETS OF PLANS ......... ' ......
SUgV~Y ........................
CBECg .........................
SgPTIC FO P,H~ ......
NOTIEY~~~
a. 'ibis applicaCic~ m~t be ~lel:ely filled in by t-yp~rlter or in h~ a~l ~i~g~ ~o ~ ~fildi~g Ins~c~or
3 ~s of pimp, ~ra[e plot pl~ ~o ~ale. V~ acco~i~ to
s~r~ts or ~ms, a~ 8ivt~ a ~[ail~ ~ription of layait of ~r~ nue~ ~ dr~ o, the dia~ ~id~
d, Ui~ ~al o[ fills ~li~i~, [he ~ildi~ ~us~c[or will is~ · ~/ldi~ ~J~ ~0 the *p~li~nt.
e. ~ ~ildi~ ~11 ~ ~i~ or ~ in ~la ar in ~rt for any ~ ~j~r ~il · ~rtl[/c~e
Zhildi~ ~ ~i~e o~ ~ ~ oE ~ct~ld, ~ffol~ ~L~, ~ York, ~ oC~r~l~, ~dh~ee
....
(SiI~u~~~ tfa co~r~tlm)
J~% ~~ 11~71
.....
Nm~ of ~r of pre~i~ea Arum ~eabla
(e~ on ct~e £ax r~ll or lotes~ deed)
If apl)lieant is a corporation, si~/~ature o~ duly ~utl~ri~ed officer.
emi title of corpo~ce of/leer)
l~tilders License No ..........................
Plumbers I,icer~ ~Io ...........................
Eleccrlcians License No ......................
9LDG DEPT
'TO~A/N OF ~OUTHOLD
b. I~cer~led u~e a~ occu~, ......... ,Re$~e~J. al. ......................
Ii,
I1.
I,t.
14.
15.
PI.CT OlAGRAH
l~cate clearly ard dlecinctly all baihlln&s, ~t~eLt~r exlstle& or propMed, ~ ir~tie0te e1,1 ser-back dlmeesiona
fmu prOpert~ lines, give etre~ and block r~ber or de~crlpti~ accordjr~ to dead, and ahc~ oR~ee~ nmea ar~! indlcaRe
SS
mall
FOU. OWgJ~
I IrOUNMI~N - lWO eiJlllD
P01 jeoJllml
2. J- JJlJ
3, INJUtJOION
4. FINAL - CON~JU~'TIO~ MUST
BE COMPLETE FO~ C.O.
ALL CONSTRUCllON SHALL MEET
THE REQUIREMENTS OF THE NY.
STATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
Sik~ fs Lhe ..... Oa~ner
(C~Cractot, ~gen:, corporate o~cer, e:c.) .....................................
Lhac Lhe ~)rk ~[11 ~ ~r~on~l in Lhe ~m~r ~L [orLh in [lie al~llca[im~ ~il~
Ann Hemblo
($i[F~d:ure oI~ hpptJcanC)
WILLIAM WICKHAM
NOTARY PUBLIC, State of New York
No. 52-4259000
(~ualified in Suffolk County
Commlsston Expires June 30, 19~