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FORM NO. 3
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)
PERMIT NO.
30202 Z
Date MARCH
30, 2004
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Permission is hereby granted to:
BRADFORD M WINSTON
333 WEST 56TH STREET PHD
NEW YORK,NY 10019
for :
ROCK WALL AND FLOOD VENTING AS APPLIED FOR AND CERTIFIED BY ROBERT
LAVINE, P.E. INSPECTION/FINAL CERTIFICATION REQUIRED AFTER INSTALLATION
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/
at premises located at
485 BREEZY PATH
SOUTHOLD
County Tax Map No. 473889 Section 089
Block 0002
Lot No. 008
pursuant to application dated MARCH
29, 2004 and approved b
he
Fee $
150.00
Building Inspector to expire on SEPTEMBER 30, 2005.
COpy
Rev. 5/8/02
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TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] !JI5ULATION
[ ] FRAMING I STRAPPING [rlFINAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRlJCnON [ ] FIRE RESISTANT PENETRAnoN
REMARKS: pI~ ~~c ~
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INSPECTOR