HomeMy WebLinkAbout25278-zFORM 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. 25278 Z
Date OCTOBER 23 98
Permission is hereby granted to:
for :
CONSTRUCTION OF A FENCE~
APPLIED FOR.
JEROME M BARKAN
34-31 81ST STREET
JACKSON HEIGHTS~NY 11372
3' IN HEIGHT~ IN THE FRONT YARD AS
at premises located at 1830
County Tax Map No. 473889 Section 055
pursuant to application dated SEPTEMBER
Building Inspector.
BOISSEAU AVE
Block
8 98
SOUTHOLD
0006 Lot No. 018
and approved by the
Fee $ 35.00
/pecto~
ORIGINAL
Rev. 2/19/98
FORH NO.
TO,ti OF SOUT|IOLD
BUILDI~IG DP, p AR'I14E NT
TOWN BALl.
SOWFIIOI,D ~
Tgi,: 765- 1802
I)l ~ppr~wed a/c ..................................
ns tot)
S~p - 8 ~
APPLTCATTON FOR ]HJILI)]N~ P~RHI'rBLDG
TOWN OF ~Ou~oL~DEP~ ~ INSTRUCTIONS
BOARD OF UEALTI! ......... ~ .... . ~
3 SETS OF PLARS ...............
SURVEY .....
SEPTIC FORH ...................
NOTIFY: .~..~..
HALT. TO: ....................
'Date
t/. 'Ibis applicatio~ r0ust be co-oletely filled in by LTix~riter or in ink ar~i a~l~ltt~l to fie adldlng Trisector
3 ~Cs,of p]~, acetate plot plan ~o ~ale. ~ accordi~ to
b. Plo: pl~ ~i~ l~ti~ oi lot ~ of ~ildi~s ~ ~i~a, ~latio~dp to ~joini~ p~t~s or Fa)lie
str~td or areas, a~ ~ivi~ a ~tall~ ~m:ripti~ o~ layout oE pro~rty ~mt I~ dr~ ~ tim divan dflch la ~rt of
this aRfl
c.~ 'R~e ~ ~r~ I~ fids a~licati~ ~y ~t be ~ ~fore is~e of ~ildl~ Pemit.
d.':. U~ a~al of ~ds a~li~ci~, tbe l~ild{~ lns~ctor ~ill is~ a ~ilding Pemit to the a0olicant.
e. i ~ ~tldi~ ~mll ~ ~pi~l or ~ in ~le or in ~rt for a~ ~ dmt~er ~til a ~rtifica~e
~y ~*all h~e l~n ~t~ by fl~ ~fildi~ Ins~tor.
~,I~T[~ 15 ~ [~ to tl~ I~dldi~ ~rtn~nt for fl~e issue o[ a ~lldi~g ~lt ~r~t
I~ildi~ ~ ~i~ of t~ T~ of ~tlold, ~ffolk ~, ~ Yo~, ~ otber a~tl~le l~s, ~il~es or
~la~i~, for:tl~ ~s~tiw of hfiIdt~s, ~iti~ or altera~i~s~ or for ~al or ~liti~,
re~dati~s,,m~ to ~iC ~ri~ in. tars o, ~i~s a~ in ~t~r ~es~ tns~ti~s.
(Sig~ture oE e~lic~t, or ~, if a co~retion)
............ / .............
8t~ d~r a~licant ts ~r, le~, ~ent, archlt~L, engi~r,'get~ral c~tractor~ electrtclan~ plier or
. ~ ~ .............................................................. , ....................................
~ o~r o r~l~ ...........
(aa ~ tie tax ~11 or latest d~)
Ii a~flicant i~ a co~rati~, ~i~re ag duly ~tberiz~l o[ficer;
(l~re a~d t~tle of corporate~off~cer)
]auilder~ License 1~ ...........................
Plmber'8 License 1~o ...........................
~l~trlei~s l,i~ ~ ......................
Otber ~'s Lice~ ~ ............. . .. ... · ·
............. ....................
.../ ........................ .... ........ ........
I~ ~r St~t i~et
~ ..... ~ ......... ~ ..... /.~...
~ty T~x~p ~). I~ ~ti~ .... ~ ......... BI~ . ''"
~i isi~ Fil~ ~p ~ · ·
(~)
2. State existing u~ a~ ~y
.. ~.~i~ ,~ ~ ~y ...~;~ ......................................................... '
b. lnCe~ ~t~ a~ ~ ... ! ...................... ~ ...................................
3.
(to ~ I~[d on [llh~ this al~lica~{~)
6, l~ I~Jl~sa, ~mrcial or ml~l ~q~, e~ct~ ~ture ~ ex~en[ o[ eadt [y]~ o[ u~ ......................
DJnenelone nj sam atn~ctl~re ~ith atteratl~x~e or ~xldltione: Front
· I
8. l)iueneic~la of entire ne~ construct:lion: l~ont ................ I~ear .....
12, ~a pro~{ mmt~tlmjlolate~: a~ ~{ng I~, ordim~e or reg~datt~l .,~ .................. ~
· ,m of Cmtr~tor '
i lq.OT DIAGIIAH ·
fro. i)rol~rLy ll~a. Ol~ nt~t ami 1)1~ amlmr or (~acript[~ acco~ln8 to ~, a~ ~ atreeC ~a ami taHeate
t~timr interior or co~r lot.
CLAIRE L. GLEW , ~
Notary Public, 6rote ~ I /
tSll~,nal:m'e c)f ^ppi
S't~',,,: (x~ ri..~..Xu~, ~"/~ // ~. ~i .......... ~ .f ...... /- ,~ 1~ '
(~m nf ~*xltvt(hml .igfd,g contract)
(C~,tractor. ge ~t, cora)rate o[flcer, etc.)
o~ snid ~r nr ~. nrxl 1~ ~hlly ~l~ri~ Co I~r[onn or h~e i~rForn~I e ~l~ ~k ~ ~J ~o n~ke taxi ~ e this
~q~)l ica~m,,; OmC .it s~a~a~n~a con~a{.~ tn cilia al~d. icaCi<m are ~n~ ~o li~e ~.C o~ I~[~ k ~I~e ~,~ I~lie~ ~,,xl
HmL [h~ ~rk ~{ti I~ ~r~on~l iu the u~l~.~r ~[ ~o~U~ in the al~l.~cn~i~m