HomeMy WebLinkAbout25011-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. 25011 Z Date JULY 9 98
Permission is hereby granted to:
for :
ERECTION OF A 4'
CHARLES JR COUTTS
FACTORY AVE
MATTITUCK~NY 11952
STOCKADE FENCE ON A VACANT LOT.
at premises locatedat 10650
County Tax Map No. 473889 Section 142
pursuant to application dated MAY
Building Inspector.
SOUND AVE MATTITUCK
Block 0001 Lot No. 003.002
15 98 and approved by the
Fee $ 35.00
ORIGINAL
Rev. 2/19/98
FORH HO.
TO~IN OF SOUTIIOLD
BUILDING DEPARTHENT
TOWN UALI,
SOII'rlIOLD, N.Y. ll97l
TEl.: 765- lB02
(lh}ilding ]t~etor ) q .
APPLICATION FOR EIlILD]NG PEEHIT
BOARD OF BEALTII ...............
3 SETS OF PLANS ...............
SURVEY ........................
SEPTIC PORH ...................
NOTI{FY:
CALL ..................
HAIl. TO: ....................
INSTRUCTIONS
a. 'lhis application ramt be con01etely filled in by t~p~¢riter or in ink nbd tnd~itted to the l~dlding lnapector
3 ~a of plnn~, accurate plot IAaa to ~cale. Fee accordin~ to twJ~edule.
b. Plot plan slain8 location of lot and of buildi~gs on premises, relationship to ~ljoining premiaes or public
streets or areas, n~ 8ivi~ a ~tnil~ ~mcriptt~ of layont of pro~rty mist I~ dr~ m the dia~ ~sid~ is I~rt of
thiv nppl ication.
c. 'H~e ~ ~r~ I~ fids n~licati~ ~y ~t I~ c~ i~fore is~l~e of ~ild{~ Pemlt.
d. t}~ a~al of ~ds a~lication, tbe lhildi~ Ins~ctor still is~ a ~lldi~ Pemit to the ~pplicant. ~sd~
~mit ~mll ~.~pt ~ ~ ~s ~ail~le for ins~ti~ th~t fie ~rk.
e. ~ ~ildi~ ~mll ~ ~pted or ~ in d~le or tn ~rt for a~ ~ dmt~er ~til a C~rtif{c~te of
~my ~all h~e I~n ~t~ by' ~m ~d]di~ ]ns~tor.
~H~I~TI~ IS }~ }~ to tim {IHldi~ ~rt~,t for t}~ issue of a ~{ldt~ ~mit ~r~nt to tl~
Suildiug ~ ~di~ of t~ ~'~ of ~tl~ld, ~ffolk ~n~, ~ York, ~ GOer a~ti~ble I~s, ~i~es or
~lati~s, for tl~ ~st~ti~ of hfildi~, ~iti~s or alterati~s, or for ~al or ~litt~, as I~rein
~seril~. ~ applier ~s to c~ly wi~ all a~llcable l~s, ordinals, ~ildi~ e~, ~ing e~, and
re~flati~s,~ to ~it ~ri~ in--tots ~ pr~i~s a~ in ~ildi~ for ~ee~ tns~ti~s.
(Sig~ture o{ a~li~nt, or ~, if a co,ration)
(as on tim ~:ax roll or latest deed)
If applicant ia a corporation, signature of duly auLl~)rir~ed officer.
(Nam and title of corporate officer)
I~fildera I.icen~e No ..........................
Pl~L~rs Licet'~se No ..........................
................................................. ·
I ~~ - ~ ~OUIRED
t~'~~UMBING
~. ~U~
BE COMmiE ~OR C.O.
~L CONSTRUCTION SHALL MEET
~E REOUIREMENT~ OF THE
gl~trlci~s l,i~ ~ ............. .... ~ATE CONSTRUCTION · ENerGY
:...,
_
~ ~E~, NOT ~ESPONSIBLE FOR
·' ~ESIGN OR CONSTRUCTION ERRORS
, ....... ....................
· ........ . _
~.~ ~ ~ No. ,.~ ~on../.~ ....... ~.~ .... t..~ .... ~ .~ ...... ~...
Subdivision ...................... Filed }lap No .......... · ..... hot ...............
2. State exit;ting ur, e and occupancy of l~ce~ni~ea end iatetx~ed u~e md occ~qmney of propo~d conatroetion:
a. Exlating tree and ocmr~k-~ocy....................-......~ .................... . :.' ............................
b, Intended u.qe and occupancy ' ' · "
/
IH.~nal~m of ~larlng srnmtuOea, 1~ any; ~a~r ................ ~ar ............... ~pfl~ .................
I~i~r ......................... ~dmr of Stories ......................
l~pth .................... l~t h~ .................... ~mt~r of 8rorlea ...............
I~i$~r ........................ ~dmr of Stories .....................
12. ~ra any ~lng
14 &klre~
I'r~a proposml cxsmtrueCion viol
t~lti loc I~ r~r~ ~ .........
~ms of ~r of p~l~s ....
· ~e of Ar~it~ .............
this p~rLy within ~ f~
PLOT DTAOllAH
locate clearly and distinctly a 1 ~b~,lldlngs, ~4~ether ~isrtng or pro~, ~ indicate alt ~C-l~
fm~ prol~rry ll~s. Ot~ ar~r ami bl~ ~si~r or t~scrlprl~ p~cordlng to ~, a~ ~ street ~ms ami t~llcare
o~ O~ltt (~r Or ~rfl~ ~11~1 J~ dtity ~thori~ ~o im~fom or have I~}rforn~l the ~id ~rk and to mice and fi
I aid I~t)ef,
that the ~rk ~ill I~ ~rfon~l In the ~l~mt~r ~C forLh in the applica(ion fiJ~ tl~r~tdt.
~rn Lo I~fore .~ this/