HomeMy WebLinkAbout25067-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. 25067 Z Date JULY 29, 1998
Permission is hereby granted to:
for :
ERECTION OF A 4'
SELIM & JUDITH SAMAAN
80 ETON ROAD
GARDEN CITY,NY 11530
HIGH CHAIN LINK FENCEr MAINTAINING PROPER SETBACK
FROM HIGH WATER MARK~ AS APPLIED FOR.
at premises located at 4875
County Tax Map No. 473889 Section 111
pursuant to application dated JUNE
Building Inspector.
NASSAU POINT RD CUTCHOGUE
Block 0009 Lot No. 010
22 1998 and approved by the
Fee $ 35.00
Building~pector~~
ORIGINAL
Rev. 2/19/98
BOARD 0ff IlEAL'I'll ...............
3 SETS aP PLANS ...............
SURVEY ........................
CIIECK .........................
SEPTIC ~0RH ...................
ROTIFY: ~ ~
HAH. TO: ....................
APPLICATION FOR BUILDING PERH][T
' Date ................ ,19 ....
]NSTRIIC'FIONS
a. '~hts applicatto~ must be conpletely filled in by LylX.~rtter or in ink and mfl~itted to the Suildlng Tnapector wi
3 sets of plans, accurate plot plan to scale. Fee according to scbeduTe.
b. Plot plan s{~tng location o[ lot and of buildings on premises, relationship to adjoining premises Or i~d)lic
streets or areas, and giving a detailed descriptian of. layc~t off property I~lat be dr~ os tbs dJagran ~ddch is part oF
th|a appl icacian.
c. '~he ~ork covered I~d rids application may ~t be con,rented before ias~mnce of l~uildlng Permit.
d. Upon a~proval of this appllcutiee, the l~uilding Tuapector ~ill~ issue a Ilutldtng Permit to the applicant. .~h
permit shall be kept on Om premises avatIable for inspection O~ront?~onc the x~ork.
e. ~-bulidi.g slm].l be occupied or used in ~4~ole or in part for an7 purpase dmtever ~mttl a Certificate of
Occupancy/~shall have been granted by Om P4dlding Inspector.
AFPLICA'FIOg IS IIE~BY NAUE co tim Ikltldlng DeparUreat for the iammeee of a Building Permit pursuant to tl~e
Iloilding Zone Ordinance of Lhe To~ si So~thold, Suffolk County, Ne~ York, and other applicable l.a~s, Ordis~nces or
Pegulatlons, for cl~e ccustructiee of hdldtnga, additions or atteral:ior~s, or for re,oval or d~oltCtee, as herein
deserlbed. ~e applicant agrees to cempty wi~h all applicable la~a, ordinances, beilding code, housing c~de, ami
regulations,~mx] to ad~tt authorized inspectors cu premises and in building for eeces~ry inspections. _
(Signature oF applicant, or name, ti a corporation)
O (Flailing address of applicant) Ix~'~'-
State ~eO~er applicant is o~er, lessee, agent, architect, engineer,' geaeral ceetrsetor~ electrician, plud~er or I~dhle~
........ .~.. ......... ~ ........... ~ ............................. e.A$ ~OT~ .........
DA~ ........ S.. -
lC applicant i~a corporation, signaL-ute o[ duly autl~)rize<l o[~icer, l=E~ '~'--~- I[¥: ,
' .~ NOTIFY BUILDING DEPARTMENT AT
......................... :,~ .............................. 7~5-1~0~ R .AM TO 4 ~ FOR THE
(Ham~ and title oE corporate o~[icer)
1 FOUIIDATION - TWO REQUIRED
Su~lde~a License I~ ...... ; ................... ]L ROU~It - FRAMIN~ · PLUMBING
3. ~SUt~ION
~lu,be;s Licenee Ro .......................... 4. FINAL o CONSTRUCTION MUST
gtectrJciana Llcer~ HO ...................... BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
Otis; Trade'a Licenee Ho ........... ' .......... THE REQUIREMENTS OF THE N.Y.
~. ]~cat;on o~ land on ~ldch propesed ~o~k ~lll be, done ........................ $:~ATE.CO~I~IL~CTION.& .ENERGY..-
Ilouse NLnber Street ilaatet
..... ,... ..... ........
Subdivision ...................................... Filed kgap lb ......... ~ ..... I~ot ............... (~)
2. State existing use and occupancy of pronlses and intemled use and occ~rpancy o~ proposed construction:
a. ?~ting ,~ and o~y .C.~.:..d~...~...~.....~...~..~:...:.~..~...~:..~--" - ~'~ ~' ..........
b. Intended use and occupancy .............................................................................
3.
ItL
II.
12.
13.
Ill.
15.
I~cate clearly and dleClnel:ly ~11 buildings,
I=ro. prolmrl:y lln~e. Oiv~ raft',stat m~l hl*:x:k utslimr
)d)etlmr i,lcerlor or cot-nar lot:.
(('~lt:ract~orporat:e ol~Elcer, etc.)
of amd (~a)ar or o~)¢.rn, ,nd ia &dy ~thorl~ to i~rfon, or I,~a l~rPor,~l I.he ~Jd ~k taxi to hake m~l f{la I. hla
flll)lteatiou; that: ell sCa)am,tls e(m :al~ la [his nlq)tleati~ are ~nm Lo the Imst of hie kt~l~ge a,~ I~J. Jef~ tt,xl
thac the ~rk ~itl 1~ ~r~on~l in .urn)mr ~t forth in the alii. ica)ion