HomeMy WebLinkAbout24785-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.
24785 Z Date MARCH 19, 1998
Permission
is hereby granted to:
KELLY MARIE LEWIS-PURCELL
PO BOX 687
GREENPORT,NY 11944
for :
ERECT A 6 FOOT FENCE IN SIDE AND REAR YARD AS APPLIED FOR.
at premises located at 10775
County Tax Map No. 473889 Section 031
pursuant to application dated MARCH
Building Inspector.
MAIN RD EAST MARION
Block 0004 Lot No. 018
10 1998 and approved by the
Fee $ 35.00
Buildi~x~ Inspec~r
ORIGINAL
Rev. 2/19/98
OWrlef[t.
TOWN OF ~;OU ~H{ ~1 r)
.FoRH HO. I
TOWN OF SOU'I'IIOLD
BUILDIHG I)EPARTHENT
TOWN IIALL
SOUTIIO1,D, N.Y. 1197 I
TEl.: 7~5- i802
I)l ~ppr,.~ed e/c ..................................
(lttli ld mg 1 nn~/,:l'or )
^Ppi,IC^'I'ION I~Oll BIITI.I)TNG PERNT'r
BOARD OF tlEALTII ...............
~ SETS OF PLANS .............. '~
SURVI~Y . .......................
CNECK .........................
SEPTIC FORH ...................
NOTIFY:
CALL .................
NAIl, TO: ....................
'DaLe ................ , 19 ....
'1[ NS'I'IIUC':'I ONS
n. 'Ibis .ppl tcaLton tt~mt be co,~letely filte(I in by tyl~vriter or in ink taxi mdmitt~ to the ~]ilding T,ml~ctor ~.
3 ~ts at pl--, ~ca~r~te plot plan to ~ale. ff~ accordi.g t~ ~m~d.e,
b. Plot plan ~1~ l~ttm of lot a~ of l~dldls~s ~ ~l~. relatJ~dp to ~jolnin8 pr~t~ or B,blic
.tr~t~ or areas, and Stvl~ a ~tailml ~ription of i~t o[ pro~rty ~mt I~ dr~ ~ tim d{.~. ~ld~ {. ~rr of
this nppl icnti~.
c. '11~ ~ c~r~ ~ Ods n~licatt~ ~y t~t I~ cm~m~l t~fore issue of ~]{tdl~ Pemlt.
d. UI~ a~al of this a~licati~, tl~ ]~ildi~ [ns~ctor wilt is~ e ~{lding Pem{t to the opplJca,t. ~'h
i~tmit ~mll ~ ~pC ~ ~ ~i~s available for tns~"i~ tbm~L the x~rk.
e. ~ ~i~di~;~mll I~ ~pt~l or ~1 in ~le o~' tn ~rt [or at~ p~ ~mt~er onttl a C~rtlflcate of
~ocy ~mll h~e I~n gran~ I~ ~m Ikdldt~ Tns~tor.
~,ICA'F[~ lS IE~ [~ to ~1~ I~tldtn8 ~rt~at [or the issue of a ~tldtng ~ml~ ~rmmnt ~o lbo
I~ildiag ~ ~1~ of t~ ~ of ~flmld, ~ffolk ~m~, ~ Yo~, a~ offer a~lt~ble l~s, ~i~es or
~dati~s, for tl~ ~s~[t~ o[ ~dldl~s, ~Itl~s or slters[tms~ or for ~al or ~lltion, as l~reln
~scri~. ~ a~lt~t ~s ~o ~ly wt~ all a~licable l~s, ordi~es, ~tldlng ~, ~Ing c~e,
re~daLt~s,,and to ~tt ~rl~ tn~tors ~ ~s a~ tn ~tldl~ [or ~es~ ins~l~s.
~ ....... - ...... : '(Sigtmture o~ a~li~ or ~, i~ ~ cor~tlon)
, ..... .............
SLate ~etber applicant is os~er, l'essee, agent, architect, engit~.~r,'geoera! contractor, electrician, plud~er off Ixdh
I[ applicant ]sa corporal:ion, signature o1~ duly ~utl~)r]~d o[flcer. NOTI~ BIJILDIN~ DEF~MENTXAT
and title of corporate officer)
l~ilders I, cerise .... ~- ....................
Plumbers Ltcense No ..............
Electricians L . · ' .......
O~l~rTracle*s Ltc~ns~No ................. · .. ·
7e~lmOt e AM 10 4 PM FOil THE
1. FOUNOA10N . TWO REQUI~ED
~. ROUGH · ~ & I~UMBING
~. INSULATION
4. FINAL · CONS?RUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION ~HALL MEET
STATE CON~,~ '~'~UC,-I~ ~ ~NL~GY
I. Ix)cation of land on
' DES{~,N OR CON3sfi .~N t-at,ORS
...... ' .....................
........ Io~7~ .........................................................
~,,~ ,.~ ~, ~. ~a~ ~,t~, .... ~. ~ ....... ,~..~ }~'. ........ ~, ...... /.¢ .......
~l~ivistm .................... ; ................. Fil~ ~p ~ ......... ~ ...... I~ ...............
State exis~
,. ............ ..................................................
b. Intended use end occupancy .............................................................................
i5.
I~cat. e clearly and diel=lsel:ly al
fr¢~. propert:y tinee. 0[~ el:teaC m~l
~dmther interior or coroer loC.
K'lture of ~,~rk (clmck ~hich applicable)) Ne~ ~lhllng .......... ~ltl~ ......... ~ Alte~CiO'h ..........
~ ~ ~ripci~)
Eat I.~ted ~sC ...... ~ ~ fc~ ..................................
(to ~ ~id txt filing thin al~llcatt~)
,
l)i.~nM~m o~ nam stalL, re ~ ~ nleera~l~s or m~Ji~ions~ Fr~C ..... ~ ~ar
................ · .,............ ~pth ..............
....... .... ......... '......../
of
iq,OT I)[A~II~
of naid (x~r of o~a~era, nl~l ia duly
thflL th~ ~)[k will I~ ~rfon~l in I.he
~)m Lo I~ore la~ Ode
~. .......... day Of
ttborJzed to i)erfonu or b,qve lerfor.ed I.be seid ~,~rk atal to nnke arxl file Ihi~
ned in I:hie elq)l lcal:l<~u are tn~e Lo t.he beet of hie klxA,~ledge alwl I~l Jeiji ntxl
manner set forth in Lhe appl Jcati~m filed therewtUt.
Nokary Rd)Lie . , ~. ....... ~ .......
Notary Public, State of New York
No. 4952246, Suffo k County
';~rrn E×pires Jufle 12,
lpml:ure of: ^ppi
.... I~ai.8 duly s~Jrn, delxJP~ae taxi Pays time lie ia tlm appl