HomeMy WebLinkAbout24789-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. 24789 Z Date MARCH 20~ 1998
Permission is hereby granted to:
for :
VIRGINIA M GOHIER
475 YOUNGS AVENUE
SOUTHOLD~NY 11971
TO DEMOLISH AND REMOVE ALL DEBRIS FROM THE REMAINS OF AN ABOVE
GROUND POOL AS APPLIED FOR.
at premises located at
County Tax Map No. 473889 Section 064
pursuant to application dated MARCH
Building Inspector.
1455 OLD SHIPYARD RD
Block
19 1998
SOUTHOLD
0005 Lot No. 028
and approved by the
Fee $ 15.00
ORIGINAL
Rev. 2/19/98
FORH ND. I
TOHN OF SOUTIIOLD
BUI I.UIN~ DEVARTNSNT
TO~N IIALL
~OIITIIOI.D~ H.¥. 1197 I
TEL; 765~ IS02
BOARD OF BEALTil ...............
3 SETS OF PLANS ...............
SURVEY ........................
CI1ECK .........................
SEPTIC FORH ...................
NOTIFY:
CALL ..................
HAll. TO: ..................
Ui sapproveO a/c ................... : ..............................................
APPLICATION FOR BUILDING PEENIT
INS'fRIICTIONS
a. 'lhis a~li~ti~ ~t ~ ~lerely fJll~ in by L~riter or in i~ ~l mdnlt~ to fl~ ~tJldin8 I~m~ctor
3 ~Ls of pl~. ~rate plot plan to ~ale. F~ ~i~ to
b. Plot pl~ d~i~ l~ti~ of lot ~ of ~ildh~s ~ ~iMo, ~lati~ip to ~joJni~ p~iMs or ~d)lic
fltr~ts or areas, ~ 8ivt~ a ~to[i~ ~:rJ~i~ of ia~Jt of pro~rty mint I~ (Ir~
this nra iceti~.
c. 'H~ ~ ~r~ I~ this a~llceti~ my t~t I~ ~l Imfore issue of Adldl~ ~mlt.
d. U~ a~ai of ~ds a~liceti~, tim l~fildi~ Inn~ctor wil~ ia~ a ~ildt~ ~mit to tim a~licant.
~it ~mll ~pt ~ ~m in~8 ~all~le for ins~tt~ th~t tim ~rk.
e. ~ ~ildi~ droll ~ ~i~l or ~ in ~mle or in ~rt for a~ ~ ~mt~r ~til a ~rtificate of
~.I~'rI~ IS I~ ~ to tim latlldi~ ~rt~nt for tim ls~e ag n ~lldl~ ~mlt ~r~t to tl~
~lati~a, for tim ~t~ttm of hdldl~, ~iti~n or ~lteraci~, or for t~,~al or
<~ri~. ~m applier ~a to ~ly ~i~ all a~llc~le l~s, ~rdl~e, ~tld~ ~i~
(~re ag ~lt~t~ or ~, i~ a co~rstl~O
....... ~2~. ........ =~... Y~ ..........
(~l l t~ ~ns
title of corporate officer)
I~ilders l,icen~ No ..........................
Plm~era License No ..........................
Electriclmm Licerme No ......................
Otlmr ~ Li~ ~ .....................
...... ........................ ..............
Str~ ~
No. ..... ...... 5.. ......
~.~m. ~ 5 ..... ~,~ ~ ~ .......... . ..... ~.~ .../Z.~ ......
State exiatlng use and occopar~y of premlse~ and inter, led uae and occupancy of propom~
a. Existing tree ami occupancy ..... '~t~.J ..... ,--.-t ............... ~ ......................................
PLOT DIAGRAH-
I~cate clearly and dJacinccly all bulldinsa, ~lmtlmr exietin8 or proposed, and indicate alt net-back dimenaionn
f:rou i)rolx~rty lines. Give atreet mxt block amber or deocrip£iao necordin8 to deed, and ,dm~ street neeco arKI iodica~e
d~tl~er J.terior or corner lot.
.. ~. ............ IJel,q; d~dy b~)r,~, delx)ses taxi m~y8 Llmt he |~ Lhe ap~l. Jc:~lllL
(J: ~aid (~er or o,a!e, rs, mil is duly mtl~rl~ to ler[onn or lu~e i~rf()r.~ Lira ~i(I ~rk taxi to ~ and file
~qq)l ic~lti(~,; tlmt till state.rite c(~)ta[~ in tills al~)l, icacia) are tn~ to the 1~8C oE hie ~l~e m~ I~lJef~
tirol Lhe ~rk ~itl I~ ~rfon~l in tim tl~A~a~r ~ ~o~Lll iff Lhe el)pi icaci(al [il~
......... : '5