HomeMy WebLinkAbout25516-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. 25516 Z
Date FEBRUARY 3~ 1999
Permission is hereby granted to:
for :
JAMES JR & ELLEN RILEY
153 OXFORD BLVD.
GARDEN CITY,NY 11530
DEMOLITION OF AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR.
at premises located at 3600
County Tax Map No. 473889 Section 111
pursuant to application dated DECEMBER
Building Inspector.
VANSTON RD CUTCHOGUE
Block 0005 Lot No. 012
30 1998 and approved by the
Fee $ 124.50
Authorized Signature
ORIGINAL
Rev. 2/19/98
FORH NO. I
TONN OF SOUTI]OI,I}
IRI1 I.!) I NO DKPAR'IHENT
'l'Ot/N IIAL1.
SOIITIIOLO, N.Y. 11971
TEl..' 765- ISO2
BOARD OF HEALTII ...............
3 SETS OF PLANS ...............
SURVEY ........................
ClIECK .........................
SEPTIC FORH ...................
NOTIFY:
HAll. TO: ....................
I/ 11 ,',.,.,',',_ / .-
. ". ' ·
L~,:o aOpllentim ntmt be c~,~letely filled
3 ~s of pl~ ~rate plot plan to ~ale.
b. Plot pl~ d~i~ l~tl~ o~ lot ~ of ~lldh~n ~ ~i~s, ~lati~dp to ~joint~ pr~t~ or ff~bllc
str~t~ or area~, n~ 8ivi~ a ~tall~ ~m:riptton o~ la~t o~ pro~rty
this nppl icntim~.
c. 'B~e ~ c~r~ I~ this n~licati~ ~y t~t Im c~l ~fore issue of ~dldl~ Pemlt.
d. U~ a~al o~ ~*ls a~llcation, tim l~ild{~ lns~ctor sdl~ is~ a ~ildlng Pemit to the a~llcant. ~h
~it ~mll ~,~pt ~ ~m i,~o~li~a ~all~le ~r lns~tl~ th~t tim ~rk.
e. ~ ~ildi~ droll ~ ~l~l or ~ in ~le or In ~rt ~r a~ ~ ~at~r ~ttl a C~rtiHcate of
~H,I~'FI~ IS I~ f~ to tl~ Ihdldi~ ~rt~nt for tim Isle of a ~lldl~ ~mlt ff~r~at to the
I~ildi~ ~ ~i~ o~ ~ ]~ off ~tlmld, ~ffolk ~m~, ~ Yo~, ~ otlmr a~ll~ble l~s, ~dh~es or
~lati~s, for tim ~t~tt~ of hdldt~s, ~lti~ or alteraCt~, or for r~al or ~lltl~, as tin.in
~scril~. ]lm appll~t ~s to ~ly
regdati~,~md to ~it ~rt~ in--tots on ~i~s a~ in ~ildi~ [or ~es~ in~tl~s.
(SigTmture o[ applicant, or na~e, if s corl~rati~O
(Hailt~ address of applicant)
State ~q~etJ]~r appIiesnt is °~n~er, leap, es, agent, architect, engl~eer,'ge~era! contractor, electrician, plumber or I~Hhle~
........ ~o~ .......................................................................................................
...... .................. ..............................................
(as ~ tl~ tax mil or latest ~)
If applicant is a corporation, slgnat~:re of duly m~tl,)rir~ed o[[icer.
(l~m~ and title o[ corporate officer)
/
~,,,~s ,.,ce.. ~..l.t~..~.~ ............
pl~sd-~rs Licerme ~ ..........................
~l~triclms Lice~ ~ ......................
Otlmr ~s Licon~ ~ .....................
I. l~ati~ of I~M ~ ~id~ p~l m~k ~ill ~ ~ ...................... ..~...... ................................
......,~.~O'~r ................. ~fl~'St~t .... ~/ ......................./;~~'~ .................
~.~ ~.x mp ~,. ~ ~, ....... ........ ~ ................ ~ ..........
~Mivisi~ ...................................... Fii~ ~p ~ .......... , ..... lot ...............
(~)
2. State existi~ u~ a~ ~y of~oni~s~a~ jnt~ tree m~ ~ of pro~ ~mtnmti~:
(to ~ [~id ~] filing this ai~liea~J~)
6.
If
Pi,o'r I)IAGRAH-
I~x:ate clearly nnd distinctly al1 bull(lings, ~heLber existing or propoaed, m~l h~licnte el! ~et-b~k dimensions
fron property lines. Gi~ sl:r~et emi block I~J[Jli~[ or dencriptio~ according to deed, and aho~ 8treeC r~res 8r~l i~licote
]~mll~r inke~ior or corner lot.
duly s~)rn, delx)ses taxi r~ay8 th,rjr lie i~ the appl. Jcuml:
lie in the ................ ~:~ . .......................................................................
(Cr~tracto~corpor~te o[[icer, etc.)
o1: Raid (~er or ~[8, taxi Je {hJly ~tl~r]~ to I~rfonn or Iwwe i~rfor],~l the ~hl ~fk taxi Lo n~ke 0[xl file this
~qqd icntion; thn~ nil statemnte c~mLai~ in Lhi~ nlq)l, icaci~, are t~ to tim l~9t of hie kill.ge
Ilmt the ~rk ~ili I~ ~rfon~l ill tl~ IlJllll~r ~C forth in the appl. JenLion fjJ~
C~
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