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Home My WebLink About2162-z FOI~M NO. 2 TOWN OF $OUTBOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2162 Z Permission is hereby granted A, & Sons Inc A/C Nichols ProDerties ......... i'~,t .t.~ t.uck ........................................... to Build at premises located at ..... 10.J~...(.~. pursuant to application dated Building Inspector Fee $..~...O. .................. · ~.6 ................ 1 9. by the FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. ~./~...~... ....... (B~ilding inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building inspector. b. Plot plan showing location of lot and of buildings on ~ remises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. .......... i ~,.. Re£1 ly... &..B, ons...trn~ ....................................... (Signature of applicant, or name, if a corporation) Mattituck (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises , .Ni~[l~:L?~ ]?~o.~er.tlr~ ................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) l. Location of land on which proposed work will be done. Map No: ,~..~.~.~, ...... Lot No: ...(~.~.) ........ Street and Number ...... ~..,..~[~..~,.~ ........ ~o~¢~O~ ........................................................................ Municipality 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ...~aO~...~ ...................................................................................................... b. Intended use and occupancy .Q~...~]$]-~[...~,~t~.~.$~ .................................................................................. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ............... Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estlmoted Cost ..... .,~..~.l.O00...]~/t~ .............................. Fee ...... '~0 ........................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... ~ ................. Number of dwelling units on each floor ........................ If garage, number of cars ......................................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature .and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front .......................... Rear .......................... Depth .......................... Height ............................ Number of Stories ......................................................................................................... Dirqensions of same structure with alterations or additions: Front ................................ Rear ............................ Depth ............................ Height ................................ Number of Stories ........................................ 8. Di~ensions of entire new construction: Front ....... .~) ................... Rear ..... ~;~ .................. Depth ....... ~.~ ............ Height ............................ Number of Stories..~p.e ........................ 9. Size of lot: Front ........ 9'~ ................... Rear ............ ~t'0 ........... Depth ...... .1.p~./."lOp ................. 10. Date of Purchase ........................................................ Name of Former Owner .................................................... 11. Zone or use district in which premises are situated ...... l~.~ll...f~t/l.~l~; .................................................................... 12. Do~s proposed construction violate any zoning law, ordinance or regulation? ........... 13. Name of Owner of premises ]~.~,~.O]..~...!;t~>~ ........... Address ............................................ Phone No. Name of Architect ...................................................... Address ............................................ Phone No. Name of Contractor .....A.i...~.t..~.t.~..&..8t~,~.~ ......... Address ............................................ Phone No. PLOT DIAGRA.M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr, property lines. Give street and block numbers or description according to deed, and show street names and indic~ whether in~erior or corner lot. STATE OF NEW YORK, ) COUNTY! OF ...~.~£O:L~ ........ ) S.S. .................. A~. t~i....~.:L.1..~ .............................................. being duly sworn, disposes and says that he is the applio (Nome of nd v dua'l signing application) abow; named. He is the ........ ~,~1~]~.~. ................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and this ~ppli~otion; that all statements contained i~l~Isrop~fi!~atio~ are true to the best of h s enow edge and be and that ihe work will be performed in the' ,~8~.,,~¢ ~o~Cj~tt~he ~qpplication filed therewith. Sworn to I~efore me this C~mlmss~on Expires Ma ch ................. .............. ......... , ...... / ............. ........................ I .... ~x~orary I~DliC~ .~,.~'.;.'.'...;...- ............... :~'. ....... :...,: ....... ~.!,,,~uq~ln,~, ~./, ~ g pp a ) /