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HomeMy WebLinkAbout2793-z FOEM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~P~ERMIT f 198 (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2793 Z Permission is hereby granted to: l~a.t;.t :Lt~_~k ..lnZe.t ..~-~'~.t~s..&..SbJ. l~.sm.d ..... ............... .a:t...~. ~....B.~.~..d.. ........................................... .................... .~...t..~..~.u. cl~,......~.~., ...................... to .......E~...e...q..t.....~...4...~..~,ut~...,..g~.c. wu~...~.tJn....l:.. ~e.c.t ~,.cu~,l....~..~..6~. ......... at premises located at ....J~/.S.....S.o~mcLJL~.e.....o~pme£te..Coz..Neak...Road ............................. ........................................... ~.t...t..S.....~....~,..... ~I~ ~ .................................................................... pursuant to application dated ............ ; ........................... ~]~,~.....;L, 19..~., and approved by the Building Inspector & ]~l/Appea:l.s Fee $......~..,~ .~'..0.. ......... ' ' '~ '~J3uiJding Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined....... .............. . ^pp,,eot,on No..?...7.3. .......... .......... ................ ....... ............... .............................. ......................... ~PLI~TIO~ ~OR 8Hl[~l~ ~[RMIT Date ...................................................... , ................ INSTRUCTIONS a. 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 p remises, relationship to adioining 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 sha~l ~e 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 pa rt 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. MATT~[TUCg .......................... MADIN~.. ~' .g}t.~.P¥,~. ,i~.}) ........... ..... . ............. (Signature of app i~t,l~lr)~ne, n¢ a corporation) r~ MATTITUCF~, N. ¥. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....... .g...~. ..........',; .............................................................................................. If applicant is a corporate, signatt,~e of duly authorized officer. ....... ..... (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map, No: ............................................ Lot No: .................... Municipality 2. State existing use and occupancy of premises and intended use end occupancy oF proposed construction: Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy ................................................................................................................................. Nature of work (check which a ble): New Building Addition .................. Alteration ............. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...... ~),'[./'./~....~. .... Estimated Cost ............................................................ Fee ..................................................................................... (to be paid on filing this application) if d~eJling, number of dwelling units .............................. Number of dwelling units on eQch floor If g~roge, number of cars ......................................................................................................................................... If business, commercial or mixed occupancy, specify nature.and extent of each type of use ............................ Dimensions of existing structures, if any: Front .......................... Rear .......................... Depth .......................... Hei ht ............................ Number of Stories ......................................................................................................... Din msions of same structure with alterations or additions: Front ................................ Rear ............................ De th ............................ Height ................................ Number of Stories ........................................ Din ensions of entire new construction: Front ................................ Rear ............................ Depth ....................... Hei ht ............................ Number of Stories .................................. Size of lot: Front ................................ Rear ............................ Depth ........................................ Date of Purchase ........................................................ Name of Former Owner ................................................... Zone or use district in which premises are situated ............................................................................................. Doels proposed construction violate any zoning law, ordinance or regulation? .................................................. Nadne of Owner of premises ........................................ Address ............................................ Phone No ................ Na~ne of Architect ...................................................... Address ............................................ Phone No Name of Contractor .................................................... Address ............................................ Phone No ................ I_ocat property I whether in PLOT DIAGRAM clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions nas. Give street and block numbers or description according to deed, and show street names and india :erior or corner lot. STAI'E O1: NEW YORK, ) COUNTY OF ............................ ) S.S. ............ be,rig du y sworn, deposes and says that he is the opp'c, Name of individug~ signing app. lication) abow~ named. He is the ....~..~..~.t.......q."~....~ ....... ...~..~...~...L.~.~....~...~...~.7...j.~.~.~....~..~.~.L.~.*.....~:....~..~.L~..)(~../~.....~.. ............. (Contractor, agent, corporate officer, eTc:) of said owner or owners, and is duly authorized to oerform or have performed the said work and to make and ' this application; that all statements contained in t~is application are true to the best of his knowledge and bell and that ~he work will be performed Jn the manner set forth in the application filed therewith. Sworn to before me this i dayof .............................................. , 19 ........ Notary Public,. ........................................................... County ........................... ~i~(~;;';'f'"~l~ii'c'~'~Ti .......................