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Home My WebLink About4252-z FOR~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4~5~ Z Permission is hereby granted to: .............. ~..~..~..~..t'..e. .......... ~ ........... ......... ,~6~.....~,~t~..~ve ..................................... ............ F3.o~.~:L..~az.~: ....... ~.~'~. ........................ to ............ ~,,~ld.. ~e.~.. m'~e,., f~m,~ ~...~'~.1.3.:~,,~ ........................................................................ ............................................... · ~.~.z...~..~.~..5 ................................................................................... at premises located at ................ ~J~.....~.~..~t ........................................................... ............................................ l~at.~t;~eke..~ ,~., ............................................................................... pursuan¢ to application dated ............................ &p]~ ....... .1~ ........ , 19..~9., and approved by the Building Inspector, SU,~?VEY FOR RONALD H. WOOD AT MATTITUOK TOWN OF SOUTHOLD SUFFOLK COUNTY~ ,~C4L'E : t''= 30~ APRIL I0~ 19~9 · ,,4 o~ '¢°~, REFERENCE~ G[)ARANT£ED TO" LA,'W,) SURVEYOr. , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. (Building Inspector ) Application No....;~;' ............ ,- ~:~ ........... 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 premises, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout of property must be dra,wn on the diagram which is part of this opplica~ tion. 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 th~ 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 hove been granted by the Building Inspector. APPLICATION IS HEREBY M,~DE 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, alterations, or for removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances and text, tions. .................... ....... /. '. .i ......................... (Signature of applicant, or name, if cz corporation) 2~3 TUl~l~ Avenue, ~lo~al Pa~k, (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Ronalcl H. Wood Name of owner of premises .................................................................................................................................................... If applicant is a corporate, signature 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.: ...................... we~ stele l~a~,Iene T~ue, I~a~f~ak, Sout~aoXd T~ Suffolk Street and Number ...................................................................................................................................................... ~ ' ~ ~ ~ O Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. v~ l~d ~. [~isti~ ~se ~ o~c~po~cy ................................................................................................................................ s~e~ h~ ~. ~o~eo~ed use cud occuwooc~ ................................................................................................................................ 3. Nature of work (check which applicable): New' Building ........... ~ ...... Addition .................. Alteration .................. Repair .................. Remoyal .................. Demolition .................. Other Work (Describe) .................. 4. Estimated Cost .............................................................. Fee ........................................................................................ (to be paid on filing this application) 5. If dwelling, number of dwetiing units ................................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................ 6. If bossiness, commercial or mixed occupancy, specify nature ,:nd extent of each type of use .................................... 7. Dimensions of existing structures, if any: Front ............................ Rear .................. .......... Depth .............................. Height ............................ Number of Stories ................................................................................................................ Dimensions of some structure with alterations or additions: Front ................................ Rear ................................ Depth ................................ Height ................................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .......... :.~..~...~..~.~ ........ Rear ........... ..~.~ ........Depth ......~.?~.~ ............. Height ............................ ,,/~t'~umber of Stories ... 9.Size of lot: Front ~i~78'?&8--- ..... Rear '?~ ................... ......................................... Depth .............................. 10. Date of Purchase .......................................................... Na'me of Former Owner .....~....~..~..O.....0....1~...O. ........................... ] ). Zone or use district in which premises are situated 12. Does proposed construction vitiate ctnv zonino law. ordinance or regulation? ........... ~ ........................ Name of Contractor .................................................. Address ................................................ Phone No .................. PLOT DIAGRAM Locate dearly and distinCtly ali buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description .according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEV~Y~[k~/~ ) cOU T 0& s.s. ................................................................................................ being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the .~..~f~'~q~.0.~'./..O..~l~/l~!l~ ..................... (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 file this application; that all statements contained in this application are true to the best of his knowledge o.nd belief; and that the work will be performed in the manner set forth in the application filed the~e~with. Sworn to before me this ~ / , I~1 . . ,/tf~l~ ..::'_~o ~. 'r?o~ /i/, . / ~,, / / ................ ~ ....... oayw ~°t .......... ~.~,,~.....~d[~,t4ic Sta.~ of New Yor~ [ .~ /~/[f //~1],~ ............... o, ................ Notary Pubhc ..-; applica,nt)/