HomeMy WebLinkAbout3566-z FORM NO. ~
TOWN OF SOUTHOLD
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? 3566 z
Date .............................. .A...U. g~ .s..t,.......~..0..., 19.....0..2
Permissionisherebygrantedto:
Mattituck Estates Inc
Mattituck
at premises located at ....~l
Blot
pursuon¢ to oppli~
Building Inspector.
Fee $..~...0. ~.0...0. ...........
....~.~ .... ...3:...0. ....... , 10..6.~...., and approved by the
Building Inspector
NO. !
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
nTOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved ' ~'] ........ t~ ......... L, :~ ~ ~ Z~
........................................ , 19 ........ Permit No .............................
Disopproved o/c
(Building Inspector~
~i. i~ /~'-~PPLICATION
FOR BUILDING PERMIT
Application No. ;~'~ ~
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 premises, 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 port 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 o Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o 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 oil applicable laws, ordinances, building code and regulations.
Mattituck '~
Estates Inc
(Signature of applicant, or nome, if a corporation)
Mattituck
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Contractor
Nome of owner of premises Mattituck Estates Inc
If applicant is o corporate, signature of duly authorized officer.
(Nome and title of corporate officer)
Matt. Est 33
1. Location of land on which proposed work will be done. rMOp No.: ........................................ Lot No.: ........................
Street and Number BZossom Bend~ Matt±t~ek
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy Vacazzt land
b. Intended use and occupancy ......... .O...~.~...~.~..~.~,,...~}(~.~.-.~?z.~ ..........................................................................
8. Din
Hei
9. Siz~
10.
11. Zor
12.
Nat ,re of work (check which applicable): New Building ...~...~.~ ......... Addition .................. AIt~eration
Repj:ir .................. Removal .................. Demolition .................. Other Work (Describe)
I (to be paid on filing this appli.
If c~welling, number of dwelling units ........ .o..~..e. .............. Number of dwelling units on each floor
tWO
If g~rage, number of cars
If Susiness, commercial or mixed occupancy, specify nature and extent of each type of use
Dir~ensions of existing structures, if any: Front ............................ Rear ................................Depth
Hei~jht ........................Number of Stories ............................................................................................................
Dir4ensions of same structure with alterations or additions: Front .................................... Rear .......................
De th ................................ Height ............................Number of Stories ................................
ensions of entire new construction: Front .......... ~ ...................... Rear ............. ~.~ ........... Depth 32
~ht ....................Number of Stories one
. of lot: Front ............................Rear .................................... Depth ................................
of Purchase ........................................................ Name of Former Owner
or use district in which premises are situated ......~......~.~..S.,~,..
Doe',s proposed construction violate any zoning law, ordinance or regulation? no
Na~ne of Architect ......................................................Address ............................................ Phone No.
same
Na~e of Contractor .................................................... Address ............................................ Phone No.
J-ocat
property ~
whether in
PLOT DIAGRAM
clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions
nes. Give street and block number or description according to deed, and show street names and indic
:erior or corner lot.
1
STATE O~ NEV, Z
~ Edward Abitz
above na~ed. He is the ....... ,C.~ officer
(Contractor,
of said o~ner or owners~ and is duly authorized to perform or have performed the said work and to ~ke and
this appliCation; that all statements contained in this application are true ~o the bes¢ of his knowledge and belief;
that the ~ork will be performed in the manner set forth in the application filed therewith.
Sworn to efore me this
Notary Pu ~lic, (Signature of applicant')
No. 52,D61~100 Sull01k ~oun~