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Home My WebLink About6789-z FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK ^UTHORIZED) 6789 Z Permission is hereby granted to: ~.t.ti.t~¢~...~,le,,t...ii~.~k~a...3[:n.e.i ................. ........... ~.t.,~z...,~.~.o. ............................................... Mattituek N.Y. ~o ..~.r~.~..e~..~.~.~.. ~.r r..~r.~¢.~.~...~r~ ~.~g~,:~.. ~.~...~.~L.~...~.~ ................... et premises loceted et ....Y~N.~G~..~AD.~..~..~;i..~96~ ................................................. Laurel Aug pursuant to application dated .0 ~ , 1~f~..., and approv~ by the Building Inspector. Fee $...:~.,.Qg. ........... o:~ th,Z~..,~......oL..~,...Z,:v.~ ....................... , i~ th, Co,~ o~--~.~-~.~...¢.--. the...~,,~.~... .......... of......,.~.:~..~.~.:.~.~..,~ ................... , Count~ of-~.~,,..,~,,,, .......... , I~. Y., ..................... .................................... WI4~:~FOP, E Your Informant prays that the depositions of this Informant, and ...................... .................................................................................... , ~m~, may be reduced to writing and duly subscribed, and that a warrant issue for the arrest of said accused, and that he be dealt with pursuant to the provisions ~o~ode of Cr~nal precedureV / 0q TOWN OF ~OUTHOLD, NEW YQRK APPLICATION FOR SPECIAL EXCEPTION APPLICATION NO, TO THE ZONING BOARD OF APPEALS, SOUTHOLD, N. ¥. hereby apply to THE ZONING BOARD OF APPEALS for a SPECIAL EXCEPTION in accordance with the ZONING ORDINANCE ARTICLE SECTION SUBSECTION THE SPECIAL EXCEPTION IS REQUESTED BECAUSE ....................... day Notary Public b,",,,L;/~A M. tlAlJRUS ~esiding in S~ffolk CounW Commission Expires March 30, FORM ZB2 FOI~i NO. 1 TOWN OF SOUTHOLD ; BUILDING DEPARTMEN? TOWN CLERK'S OFFICE! SOUTHOLD, N. Y. ......... Z 197 .. . . '- .............. Examined Approved ............ !: ............ ;,~ .......... , 19. Z!, Permit No. ~ ........................................................................ (B~ldi~ I~t~) APPLICATION FOR ~UILDING ~ERMIT ................... ........... INSTRUCTIONS ~. This ~pplicQtion must be completely filled i~ by typewriter or in i:nk ~nd submitted in ~r~pJic~t~ to Ihe ~udding ~nspect~, with 3 set~ of plans, accurate plot plan to scale. Fee according fo schedule. b. ~1~ plQn sMowin~ Ioc~hon of lot ~nd of b~ildi~s on D~n,~o~, rduti~n~hip Io ~dlcumn~ L~rcnu:,c"~ areas, and giving a detailed description af layout ofproperty mu~t bo drawn ~,n the chagram w]uch ~ parl c. The work covered by this ~p~lic~tion m~y ~o~ b~ commenced beJor~ ~ssuQnco of ~ildm~ P~md d. Upon approval of this application, the Building Inspedor w4i ~ue ~ GuHdmg ~erm,t to the oppM ont shah be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in w~o[e or in p~r[ for ~y ~u~o~e wh~tewr u~ti[ a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the ~ildi~ Department for ~'he issuance of a ~uilding ~ermit pur~acnt to the ~ui~ding Zone OrdinQnce of Che Tow~ of Southo[d, SufFolk Cou~t~, New~ork, ~nd other ~p~ic~b~e L~ws, Ordinances Regulations, for the construction of buildings, additions or ~[teration~, or for remowl or d~molition, ~s her~in described The applicant agrees to comply w~th all applicable laws, ordinances, bui[di~ng ~ode, housing code, fl~d regu[atio~s, find to admit authorized inspectors on premises and in buildings for necessary inbpections. ....... · .~. ~.::.~, X.~ ...L.Lk~-;;.L..k :/:: ~'.L ~L<~ ..................................... (Signature of ~p~lic~nL or n~me, if a (Address of applicant) State whether applicant is owner, lessee, agent, architect, engmoer, general contractor, electrician, plumber or Name of owner of premises ..r...z..Mt.:.~:....'r..~.~...~ ...... ::.~w.:..._; ...... z~..M....~ ......................................................................... I~npph~an~.~s a corp~gte, s~gnatu~ of duly a~thonzed office . - , ........ .tZ .......... '~f~ -6.~ ...... ~. .... · · (Nome a~ title of corporate 'officer) .............. : Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ......................................... Lot No ........................ Street and Number ................................................. Municipality State existing use and occupancy of premises and in?nded use and occupancy of proposed construction: a, Exisiting use and occupancy ...................................................... i ................. t .................................................... Did'eat Lenal ~i~n~ ,~ld.~,ich Lane ~nd ,._at~ ....... : b. Intended use and occupancy ............................... :: ......................................................................................... 3. Nature of work (check which applicable): New Building ................ .. Addition .................. Alteration ............. Repair .................. Removal .................. Demolition .................... i~Other Work .............................................. : . ~ ~ (Descript,on) 4,: Estima;~ed Cost ................................... ......................... Fee ............. ; ................. ; .................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number ofidwelling units on each floor ......................... If garage, number of cars .................................................................. ! ...................................................................... 6. If business, commercial or mixed occupancy, specify nature ancj extent of each type of use ~ 7. Dimensions of existing structures, if any: Front ............................ Re, ar ................................ Depth ................... Height Number of Stories ....................... i " Dimensions of same structure with alterations or additions: Front J ................................... Rear ........... Depth ................................Height ............................Number of StOries ................................ 8. Dimensions of entire new construction:. Front .................................. . Rear ............................Deptt~ .......... Height .................... Number of Stories .......................................... : ................................................... 9 Size of lot: Front ........................................................ Rear .......................................... Depth ......................... 10. Date of Purchase ........................................................Name of For,rper Owner ..................................................... 11. Zone or use district in which premises are situated .......................... ~! ..................................................................... 12. Does proposed construction violate any zoning law, ordinance or r~gulahon .................................................... 13. Will lot be regraded ............................ Will excess fill be removed !rom premises: ( ) Yes ( ) No 14. Name of Owner of premises ............................... : .................... Address' ................................Phone No ..................... Name of Architect .............................................................. Address ................................Phone No ...................... Name of Contractor ............................................................ Address: ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly ali buildings, wheti~er exhtlng or proposed, and ind,cate all set-back d~mensions from property lines. Give street and block number or descnpt on according fo deed, and show street names and ind,cate whether interior or corner lot. STATE OF NEW ,~OR~,-..--.d i, COUNTY OF ..... . .'~ .Y., .L:~..'.~...~. ....... ~ "'"~ ............. ........................ ....... .be,rig du, swo (Name of individual signing contract') n, deposes an~'says that he is the c~2phca:~ obove homed. He is the ........... .~...C~.,.~;~L~,~,f~. ............................. ..................................... ........................ ............................................ (Contractor, agent, corporate officeG etc.) of said owner or owners, and is duly authorized to perform or hove perfd, rmed the said. work and th s app ication; that oil statements contained in this app?cetion ore true to the best of his knowledge and be,~er,'; and tho~ the wbrk will be performed in the manner set forth in the application filed therewith. t~ ~ore me this ...... .s..w..? ............... da, o, .............. ............... . t,' - (SigNature of opplicohtO * '