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Home My WebLink About26443-zFORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 26443 Z Date APRIL 7, 2000 Permission is hereby granted to: PARK DIST MATTITUCK PO BOX 1413 MATTITUCK,NY 11952 for : CONSTRUCTION OF A 4' PENCE AS APPLIED FOR. at premises located at 5155 BREAKWATER RD MATTITUCK County Tax Map No. 473889 Section 099 Block 0002 Lot No. 019.001 pursuant to application dated APRIL 7~ 2000 and approved by the Building Inspector. Fee $ .00 / - Aut-horl Signature Rev. 2/19/98 ORIGINAL % (2)x MATTITUCK pARK!DISTRICT 19.1 17.2A(c) 1 I. 7OWN OF SOUTHOLD (4) 2 (7) 358 17 1 1.GA(c) 2 ¥Olm No. ! TO~ OF SOiITHOLD BUILDING DEPARTHBNT TOI. IR HALL SOUTHOLD, N.Y. 11971 T~L: 765-1802 Ois.~Lu~uved a/c · / (lhilding Im~r) APPLICATION FOR BUILDING PERI/IT INSTRUCTIONS BOARD OF HEALTH ................ 3 SETS OF PI. AMS ......... ' ...... SURVEY .......... CHECK ......................... SEPTIC FORH ................... NOTIFY: CALL .................. HAIL TO: .................... Date ................ ,19 .... a. ~his npplication mst be coqfle~ely filled in ~ ~iter or in i~ ~ 3 ~ts of pl~, ~a~ plot plm W m~te. i~ ~i~ ~ ~le. b. Bo~ pl~ ~ l~i~ of lot ~ of ~Mi~ ~ ~s, ~lati~ip ~ ~joiui~ p~ or ~lic s~ts or ~, ~ gi~ a ~il~ ~i~ of l~t of ~ ~t ~ ~ ~ ~ di~ ~i~ is ~ of ~is ~li~ci~. c. ~ ~ ~ ~ ~is a~li~ti~ ~ ~ ~ ~ ~ i~ of ~ildi~ ~t. d. ~ ~ of ~is ~liati~, ~ ~ildi~ ~ ~11 i~ a ~ldi~ ~ ~1 ~.~pt ~ ~ ~s ~il~le ~r i~ti~ ~t ~ ~. e. ~ ~ildi~ ~11 ~ ~i~ ~ ~ in ~le or in ~ for ~ ~ ~t~r ~til a ~ifi~e of ~ IS ~ ~ W t~ ~ldi~ ~t for ~ is~ of a ~ldi~ ~Mi~ ~ ~ of ~ ~ of ~,~ld, ~lk ~, ~ Yo~, ~ o~ ~li~le ~, ~i~s or ~a~, ~ ~ ~ti~ of ~i~, ~ti~ or ~terati~, or for ~ or ~liti~, ~ T~I~ I~ O~lOjl~ ~T~ /~e ~ ~li~, or ~, ifa ~ti~) ~ ~ * ~ ~ ~ih~ ~ of ~li~t) 9. l~ture of work (check ~dfich spplicable)c ~ Doildin~ .......... PAdltion .......... Alteratio~ .......... Repair .. .......... RemovaI ............. De~olition ............ Other ~ork ../~/~ ...................... 6. I~t imated Cost ..... [ ............ fee .............................................. I (to be paid o~ filing this application) 5. If d~elli~, m~ber of d~eili~ traits ............ l/m/oer of d~elling onits a~ each floor If gj~rage, number of cars ~ ..................................... 6. If Imsiness~ eo~ercial orlmi~d occupancy, specify nature and extent of each type of use ...................... ~. Dimensions of ex/sting stn~c~ures, if any; Froflt ................ Rear ............... Depth ................... ~ ..... Nmber of Stories ...................... Di~nsions of sam structure ~ith altersticrm or additions: Front ............... R~ar Depth 8. Din~nsior~ of entire ne~ ccostraction: Front ................ Rear ............... Depth Height .................... i .....ltn~er of Stories ..................... 9. Size of lot: Froot ....... ~ ............. Rear .................... Depth .................... 10. Here Of Purdmse .......... l ........... ~ of Former O~nmr ................................. ....... .. I I. ~me or use district in u/~ilch praises are s~ated .............................................................. 12. Does proposed coo~trv~tiofl vxolate any z~lng la~ ordinance or regulation: ........................ 13. ~/ill lot be regreded ...... [ .............. Will e~_ess fill be removed 14. l~ of O~er of premises [ ........................ Address .............................. ~ No .............. Nam of Architect ......... [ ........................ '... Addrese .............................. Pbe~ No .............. ~ of C~otrsctor ........ ~ ....................... .... P~drese ............................... Phose No .............. 15. Is ~his property ~ithin ~00! feet of a tidal ~etland? ~ ~ .......... NO .......... lk)cate clearly and distinctly all buildings, dsell~er existing or proposed, and indicate all set-beck dimnsicas f~m property lines. Give street and block r~iber or description according to deed, and aho~ street names and indicate ~hetber interior or corner lot. A~'PROVE~ A~ f~ (lt~e of xnd~wduat signiug contr{ct) ~J above n~rsed, / , / (~tr~tor, ~n,C~ co.rate officer, etc.) of ~d ~r or ~rs, ~ is ~ly ~C~ri~ to ~rI~m or ~ ~r~ ~ ~id ~ ~ to m~ ~ file this a~li~i~; ~t all stat~Cs.c~tai~ in ~is a~lieati~ flint ~rfo~ m~ tl~ m~r ~t fora in ~ fild ~m tp ~fom m ~is .~ ~ ~ (S~ o~ a~ti~t) ROBERT E, REICH ' ~W p~blic, S~te of N~ YO& ~,01RE5037781,5uf~k~ 4. FIN~ · BE~~ ALL ~N~ON THE flEQUIRE~ OF STATE CON~ON CODES. N~ RESPONSJ~ DESIGN OR ~flU~'