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Home My WebLink About22713-ZFORM TOWN OF $OUTHOLD BUILDING DEPAETMENT TOWN ~ SOUT~4OLD, N.Y. N? BUILDING PERMIT ITHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ~ .............................. 22713 Z Permission Is hereby granted to: ....... ...... ..~.~..~ ................................................... ~ ~~ ............. ~......./...~.. ,o....~.~ ....... ./...~.~. ~~ ....... ~ ........ ~.~. ~ .......... at premises located at....../~....~.~.~.........~'~: ................................................................... CounIy Tax Map No, lO00 Sectlon.,.../~ ..... Block ...... ~.~ ........... LotNo...~.../~.:...~. ............. pursuant to application dated ...~,.,,/~...,~ ~ ~Z..~.. 19,...~...~.....-~..,. and approved by ~he Building Inspector. ................ ~' ...... ' Building Inspector Rev, 6/30/80 FORM /',JO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 1197] TEL.: 765-1802 Examined.....'.~./( ....... ,19 ~..~'- Approved ..... .~'/./. ..... , 19~..-~.. Permit No..~..~..~./.4.~-.. Disapproved a/c ................................ ' BOARD OF tIEALTII 3 SETS OF PLANS ........ SURV£Y ................. CHECK ......... ~ ........ SEPTIC FORtl ............ NOT I PY ~ CALL ................. HAIL TO: · (Bi, iSling Inspector) APPLICATION FOR BUILDING PERMIT Date April 26 19 95 INSTRUCTIONS a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with ~ sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public sti'eet or areas, and giving a detailed description of layout of property muir be drawn on the diagram which is part of this appli cation. , c. The work covered by tiffs application may not be commenced beford issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permil shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in.whole or in part for any purpose whatever until a Certificate of Occupanc3 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. Mattituck Fire S istrict - - (Signatur9 of applicant, or name, if a corporation) PO Box 666~ Mattituck, NY 11952 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractoL electrician, plumb~r or builder. (as on the tax roll or late~l~lg~~PAffllOl~Wr AT 7e~-1802 ~ AM TO 4 I~M FO~ THE If applicant is a corporation, signature of duly authorized officer. /l/~/'"~-,., ~ IN~l~g'[lO~ Builder's License No. ~/Tg/2'Z~Y' '"'~) t I~lOL~YlO~ . FINAL - CO#~'r~l ,I,.~IION Mu~F Phnnber s LJcense No. ~/~ ~. ~~~0. ' ......................... A~' CON$~ ~ ~ ~a~ . THE HmmREME~ OF ~ N.Y. Eiecn'c'an s Eicense No ....................... ' ~ATE ~NS~ ~ ~ERGY Location of land on which proposed work will be done .............................. '... :. .... :. .......... 940 Pike Street, Mattituck, NY 11952 [ louse Number Street Jlanllet County Tax Map No. 1000 Section . 140 Block 03 ' Lot 010 Subdivision ........ ............................. Flied Map No ............... Lot ............... (Name) Slale existing use an(t occt,pancy of premises and intended use aud occupancy of proposed construction: a. Existing use and occupaucy VACANT NONE b. Intended usc and occupancy 3. Nature of work (check which applicable): Ne~v Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolilion .XXX....... ..... . Other Work ............... .... (Dcscriptiou) 4. Estimated Cost $5,000.. O0 ' Fee ............................... (to be paid on filing this applicalion) 5. If dwelling, number of dwelling units .... O.N..E ........ Number of dwelling units on each floor ................ · If garage, uumber of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and exlent of each type of use . . ]R~E.S.I.D]3~.I.h~, ...... 7. D ne ~s ons of existing structures, ifany' Fro~t. 27' . Rear .... .2.7.' ....... Depth . .~.4.' .......... lleglt .~.~ . . . NunberofStores ......... 1~ Dimensions of shine structure with alteratio~.s or additions: Front ................. Rear .................. Depth ' lteigbt ........... ' ......... ·.. Number of Stories ...................... 8. Dimensions of entire new construction: Front .............. : Rear ............... Depth ............... lleigbt ............... Number of Stories ....................... ~ ................................ 9. Size of lot: Front ........ ~ ............. Rear ...... .5.2...9.7. '. ......... Depth . .2..1.5...6.5. '. ............ 10. Date of Purchase ............................. Name of Former O~wmr . .R.: . .~.a.z.~.u.l.~?.J: ............. I 1. Zone or use district iu which premises are situated ..................................................... 1 2. Does proposed construction violate any zoning law, ordinance or regulation: ........ .N.O. ..................... 13, Will 10t be regraded ....... ...Y?.S. ................ Will excess fill be removed from premises: ~ No 14. Nmne of Owner of premises ~.~,T.~.T .U.O.K. ?...I.R?..D..I~]dress . .9. QO...P~.K.E.. ,S.T ..... Phone No. 2. q8. 7.8.8.3.7... :. , . Name of Architect ........................... Address ................... Phone No ................ N~une of Contractor gb¥.M.o.~. P. F.-...~.:t ~.~. ........ Address .~.&?. ~Tp.C.~... ~Z... Phone No.2.9.~ ={3.8.2.8. ...... 15. la th:l_s property within 300 feet of a t±dal wetland? ~¥es ........ ~o..7,XX... · If yes, Southold Town Trustees Permit may be required. PLOT D~AG RA~ Locate clearly and distinctly all buildings, whefl~er existing or proposed, a~d. indicate all set-back dimensions from ?roperty lines. Give street and block number of description according to deed, and show street naanes and indicate whether interior or corner lot. ., t.~.~: ~". '.~ .~ ~'~ ................ being dnly s~vorn, deposes mid says that he is the applicant (Contractor, ageut, corporate officer, etc.) said owuer or owners, and is duly autllmlzcd to perform or bare performed the said work and Io make and file this plic:Hion; that all stalcments contained in this application are ~rue to the best ~[his knowledge and belief; and that the nk will be performed iu II~e manuer set forth in the applicatiou Bled therewith. .'om to before me this ~ Cr~ .day of .... .~e~(~ ......... 19.75~ (Signature of applir'md')