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Home My WebLink About25263-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. 25263 Z Date NOVEMBER 4~ 1998 Permission is hereby granted to: for : LAURIE D WHITE TUTHILL LANE MATTITUCK~NY 11952 DEMOLITION OF AN ACCESSORY BUILDING AS APPLIED FOR. at premises located at 6105 WICKHAM AVE MATTITUCK County Tax Map No. 473889 Section 107 Block 0004 Lot No. 002.002 pursuant to application dated SEPTEMBER 21 1998 and approved by the Building Inspector. Fee $ 25.00 Buildin~ Inspect~r ORIGINAL Rev. 2/19/98 FORH NO. I TORN OF SOUTHOLD BUILDING DEPARTI~IT TO~I HALL SOUTHOLU, N.Y. ! {97 I TEL: 765- 1802 Approved.~....~.., Permit No. f.~..~.~.o~...'~..'~. Disapproved a/e .................................. APPLICATION FOR BUILDING PERHIT 8LOG DEI~. ,:~r INSTRUCTIONS BOARD OF HEALTH ............... 3 SETS OF PLANS ............... SURVEY ........................ CHECK ......................... SEPTIC FORN ................... CALL . .... 1/AlL TO: .................... Date ................ ,19 .... Ti~N OF SOUTHOL~J a. 'mis application ,mst be c~plecely filled in by ~iter or in i~ ~ mitt~ to ~ ~ildi~ I~tor t 3 ~ts of pl~, ~ate plot pl~ to ~le. F~ ~i~ to ~le. b. ,Plot plm ~ l~ti~ of lot ~ of ~ildi~s ~ ~s, ~lati~ip to ~joini~ p~s or ~lic struts or ~, ~ givi~ a ~tail~ ~ri~i~ of last of pro~ ~t ~ ~ m ~ diem ~i~ is ~rt of ais a~li~ti~. c. ' ~ ~ ~ ~ ~is a~li~cim ~ mt ~ ~ ~fo~ ism of ~ildi~ ~t. d. U~ ~al of ~is a~li~ci~, ~ ~ildi~ I~cror ~11 is~ a ~ildi~ ~t to t~ ~li~t. ~t ~11 ~ ~pt ~ ~ ~s ~ail~le for i~ti~ ~t ~ ~&. e. ~ ~ildi~ ~11 ~ ~i~ or ~ in ~le or in ~t for ~ ~ ~t~r mtil a ~rtlficate of ~ ~11 ~ ~ ~ ~ ~ ~ldi~ ~tor. aI~ IS ~l ~ to t~ hildi~ ~mnt for ~ 'is~ of a ~ildi~ ~t ~t to t~ ~ildi~ ~ ~i~ of ~ T~ of ~ld, ~ffolk ~ ~ Yo~, ~ o~r a~li~le ~, ~i~es or ~lati~, for ~ ~t~ti~ of ~ildi~, ~iti~ or alterati~, or for ~al or ~liti~, a ~in &~ri~. ~ ~li~t ~s to ~ly ~ ~1 ~li~le 1~, o~i~s, ~ildi~ ~, ~i~ ~, ~ ~lati~, ~ to ~it m~ri~ i~tors ~ ~s ~ in ~ildi~ for ~ j~ti~. .... ~ili~ ~m~ of ~llmt) State ~,t~ether applicont is o~ner, lessee, agent, architect, engineer, general c~tractor, electrician, plumber or buil& ~ of o~er of premises ........................................................... ~~ .......... If applicant is a corporation, signature of duly autborised officer. (l~e and title of corporate officer) Builders License No .......................... Plumbers License No .......................... Electricians Li~-n~e No ...................... '/~-1~1~ I AM TO 4 PM FOR THE I, OIIOWlWll ~: I ~ - lWO REQUIRED 2. ~ - ~ & Iq.UMBING $. INSULAI1ON 4. FINAL - CONS?RUCTION MUS] BE COMPt. E~ ~ C.O. ~ ALL CONSTRUCTION SHALL MEET OLher Trade's License lqo ..................... THE REQUIREMENTS OF THF N Y I. lncation of laed on ~hich proposed ~rk vfill be done... STATE CONSTRUCTION & ENERGY ..................... t:'d b~'g ' ' N'OT'' ~l:~ t'H~,L',~';;'- ' ';,". ..... DESIGN OR CONSTRoC' IOI Rouse I~,,.her St--t/n~ ,on ....... ..... .., ........ Subdivision ...................................... Fried Hap No ................ Lot ............... 2. State existing use and occupancy of premises and intended use and occupancy of proposed ccostraction: a. ~xisting use and occup~cy ............................................................................. b. lntpnd~t use ~ occupallcy .............. I0. II. 12. 13. 14. 15. I~.amre of ~ork (cheek ~idch applicable): Ne~ Building .~/ ..... g~idition .......... Alteration .......... Repair ............ Rea~ml ............. Demolition ..~,:. .... Other gork ............................ ~Description) Estimated Cost ......................... fee .............................................. (to be paid on filing this application) If &~elling. ~ut~er of d~elling traits ............ limber of a~elllng traits on each floor ................ If ~arage, nmber of ears ...................................... If business, cn.,~reial or nti~-d occupancy, specify nature and extent of each type of use ...................... tleight ......................... bluenber of Stories .... ~. ................ Dimensions of sam structure with alteratlmas or additions: Front ............... Rear ............... Ilepth .................... tlei~ht .................... Nm~er of Stories ...... ,iai ~, ,', ;. -~ ;~[~"l~'¥ Il ~l ~l Iii~s:r'~ IIIll }Might ......................... R~ber of Stories ................. 11,1 ~(.3 ' [!'l' il I1 of lot: ..t .... ............ Rear ........ ] Zone or u~ district in ~hlch t,~.ines ar~ situated .............................................................. Does proposed construction violate any ~oning 1~,~, ordinance or regulation: . .~ ............... ~ of tax:hitoct .................................... A&lress .......... ,~ ................... H~ee No ............... ~ of ~tr~to~ ..em4.~.L..~.. .............. ~ess ..L~..~...~.. ........... ~ ~ ............... Is this ptoOert~ within ~0 f~t of a tldM merle? ~ 'i~ .......... 1~ . .~. .... PLOT DIAGRAH Locate clearly ~ distinctly all buildings, ~nether existing or p~posed, and indicate all set-back dimensions property lines, give street and block t~aber or description according to deed, and sho~ street nines and indicate ~hether interior or corner lot. .......... ~.!1 , I~ is the ......... .~ ....................................................................................... (~tr~tor, ~nr, eo~rat~ officer, etc.) of ~id ~r or ~rs, a~ is ~ly ~t~ri~ to ~rfom or h~ ~rfo~ O~ mid ~ md to m~ a~ file OHs a~lication; ~at all stat~nts ~tai~ in ~is a~l. icati~ are t~ to ~e ~st of his ~1~ a~ ~l. iefl a~ that t~ ~ will ~ ~rfo~ in tim m~r ~t forth in ~e a~lieati~ fil~ t~. ~m to ~fo~ ~ .. .... ~ ...... ~y o~... ~s./.~...