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Home My WebLink About6792-z FOEM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMEN'I TOWN CLERK'S OFFICE SOUTHOLD, N,. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6792 Z Permissi.on is hereby granted to: ~ Matti~uck erect and maintain a ~ft side line fene~ (CL~ to ............................................................... ~ .................................. ; ......................................................... ~ike 8~ at premises located at ............................................................................................................................ Mattituek N ~g, pursuant to application dated ..................... .A.l~..g. .......... .1..~.. ............ , 19~..~...., and approved by the Building Inspector. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , .................................... .................... .............................. ................. (Building Inspec,~ ~ APPLICATION FOR BUI?DING PiERMIT ~ Dote .......... J.~'......, 19...?..~... INSTRUCTIONS ~x~t a. This application must be completely filled in by typewriter o¢. in fnk and submitted in triplicate to the Building Inspector, with 3 sere of plans, accurate plot plan to scale. Fee according to schedu e. b. Plot plan showing location, of lot and of buildings on premises, relah6nship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn ~)n the diagram which is part of this application. c. The work covered by this application may not be commenced befor~ issuance of Building Permit. d. Upon approval of this application, the Building Inspector will ssue ~ Building Permit to the applicant. Such permit 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 unt a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the iissuance 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 aJterations, or ~:or 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 buildings for necessary inspections. ,;,..~..~.L~.L..~o..~ ........ ~.~.~.¢ ......................... (Signature of applicant, or name, if a corporation) .......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... .cc.%~:~ ................................................................................................ ~ ........................................................................... Name of owner of premises ..J~..~'..~:~¢~,..~. ...... j~.~......C~.~...~....~)j~..~..j~....~...~"~..~..~.~.L..~..~..~:~`.~.j~t~. If a~corporate,,,,~ignature of duly authorized officer. ......... Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Zrade's License No ............................................... I. LacaHon of land on whic/~, r,~j?osed ~o~will be do~,/M~,~.~.. Street and Number ...,~r.~g~_y,~......~.. ................. ~ Municipality S~ate existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..~-~~ ................ .......... f~;~_~......,...../;;~ ..................................... b. Intended use and occupancy ............. ·~.~ ................................................. ' ...~....~...~ ................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ...' ............. Repair .................. Removal .................. Demolition .................... Other Work ..... .~.~, .~. ~ ...................... ~ ~ .~.'~/~ (Description', 4. Estimated Cost .........~...4~.. ...... 'i ..................................... Fee ........................................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ........................... If garage, number of cars ........................................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............. 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................ Dimensions of same structure with alterations or additions: Front ....................................Rear ............................. Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ...................... Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ......... .'~....~ ...................................... Rear ........ ....~m(~. ........................ Depth ...... .7...~.... .............. lQ,~' Date of Purchase ........................................................ Nome of Former Owner ........................................................ 1 1. Zone or use district in which premises ore situated ................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ~'/~.O ........................................... 13. Will lot be regraded . ........................... Will excess fill be removed from premises:(. ) Yes, (~,) N, · ......... ' or-AZ~ ~' ' ' t/~: '/r' d~' 14. ,ameofOwnerofprem,ses....~..,..~.?. .~. !./(L. Address ..~.'././...~l~o~ne Name of Architect .............................................................. Address ................................ ~'~' / Phone No. Name of Contractor ............................................................ Address ................................ Phone No ......... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exi.~tlng or proposed, and indicate all set-back dimensi )ns from property lines. Give street and block number or descriptioj~ according to deed, and show street names and indicate whether interior or corner lot. i ,¢ STATE OF NEW~YOI~I~ ' "- ~'SS COUNTY OF .c~.u..~...~'~.o..~..~%....J' ' __. ..... . .~'....~..~...N~¢~. ~. .......... & ........ ;T~.~ .~.. ~i~..~....~,.. ........ being (Name of individual signing conti~cf) above named. duly sworn, deposes and says that he is the pplicant (Contractor, agent, corporate officer, etd.) of said owner or owners, and is duly authorized to perform or 'have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and be ief; and tha~ the work will be performed in the manner set forth in the application flied therewith. Sworn to before me this ~ ........... ........... , ,..,/_.,/ .... Notary Public~.~..,~...~_.~_~.. ~unty .... ~~....~..~~ ................... ~ (Signature o~