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Home My WebLink About6798-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N*. Y. (THIS PERMIT MUST BE KSPT ON THE PREAA~$~S UN/IL FUll COMP/ET;ON OF TH5 ~VORK AUTNORIZED) 6798 Z Dote AU~ 1 ~ ] 9..?.3 Permission is hereby granted to: ~32 Middle Country Ro~d Selden ~ .Y. ( sub~ect to rr$-letterin at later at Premises located ....... r ..................................... ; .............. .I~. ..~. .................. ' Mattituek N,Y. Buildin~ In~pector. Fee $.~ ~ ~.~..Q ........... Examined ... ~ ........ , Approved ........................................ FOR1V[ NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19.??. Permit No.~..~...~... ~.~ ........ APPLICATION FOR BUILDING [ERMIT Date .......~...,.,/,,~..'~..i .............. , (9.~... ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or~ in ihk and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according {o schedule. b. Plot plan showing location of Jot and of buildings on premises, relatic~nship to adjoining premises or public streets or 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 before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue O Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the worE. e. No building shall be occupied or used in whole or in pa rt for any purpose whatever unfit a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the iissuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New ~ork, 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, buildihg code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ............................. (Signetu(e of applicant, or name, if a corporation) (Address of applicant) Stale whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................- ................................................................................ ........................................................................... Name of owner of prem ses .,~..~:~,.../~...~.?..~.....~...~...Y~..~.....J.../~...¢...: ..................................................................................... If applicant is a corporate, signature of duly authorized officer. .!?.-.: ........................ (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done· Map No.: ....i ...................................Lot No ......................... Street and Number .~../..~2. .......~(~.~.~..L..~..~t.~.~.~..~L..~.....~`~.;..~..~j~.2~.~..~..k./...~...~...~..(.~ ....... ~.:..~....: ........................... ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: · a. Exisiting use and occupancy ~.?~?~..~...~. ~. !7~ ~.o .~.¢f {~ O~/~ee ~-V~'~?-- ~4r~uS,z b. Intended use and occupancy ..... ~...l,~J~!..~.~.~.~.?.L~.).,~...\~(~.../.~.?...~..fl...~.-.~ ................................................................ 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .............. Repair .................. Removal .................. Demolition .................... Other Work ...~..)...~...../~...: ................................. (Description) 4. Estimated Cost ............................................................ lee ..................................................................................... (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 ................................ H~ight ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ......................... Height .................... Number of Stories .................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ..................................................... 11. Zone or use district in which premises ore situated .................................................................................................. 12. Does proposed construction violete any zoning law, ordinance or regulation: ....................................................... 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) N, 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 all buildings, whether existing or proposed, and indicate all set-back dimensi }ns from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner let. STATE OF NEW ~OR[k(,~, . ~' S S COUNTY OF .... ..~...~..~...~..a.k!.(, ...... f ' ................................................................................................. being duly sworn, deposes and says that he is the :pplicont (Name of individual signing contracf) above named. He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) 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 b,,lief; and thor the work will be performed in the manner set forth in the application filed .therewith. Sworn to before me this ........................ CrY of ..: .............. ..%., ...................... , .... ,., ) --x/) /" Notary Public, ...~.....~,a~.... County ...~.~~:' ............ (Signature of applicant) ~'¢I~T~RY PUBLI6, State o( I~.~ '(~J$ formerly James F. Y?ornbo ;~ .~. 0 ITl Z \ \ x, \ x,