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Home My WebLink About8825-z FOEI~ NO. 2 TOV~H OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PJ~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 8825 Z Permission is hereby granted to: ~..~..~..o.~..~.e.~,.q~....c..,o....z.~.e. ..... ~.c. ..... .~.',.~..e.~. Mattituck ::.....~..~ .................................................................................................................................. premises located at ...... ~N...~.~Q~J.~..~[.~..~DZ~..~[7~ ........................................... ~ttituck N.Y. to dpp~c, ation dated ........................ .~.~.....~..~. ............... , 19...~...~.., and approved by the Inspector. ........... ~0~ NO. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Examined ............... , 19 praved ........................................ Disapproved ~/c ..~~ ................................... APPLICATION FOR BUILDING PERMIT Application No .............................. INSTRUCTIONS o This appllcahon must be completely filled in by typewriter o¢ in ~nk and submitted in triplicate to the Buildif Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b Plot plan showing Iocahon of lot and of buildings on premises, relationship to adjoimng premises or public streets areas, and gwmg a deta,led description of layout of property must be drawn on the dmgram which ~s part of th~s apphcotio c The work covered by this apphcahon may not be commenced before issuance of Building Permit d. Upon approval of this application, the Building Inspector will ~ssue a Building Permit to the applicant. Such pern shall be kept on the premises available for inspection throughout the work. e No bu,ldmg shall be occup,ed or used m whole or in part for any purpose whatever until o Certificate of Occupan, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Build,ng Department for the issuance ,of a Building Permit pursuant~to tl Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulahons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The opphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit aulhorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Ad~Jress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build.- ...................................... ~~~A~1~ Z'.~t~.~.t~. ................... ,. .................................................................................................... Name of owner of premises .~.~..~:..~.~..~. .................................................................................................... If applicant is a corporate, signature of duly authorized offmer. (Name and title of corporate officer) Builder's License No ....... Plumber's License No ................................................. Electricmn's License No ............................................ Other Trade's License No ............................................... Location of land on which proposed work will be done. Mcp No ................................ Lot No ...................... Street and Number ...~[lq.g.~P..~.. h'~.~...~.~.~.t;.~.~.~...~.~.,.,.Y,~...~,~ ........................................................ Municipality . State existing use and occupancy of premmes and m.~e. nded use and occupanicy of proposed ~onstruction. a Exisiting use and occupancy ............................ .1~.~t ..~..~l~l~.~l~r..~.~.~.'~t~ ..... b. Intended use and occupancy ............................ 1~1~1~ ..~.~lJ~.~,~r...~.tl~r~,~lj[ ........................... 3. Nature~i~f work (check which applicable). New Building .................. Addition .................. Alteration ................. Repair .................. Removal .................. Demohtion ................ Other Work ...~.~;~.~1:1~ ......................... (Description) 4. Estimated Cost .~.~.(}~.t~. ................................... Fee .......... .~.~,13~ ........................................................... (to be pa~d on filing th~s apphcat~on) 5. If dwelling, number of dwelling un,ts ............................ 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 Stones ................................................................................................................ Dimensions of same structure with alterat,ons or additions. Front ....................................Rear .............. Depth ................................ Height .......................... Number of Stories .............................. 8. Dm?.ension$ of entire.new construction: Front ................................... Rear ............................ Depth ................... Height ................... j Number of Stories .................................................................................................................. 9 S,ze of lot: Front ...: .................. .~..~..;1____g. ......................... Rear ........... ~../~..?.. ................... Depth ...... ~..~.~ ............. J0. Date of Purchase ....................................................... Name of Former Owner ..................................................... 11. Zone or use district in which premises are situated ................................................................................................. 12 Does proposed construction violate any zoning law, ord,nance or regulation' . ..................................................... 13 VCdl lot be regraded ............................ Will excess f,II be removed f~P~[~3~k )~s~ ( ) No 14 Name of Owner of prem~ses~..e...;;....~...l~t).~.~t .............. Address ~z~.t~tz~3]c...l~t~"... Phone No ..................... Name of Architect ............................................................ Address ................................ Phone No ..................... Name of Contractor ................................................. Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether exzsting or proposed, and indicate all set-back dimensions fro[ to names and indicai property ~ines. G~ve street and block number or descri wbeth~ ~ interior or corner lot. STATE OF NEW_YORK COUNTY OF ....~.~.~.-~.~.~ ............ ~, 1~']-~O~. being duly sworn, deposes and says that he ~s the apphca (Name of indiwdual signing contracf) He Is the ¢O~~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and ~s duly authorized to perform or have performed the said work and to ~ke and f this ~pplicat~on; that ~11 statements contained that the work will be performed in the manner set foffh m the apphcation filed therewith Sworn to b~re me this _ ...... o, ........... '....., ~ ' , ...... , ~~ I (Sifln~¢r~of applicant) ........ ~o ~2 03449C3, Suffolk Co~