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Home My WebLink About6325-z ~O~,~f NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD; N,. Y. BUILDING PERMIT (TH/IS PERMIT MUST BE I~EPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) 6325 Z ........ ~~..~...~.:~.~. ........................................... ~.~-...~i..~.~ .... . ,//, ~/~ at premises ,o~ated at ...~~......T;.,.~~.,:..~~....~~ ....... .: ...................... ~~.~..: ......... ~,....~~,......~...~ .................... pursuant to application dated ....... .~ ......... ~Z ...... '~..., 1 and approved by the Building Inspector, FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUT,O,D, N. Examined .................. ./.../.../.~ .......... , 19.Z~ Approved ................ ../..,../..;~:. ........... , 19/~.~.'~... PemJfNo. Disapproved o/c ............................................................................................ (BdJlding Inspector) Application No...~.~..,~ .......... { APPLICATION FOR BUILDING PERMIT Date ~,11~ ~1 1972 ~ INSTRUCTIONS l a. This application must be completely filled in by typewriter or in ink and submitted m triplicate to the Building Inspector, with 3 sets of plans, accurate plot pJen to scale. Fee according to scheduJe. b. Pict plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a deteiled description of layout of property must be dr~wn on diagram whiCh is part of th~s application. c. The work covered bv th~s application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Buildin~ 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 wl~atever until a Certificate of Occupancy shall have been granted by the Building inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanc~ 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 inspect6rs on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) M~IN ROAD. M~TTITUC~. N.Y. 119~2 (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. G~:N~]I{t:L GO,TRACTOR N~me o~ owner o~ premises ............................................................................................................................................... .~ If appli~m~t is a corporate, signature of dul~ize~/ .................... 1. Location of land on which proposed work will be done. Map No.: ......... ........... Lot No ........... ~. .............................. Municipality 2. State existing use and occupancy of premises and intended use and occJpancy of PrOPosed construction: a. Existing use and occupancy ............................................................. 3. Nature of work (che~k~i(~h applicable): New Building ....................... Addition ..................... Repair ......................... Removal ......................... Demolition ........................ Other Work.....] 4. Estimated Cost ......... ~.0,.~ .0..0. ........................ Fee .........~ .1.~.~,,0,,0. .............................................. (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 ....~.0..~.0..0. ...................... Rear ........ ~.I~.~.~.Q. ..................... Depth ...... ,l,~; Height .................................................... Number of Stories ...................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................ 1 I. Zone or use district in which premises are situated ............... .~]....//. ............................................ 12. Does proposed construction violate any zoning law, ordinance or regulation://~...d.. .................... 13. Will lot be regraded .................................... Will excess fill be removed from premises: [ ] Yes 14. Name of Owner of premises ....................................................................................................... (Address) Name of Architect ...................................................................................................................... (Address) Name of c~ntract~r~'~.'''~...~''~.''~'.~;~.~.~.~.N'~.C'~`~*.~.~.~e~'~.~'~'~.[/,~J~..l~t~..~r~)~ .......... ~ (Address) PLOT DIAGRAM · Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-I property lines. Give street and block number or description according to deed, and show street nam~ er interior or corner lot, STATE OF NEW Y~ORK, COUNTY OF ....~'~.,~.~..~.~*'5.~. ................... SS Mteration., ............. (Descriptign) []No ~hone No.) ~hone No.): !~,dglS~..~ .............. ~hone No.)! ~ck dimensions from s and indicate wheth- .~.--'~-<~..~.....~..~.%..~..~.....~...~..~.~.~....~ ................. be ng du y sworn, deposes and says that he is t~e applicant above named. ......................... i~'a'~e of i;~dividual s~gning contract J I He L, the ........................... .Q......:X.~...~h.~,.'C~.Lh....':~. ........................................................................................................ t' ....................... (Contractor, agent, corporate officer, etc.) I of said owner or owners, and is duly authorized to perform or have performed the said work and to make and e this appligation; that al performed )n the mannm .;tatements contained in this application are true to the best of his knowledge and belief; and that the work will set forth in the apphcation filed therewith. ............... .~ ..................... o y of .......... ' ......... Notary Pubhc, ..~~...~.~~. uounty