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Home My WebLink About6330-z FOEM ~0. ~ TOWN OF SOUTHOLD BUILDING DEpARTME~IT TOWN O.E,K,S OmC~ SOU~HO~,, N~. Y. ] BUILDING PERMIT ~ (THIS PERMIT MUST BE KEPT ON THE PREM!SES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6330 Z Bate Pern~ission is hereby granted to: · .'Lo.~...&.,...~n~ ~ ..................... . ..... Alll ....... I.a, pe~a..Ll~l~e .................. ' .................... ..... .c..~.~h.~.g.~e. ......... ~ ................... BI'eot; and ma.%nta~n a ~4~ to ................................................... ~ .~-.~ ~...~,...~. ~.a,~l... ~.a,~.(l at premises located at ............ CutchogLte pursuant to application dated . . ,]'all ~ ' '9.,ff..~, ond approYed by the Building Inspector. Fee ~.!.~:.?...°. ........... Building In'~pector ................. FORM NO. 1 · ow, o, sou .o,D sou,.oL., ,. Exom ned. ....... , Disopproved a/c ............................................................................................ ......................... .............. ................................. APPLICATION FOR BUILDING pERMIT INSTRUCTIONS 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 plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of braidings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on diagram which is part of this application. c. The work covered by this application may not be commenced before issuance df Building Permit. d. Upon approval of this application, the Building inspector will issue a 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 m part for any purpose whatever 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 Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buddings, 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 inspectors on premises and in buildings for necessary inspections, (Sig~ti~j~e 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. Name of owner of premises ........ .MJ..c).~C.:~....~..~...q.~.~ff...d...~.-- ............ i .............................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1, Location of land on which proposed work will be done. Map No.: .,.~....-~.,.~;~. Lot No ........ ;~ ............................. Street a,d Number ...... ~.../.~ ....... ~./O.~-./..~../Z~,......~<./44..~..~.<..X~...~/~.'.~...~.. .............. ./.~/~... ......................................... Municipality 2. State existing use and occupancy of premises and intended use and occdpancy of proposed construction: a. Existing use and occupancy ............. ,.Z~..iz~.......,.~.. ~J:'~ ................ ~,..~. ......................................................... b. Intended use andoccupancy ~r~ ~' ~' ~:--~ ~ / 10. 11. 12. 13. 14. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteratior ............... Repair ......................... Removal ......................... Demolition ........................ Other Work ..~. ~.~:.../.,Z,.....~..' ~'...,~..~...~. (Descripl ion) Estimated Cost ~:~ ...~.~. Fee ................................................................................. (to be paid on filing this application) If dwelling, number of dwelling units ....... ./.~L~..~... Number of dwelling units on each floor ......................... ; ............... If garage, number of cars ............................................................................................................................................ If business, commercial or mixed occupancy, specify nature and extent of each type of use ..... t" ............................ Dimensions of existing structures, if any: Front ....... :~..~....~...... Rear ....... ~..: .~.. ............ Depth ... L~.~f...'~. ........ i .............. J//,.,I ~- ~ / Numberof Stories /~ ~ ~ ii Height Dimensions of same structure with alterations or additions: Front .......................... Rear ......... t ............................... / Depth ............................................. Height ......................................... Number of Stories ........ t ............................... / Dimensions of entire new construction: Front ......................... Rear ............................ Depth 't ................ r .............. Height ................................................. Number of Stories ....................................................................... / ! ............... Size of lot: Front ......... /..'~.~. ................... Rear ........... /..~..~. ...................... Depth ....... ~...../.~. Height .................................................... Number of Stories ....................................................................... I ............... Date of Purchase ..... ./...~..~...~.. .................. Name of Formerxl Owner ..... Z..~.~....~ ....... ..~...~...~../M]..~.~ ............ i ............... Zone or use district in which premises are situated /~.~J..d~. .............................................. Does proposed construction violate any zoning law, ordinance or regulation: ........................... Will lot be regraded ........... ,/~'.~ .................. Will excess fill be removed from premises: [ ] Ye~ Name of Owner of premises ....... ~..~..~.....~.....~ (Address) Name of Architect ...................................................................................................................... (Address) Name of Contractor ................................................................................................................... (Address) []No .Z.&.¢..% ..... Phone Phone No.)i .............. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-I~ack dimen: property lines. Give street and block number or description according to deed, and show street name~ and indic~ er interior or corner lot. / ions from ite wheth- STATE OF NEW YORK, ~ ) COUNTY OF ...... ~, 9...~.~. f~ ~ ..~../.~ ................ ) SS (Name of individual signing contract) He is the ....................................... ~.?...~..~......~....~m-.{~ ................................................................................................ (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 fil :~tatements contained in this application are true to the best of his knowledge and belie~)~.,..~ ~.h~/~-~r~ will be applicant above named. ~ this application; that all performed in the manner ~ , tx~o o*, New York forth m the application filed therewith. NOTARY ~UBL,C, St . ~ /~ . No, 52-0138000 - S'affolk Count~ ~ ............. ........... ................. ....... , ............... . ...................... ......... ~ ~ ' (Signature o/applica~ t) ~