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Home My WebLink About11452-z FO~ ~0. Town ,0~ S~UT"OL BUILDING D~PA~ TOWN HAL~ ~ SOUTHoLD, N~ Y. (THIS PE~IT MUST BE KEPT ON THE PREMISES UNTIL'~ULL COMPLETION OF THE WORK Building Ihspector. _/,./ Fee $.~...1.....~.. Building Inspecto'r FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ~ /'~/ /'.5- ~ TEL.: 765-1802 Examined .~.~.. i . ........ 19.....~ Application No. ~/. ~..'~d ...... Disapproved~~~..~ ,~~ ~ f .~ ~a/c ....... ; ........................... '. ' . . ~d/~/~/~ ~ ~ APPLICATION FOR BUILDING PERMIT ' .... ~c. ~, I ~, ~ ~ ~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in ~p~cat~ to ~ Bufldi Inspector, with 3 sets of plans, accurate plot plan to sc~e. Fee according to schedule. b. Plot plan showing location of lot and of buildin~ on premises, relationship to adjoining p~mi~a or public stre¢ or areas, and giving a detailed description of layout of property must be dn~ on the dia~am which ia part of this apF cation. c. ~e work covered by this ~pplication may not be commenced befo~ ~ce of BufldMg P~it. d. Upon apprc':~ of this application, th~ BuildMg Inspector will ~u¢ a Building P~it to ~ appSc~t. Such peru shall be kept on the premises ava~abl¢ for inspection throughout the work. e. No buildiag shall be occupied or u~d in whol~ or in pas for any pu~ose whatever until a Ce~ificat¢ of Occupan shall hav~ been granted by the Budding Inspector. APPLICATION IS I IEREBY MA DE to t~ Building Depa~ment for th~ ~suance of a Building P~it pur~nt to t Building Zone Ordinance of the Town of Southold~ Suffolk County, N~w York, ~d ~h~r applicabl~ ~w$, OMinances Regulations, for the construction of buildings, additions or alt~rat~ns, or for ~m~ ~ demoliti~, ~ ~in desc~be The applicant agrees to comply with all applicabl~ laws, ordinances, building c~e, housing cod~, ~d ~lations, ~d admit authorized inspectors on premises and in.bulidin~ for neces~W M$pectiona. (Signature of applicant, or n3m¢, if a " ....;'" (Mailing address of al~plic~nt) / State whether applicant is o~vner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, .................................................. .............. :: ........... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer, (Nalne and title of corporate officer) Builder's License No .......................... Plun, ber's License No .... ~"~... Lk ~- Lt Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ........... .................. ..... House Number Street Hamlet. / ~ .o. ~.. oo./~'. County Tax Map No. I000 Section .................. Block ............ Lot ......... Subdivision .~./~r.....~:.:..-~,~.~ ................. Filed Map No.. t'.~.<~.~. .... Lot.. ~. ....... (Name) 2. State existing u~c and occupancy of preinises and intended use and occupancy of proposed construction: a. Existing use and occupancy .~'~f~..~.~..~... ~-,.,~. ff/,.~ ..~. : /,. ....... ......... ,'.... .... occupancy ,...~./...,~.. ? ~ ' b./ntended u~e and ,~.4 ,. ,~.Nature of work (check whicl, pplicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... Estimated Cost ..................... e .................... .~ ........... ! (to be paid on filing this application) ;. If dwelling, number of dwelhng units Number of dwelling units on each floor Ifgarage number of cars ;. If business, commercial or mixled occupancy, specify hature and extent of each type of use ..................... i. Dimensions of existing structures if any: Front .... Rear .............. Depth ............... Height ' Number of Stories Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... !... Iteight ...................... Number of Stories ................... $. Dimensions of entire new cons.~ruction: Front ............... Rear ............... Depth ............ Height ............... Nmnber, of Stories ......................... ~ ........................... 1. Size 6flot: Front Rear .......... ~ ........... ;/Depth .................... ). Date df Purchase ............................. Name of Former Owner~' .......... t ........... I. Zone.or use district in which plremises are situated ............................................... !. D,.o, es proposed construction vigl~t~¢~zoning law, ordinance or regnlation: ..................... L %ill lot be regraded ........ ' .~..~.~....' ........... Will excess fill be removed from premises: ~ No t. Na ~e of Owner of pre ~ s~'s Address . Name of Architect ......... : .................. Address ...... ' .... ' ......... Phone No ................ Nam e of Contractor Address Phoue No PLOT DIAGRAM Locate clearly and distinctly ali ou'ldings, whether existing or proposed, and. indicate all set-back dimensions from roperty lines. Give street and block nun:ber or description according to deed, and show street uames and indicate whether terior or corner lot. sworn, deposes and says that he is the applicp, nt is the ........................... (Contractdr, agent, corporate officer, etc.) said owner or owners, and is duily authorized to perform or have pe~;formed thc said work and to makb and file this >plication:; that all statements contained in this application are true to the best of his knowledge and belief; and that the 'ork will be performed in the manner set forth hz the application filed therewith. worn to bgfore me this I .... .... t ZXup '., ..... Co..ty _ , Term Expires Marcl~ 30, ;ii F- REVISION , REViSiON ',,ti F ' =3[E:-C 0 h4B> F: L. O0;-Z 4-1 ~/~PP, ROYED AS 'NOTED BUILDING DEPARTMENT AT ~ ~ AM TO / PM FOR THE CfX-L.L &E' £ LO-'FC. LX 0 G r , r G/'%,I 'P'%,f3 I' t"')f'~ A i A L)L..L)E)L:'%.L~ ,z-k:~.,~..k,. l IZ ~4 I~LT ;4. Z I! £'c~uTt 'l ~CI- ..... ~,,&~ ,C Io8 I, L3~'