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Home My WebLink About12980-Z 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 ;xamined....~-2~..~..., 19~ ~. .. · ,pproved ·....~.~-..~.., 19~.~. Permit No.. (.~'..~. ~'Q..~ )isapproved a/c ............................ ' ......... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... ,19... a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 :ts of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relatior~ship to adjoining premises or public streets r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ~.tion. 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 issued a Building Permit to the applicant. Such permit tall be kept on the premises available for inspection thronghout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupanc~ ~all have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or .egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to flmit authorizedinspectors on premises and in building for necessary in~ .~~ ....... ~ (Signature of applicant, or name, if a corporation) <o. ..... ......... /-~ (Mailing address of applicant) ;tate whetlier applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ............................ . ........................................... qame of owner of premises . ..---~.~ .~.'~TLA~...~.....~...~..~...&'~.[:'..~..~. (as on the tax roll or latest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other T rade's License No ...................... 7 S ~-~-~'%--"- House ~'u~l}~r' ....... -- ' 'Street Hamlet ...... Subdivision ~n Filed Map No. ~ Lot .~. (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy ..... . .'~.>...qT~....~'. ................................................... 3. Nature of work (c,~,eck which applicable): New Building ..... ' ..... Addition . .lr'~ ..... Alteration Repair ....... ~'f'~-, .... Removal .............. Demolition .............. Other Work ............... ~ .~, ,~ ._ (Description) 4. Estimated Cost ....~ ...................... Fee....-~...~.. '.~'. ........... : ............. '" (to be paid on filing this application) t'-' 5. If dwelling, number of dwelling u!l,its ..... .~.\[ ...... Number of dwelling units on each floor ................ If garage, number of cars ...... ~.. ~J...~. ~/~ ~..~ .-~.) ...... '. ......................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . .~.<3/4 bf ~3g.c.(.~:.C.... 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 Rear ...................... Depth ...................... 0. Date of Purchase i~.'.'~i~i~i,i ),i.~1601.i ....... Name of Former Owj~er ............................. I. Zone or use district in which premises are situated .... .~ ~{. M. ~ g..¢.t, ib.~ .............................. 2. Does proposed construction violate any zoning law, ordinance or regulation: .. K].O.: ........................ 3. Will lot be regraded ......... .M. ¢1.., .............. Will excess fill be removed from premises: Yes No ~. Name of Owner of premises . .t~...t~x'~.~ C/. ~. :... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Nmne of Contractor .......................... Address ................... Phone No ................ PLOT DIAG R.adM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from ,roperty lines. Give street and block number or description according to deed, and show street names and indicate whether ~terior or corner lot. ,TATE OF NEW Y. DRK, ..... ~....~..gT..~'. '..k,~..~...'.'~. :... ~ .~. ~. ~ ....... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) bore named. (Contractor, agent, corporate officer, etc.) ,f said owner or owners, and is duly authorized to perform or have 15erformed the said work and to make and f'de this pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the 'york will be performed in tile manner set forth in the application filed therewith. iworn to before me this 4otary Public .... ~ ......... County ('"x ?~0D',RY F;.;2! ig. ~c~:~te o[ New Y0r~ ..................... i,:,', 4?07?: ::~, Eu:I;,Ik Cour*ty..~- (Signature of applicant) 765-1802 9 AM Y0 4 PM FOR THE' FOLLOWING I~?ECT ONS: '~ ----D ' I FOU UATt~'-T~VO REQ~JIN~,~' 2. ROUGH - FRAMFNG & pLUMBIN ALL CONqTR~JCTION SHALL MEE~ STATE CONSTRUCTION' & ENERGY CODES. NOT REsP0NS BLE'; FOR DES GN OR CoNSTRU~TION"~RRO~g, PLAN NO,