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Home My WebLink About13022-Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Approved Disapproved a/c ..................................... Application No .................. (Building Inspector) no APPLICATION FOR BUILDING PERMIT Date . INSTRUCTIONS This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public street or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli cation. -;' ~'~ C. The work covered by this application may not be commenced before issuance of Building Permit. c. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permi shall be kept on the premises available for inspbction throughout the work. ! · e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupant. ~shall have been granted by the Building Inspector. ·" APPLICATION IS HEREBY MADE to the Building Department for the issuance off.~.-~Building Permit pursuant to th, Buildin'g-Z3ne Ordinance of the Town of Southold, Suffolk County, New York, m .~otheJ applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterations, or for rgnq 'al 9trdemolitionrlas herein described The applicant agrees to comply with all applicable laws, ordinances, building~ode hgdsing code, jtfffi regulations, and t~ admit authorized inspectors on premises and in building for necessary inspectigfis. ~ .//. ~ ~. ,. - ' ' ............ ;,/it; ;,'" · . " (Signatur'~of a hcant, or name, if a Oorp o ......... .... ~ (Mailing address of applicant) whether applicant is owner, lessee~architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises ...... d~..d ..... &d~' ~'''' ............. ' (as on the tax roll or latest deed) '. ' If applicant is a corporatio, n, signature of duly authorized officer. (Name and title of corporate officer) ~ Builder's License No .......................... Plumber's License No .... ~ .............. .,' Electrician's License No.../~...~..'?.. ~... 1;"! "Other Trade's License No .... ~. ~ t' .............. ............... .:. i ' 1. L ation of land on which proposed work w~l be done. . House Number Street Hamlet County Tax Map No. 1000 Section f.~. ~...'/. '~ .~. ~"~ ...... Block ...... .-~ .......... Lot...~.'..2 .......... (Name) {o 'B."/'~. 2. State existing use and occupancy of/~mis, es and intended use and occupancy of proposed construction: a. Existing use and occupancy .../~ ......... ~/~2' ~' 'X ......................... b. Intended use and occupancy ..... .~...~/r~~ffr.....~...~. . .; .. Repair ..... ' ......... Removal .............. Demolition i . . Other Work aO~ '0 (Description) 4. Estimated Cost ......... ?..~.. ......... -.. Fee 5. (to be paid on filing this application) If dwelling, number of dwelling units ..... l .... : .... Number of dwelling units on each floor ..... .~1... If garage, number of cars ..... /. ...... 6. If business, commercial or mixed occupancy, specif,y~fi, ature and extent of each~ty_.Epe of use .. ~...T ............ 7. Dimensions of existing structures, if any: Front ~' ..~. ..... Rear . 5~' De Height ...... ~ ...... Number of Stories .... ~,~ ........ pth .. ~ ........ Dimensions of same structure with alterations or additions: Front ............... Rear Depth ............... Height Nu .... · . . '. - ..................... tuber of Stones ........ 8. Dnnensions of entire new construction: Front .............. Rear~ ................. Denth .. Height ............... Number of Stories .... /~.~..~....~.[~ ~..~..~_~%..~ 9. S~iz.eofl_ot: Front ...../.~..~., ............. Rear ..... ~.~. ....... 10. c~a~e of I'urchase ...... ~.-~.- .~.~ ..... ' .........~Name of Former Owner .~.~T.'. i ~'.'b~_~i ......... 11. Zone or use district in which premises are situated.. ~..~ ................. ........................ 12. Does proposed construction~violate any zoning law, ordinance or regulation: . . .~..O. ..................... 13. Will lot be regraded . . . ~. ~ .......... ~- ........ Will excess fill be_removed from premises: Yes 14..N. mne of Owner of premises ~7..~.~....L?~t~..¢., ....... · Address O.,~. .ned. ,S'?. O~',_-~ Phone No ~-Z ~.20"~'~ -(~ Name of Architect A~' · .................. .,y,r: .......x .... · ' ·; ....................... oaress ..... ; ~ ........... Phone No .............. Name ofContracto '~.~7...~,~.. ?~.4: ,~rl... Address fffl¢~.,.,2?_,;~ ........ Phone No~.~.6~.'..J~../.~' . ' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ~ ~._._ ~ ~. B.P. ¢ 130::z.z.,"k BY: _ X.~ ,6.L.. 765-18:'? o A.M TO ,:~ PM FOR THE FO[!C"~<x'": i?SYZCTIONS: 1. FC~ ...... '*':"!~¢~ - TWO REQUIRED F¢~ '""~2'q CONCRETE 2. ROI ~'7" FRAMING & pi ~,!MS!NG 3. INm" ,,', ~*.,~ 4. Flh'~ :""" :: '~'-'~ICN MUST BE ......... : :~R C. O. ALL C ...... : ~ :~,~ ?-~AL_L MEET THE PF :',-;'-c ~F THE N.Y. STATE C: :"¢-~OH & ~NERGY CODES. N~ ~%~Oh'S~PLE FOR DESIGN OR COF-~7RUCTION ERRORS. being duly sworn, deposes and says that he is the applicant e is the .................................. ~ ....... .... (C°ntract°rkage~ldcorporate officer, etc.) t s..aid .owne.r or owners, and is duly authorized to perfo-~'~ or have nerr,~,-,~,-~ -~- .............. ' ' ~ ....... u tn~ sam woad, anti to mate and file this ~pncat~on; 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 fortlt_i~ the application filed therewith. .yom to before me this / ] · // ~ / .... .... ...... '. ......... I ~'~na Ex~}-~ ~a~e~ ~ la~ · (Signature of applicant) $E~O~ 72C9 OF T~E H~ y~ ~TA~ I l~U TION. GUARANTEES ADDITIONAL INSfli'UTION.~ _