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Home My WebLink About19861-z FORM NO. 1 TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTII ......... -] SETS OF PLANS .......... SURVEY ................... Cll£cK .................... SEPTIC F 0 R,'I .............. ,,O, LE! : CALL MALL TO: . O~M~'il d in g,~fal% c t o r)' APPLICATION FOR BUILDING PERMIT ; ,5 -' ,t'O ..91 Date ., 19... INSTRUCTIONS : a. Tlfis application must be completely filled in by typewriter or in iuk and submitted to the Building Inspector, with 3 ~ 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 streets ,~reas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ion. c. The work covered by this application may not be c'~mmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit i1 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 whatever until a Certificate of Occupancy 11 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 Iding Zone Ordinance of the Town of Southold, Suffotk County, New York, and other applicable Laws, Ordinances or ;ulations, for the construction of bu;idings, additions or alterations, or for removal or demolition, as herein described. .' applicant agrees, to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and to nit authorized inspectom on premises and in building for necessary inspectionfi. ~_.. /..~.~ (Signature of applicaot, or name, if a corporation) (Mailing address of applicant) te whether applicant is owner, lessee, agent, architect, engineer, general contractor, el8'6trician, plumber or builder. ........................ neofownerorpremises .~..A'T"E~ A~ ~lict4E.-Ll,_.._~_ (as on the t,Tt roll or latest deed). .oplicant is a corporation, signature of duly authorized officer. ,' Intended use and occupancy (Name and t~tle of corporate officer) Builder's License No. I Plumber's License No ......................... Electrician's License Other Trade's License No ...................... .ocation of land on which proposed work will be done ............... gb5 5. F_.co s-r een- ................................... ............... NJE~ ~O:FFO L K louse Number Street ................ Hamlet ounty Tax Map No. 1000 Section ..... 1.1.7. ........ mock ..... ,~bdivision ..................................... Filed Map No. (Name) .............. Lot ............... ate existing use and occupancy of premises and intended use and occupancy of proposed construction: XlStlng usc an CCupancy ................. 3.Nature of work (check which appl cable): New Building .... Addition ........... \Iteration .......... Repair .............. Removlal ......... Demolition ... ~1 5% ..... '"' · ...... Other Work .3.,'J'.~.O.K.P,..~.~,.~ 4. Estimated Cost ........ O ~ ~ (Description) If dwelling, number of dwelling i (to be paid on filing this application) 5. u~its ............... Number ot' dwelling units on each floor ................ . If garage, number of cars . 6. If business, commercial ........... or m~xed c , ' .......................... ~,ensions of existing structUres,° CUpancy, specify nature and extent of each tym of uso .......... .. 7. Din if any: Fro~t ............... Rear .............. Depth ............... Hmght ............... Number of Stories ........ D~ensiohsofsame stmc~--~ '-,J · · ,m~ with alteranons or additions: Front Rear Depth ...................... [He ght ................... j'' ~' ............................. 8. Dimensions of entire new constmc~tion: F t nber of Stories ...................... Height ront ............ Rear ...... Depth ....... Num be,r of Stones ..... 9. Size of lot: Front .... ~ ............... 0. Date of Purchase ... j ........ ; ......... Rear .... ' .......................... . · ................. Depth .., ........ : ................ Name of Former Owner ................... I. Zone or use district in which premi;ses are situated .... ' ............................ ' Does proposed construction violate any zomng law, ordinance or regulation: Will lot be re,faded ' · ...... Will exces~t~ ~e removed fr~re~sea~"~ Ye~ ~ No 4. NmeofOwnerofpremises ... ~ ......... Address~g.~W~o~~,/~ , Nme of Architect ' ''~ ~ ..... Address~... ~ /~,.~.(~hone No~]~ N~e of Contractor ........... ~ ............. Address .............. Phone No 5. Is t~s property wtthtn 300~ ear oE a ~mda~ wetland? ~Yes ........ No..~ ~If yes, Southold TOwn Trustees Permit may be roqulred, "" i PLOT DIAGR~ ro~t~ clea~ ~ d~stln~l~ ~1 bu~lfl~gs, whether existing or proposed, and. indic te . . · . ' . ~. y nes. ~l~e street ~a moc~ numoer or descfivtioh accord~-~ t~ ~oa - ~ ~ ~ ~1 set back q~.ensmns from ~enor or comer lot. ~ ~ ~.~ ...... , dna snow direct n~es and indicate whether 7 ~-1802 9 AM m 4 PM FOR HE FOLLOWING INSPECTIONS: , C ~ ~ ~ ~ ~' U 1. FOUNDATiON~* ~OREQUIRED FOR POURED CONCRETE 3. INSULATION 4, FINAL CONSTRUCTION MUST BE CO~,PLETE FOR C.O ALL CONSTRUCTION SH~LL ME~ THE REQUIREMENTS OF THE N,Y. STATE CONSTRU~ION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRoRs '~TEOFNEwY ' ~ ~ ~/ ~ . ~ / ~ . ~ . ORK, ~ . 'Name "' "' '; '" ......... · ......... bei ~g ( t y sworn, deposes and says that he is the applicant [ ' ol mmvmmu sign ng contract) . e named. ~ the ........................ I ............. ~' t ontractor, agent, corporate officer, etc,) ........ fid OWner or owners, and is duly authorized to perform or have perfommd the saki work and to make and file this c;1'l~;;e tb~t all s?tements contained i,) this application are true to the best of his knowledge and belief; and that the ' Perro~ed in the manner set forth in n to before me this ~ the application filed therewith, , lO~ /) ' ...... .... ........... . ...................................