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Home My WebLink About25705-Z l~ORlt NO. I TO~IN OF SOul'HOLD BUILDING DEPARTMENT TOTal IlAl.1. SOUTIIOLD, N.Y. I I97 ! TEL: 765- ]802 BOARD OF HEALTE ............... 3 SETS OF PLANS ......... ' ...... SURFKY CHECK SEPTIC PORH ................... NOTIFY CALL .................. IdAIL TO: .................... Ui~,~-d a/c .................................. ~1 [",~ i~J] AP~ICATION FOR BUILDING P~IT [ L_~.:~~ ,,s~cT~o.s ......... t ;gw~:T9, S~a'~OL~ 3 ~ts of pl~, ~m plot p~ m ~e. F~ ~i~ to ~le. b. ~ot pl~ ~ l~tim of lot ~ of ~ldir~ m p,~s, mlati~ip m ~joini~ ~i~s or ~lic s~ts or ~-, ~ ~ a ~r.tl~ ~im of l~t of ~Ly ~t ~ ~ m ~ di~ ~i~ is ~ of ~is ~li~tim. c. ~ ~ ~ ~ ~is ~li~tim ~ mt ~ ~,~,~ ~fom is~ o[ ~ildi~ ~t. d. U~i ~,~ of ~is ~li~ti~, ~ ~ildi~ T~or ~dll i~ a ~ldi~ ~t to t~ a~li~t. e. ~ ~ildi~ ~1 ~ ~i~ ~ ~ in ~le ~ in ~ for ~ ~ ~at~r ~til a ~rtificate of ~ati~, ~ ~ ~i~ of ~ildi~, ~iti~ ~ ~temti~, ~ ~ ,~ ~ ~liti~, ~ ~in ~ri~. ~ ~li~t ~s to ~'.,~,1~ ~ ~1 ~li~*hle 1~, ~i~s, ~ildi~ ~, ~i~ ~, ~ ~ati~, ~ to ~t ~i~ ~t~ ~ ~s ~ in ~ildi~ ~r ~ i~tims. .... ...... ..... ............ ...... (Siam of ~li~t, or ~, if a ~rati~) (~ili~ ~ss of ~li~t) S~te ~r ~li~t is ~r, les~,~, ~i~t~ ~i~r, ~ral ~t~tor, el~trici~, pier or ~il& ~ of ~ of ~-- ~lry ~z ~¢~. ~!~ ................................................. (~ m ~ ~ mi1 ~ la.st ~) If ~li~t is a ~t~, si~ of ~ly ~i~ offi~r. .... ................... (~ ~ tit~ 8f mt~ offimr) 3. 10ature of ~ork (check ~hid~ applicable): N~ Building .... .~.... fidditioo fiil~rati~n .......... Repair ............ Pa~wal ............. Demolitioo ............ Other l~ork .................................. . ~ (Deacriptioo) 6. Estimated Cost .................... fee .............................................. (to be paid oo filing this application) 5. If d~elling, nmber of d~elling units ....~. ...... lq~ber of d~elling units on each floor ..... [ .......... If garage, nunber of cars .......... /~.0~...~. ................... 6. If brininess, ~-,,ercial or mi~d occupancy, aqpecify nature and extent of each type of use ...................... 7. Dimensions of existing strucUtres, if any: Front ................ Rear ............... Depth ................. tleight ......................... ,.Nm~r of Stories ...................... Dimensions of sam structure v, dth alteratioos or ar~titions: Front ............... Rear ............... Depth .................... Beight .................... Nun~r of Stories ............... 8. Dimensions of entire ne~ construction: Front ...f./.j.~ ....... Rear .../../.'.~.. ..... Depth ...5~77~. ...... Height ...... ).~. ............... ltua~er of Stories ..... /.' ............... 9. Size of lot: Front .................... Rear .................... Depth .................... 10. Date of Purdmse ..................... Name of Pormer O~ner ........................................ I I. Zone or use district in ~hich premises are situated .............................................................. 12. Does propased con~truetioo violate any zrming la*t, ordinance or regulation: ........................ 13. }/ill lot be regrad~d .................... }/ill _,~c_ess fill tm ~ ft~ pr~aises: YES 16. l~s of O~er of p,~,,ise8 ........................... /~iress .............................. Phone NO .............. of .... ........... .......................... No... ~ of Ctmtractor ./~..~..~.~./.(.4"g~.O..~.~. ............... Address ~..~...~..~..4.f4 ............./~.fi/.~...~.~.~. ~ No. 15. Is this property within 300 feet of a tidal ~etland? * Y~S .......... (~) .......... PLOT DIAGRAH I~cate clearly and distinctly all buildings, ~ahether existing or proposed, and indicate ail set-back dlmer~ioos ha. property lines. Give street and block r..-her or description according to deed, and ah~ street n~es and indicate u~ether interior or corner lot. St^lB OF ti~ SS O[}l~l~f C~ ....................... ........ '~"~" ?"~"~' .... ~((g~q~ .................... ~i~ duly ~m, ~, ~ ~, ~t ~ is O~ a~limt (~ of iMivi~l si~ing ~tr~t) (~tr~tor, ~nt, m~rate oilier, etc.) >[ ~id ~r or ~rs, ~ is ~ly ~t~ri~ to ~rfom or ~ ~rfo~ tim ~id ~& ~ to ~ ~ file this a~lication; ~at all stat~nts c~tai~ in ~[s a~licati~ are t~ to ~ ~st og his ~1~ ~ ~lief~ a~ that ~ ~ will ~ ~rfo~ in tl~ m~r ~t forth in ~ a~limtim fil~ ~. ~m to ~[ore m .................. ....... ~ ~~$ - . ...... ~T~Y~~~ (Si~ of ~ti~)