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Home My WebLink About26059-Z FORHNO. I TONN OF SOUTHOLD BUILDING DEPARTHENT TONN HALL SOUTHOLD, N.Y. 11971 TEL: 765-]802 BOARD OF HEALTH ............... 3 SETS OF PLANS ............... SURVEY ........................ CHECK ......................... SEPTIC FORH ................... NOTIFY: Disapproved aJc .................................. CALL .................. NAIL TO: .................... (Building Irmpector) APPLICATION FOR BUILDING PERHIT INSTRUCTIONS Date ................ ,19 .... a. this application n~=dae. 91etely filled in by type~iter or in ink and sulnitted to the Building Inspector wi ] sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan slmwing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property mast be drmm on the dingran ~ahich is pert of this application. c. The work covered by this application may not be cu,uenced before issuance of Building Permit. d. Upon approval of this al~lication, the Building Inspector will issue a Building Permit to the applicant. Such permit shall he kept on the premises milnble for inspection throughout the work. e. No building shall he occupied or used in ~aole or in part for any par~se ~natever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATIG~I IS ~ ~ to the Building Depmh,,-nt for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Tram of Southold, ~uffolk County, Ne~ York, and other applicable Laus, Ordir~ces or lk~gulati=, for the constroction of buildings, additions or alterations, or for r~roval or do~olition, as herein described. The applieamt agrees to o-,-.,ly ~rith all applirahle la~s, ordinances, building code, housing code, and regulations, and to a~nit mthorized inspectors on promises and in building for necessary inspections. (Signature of ~t~licant, dr nane, if a corporation) (lq,ailing arltlress of alSplicant) State ~hether applicant is miner, lessee, agent, architect, engineer, general contractor, electrician, plt~ber or builder ........ ~.~ ./ ..................................................................................................... ~ of oaner of premises .... ~..OOZt~....Z~.~/.~....~..Odd.~d~... ~..~/ ............................................. (as on the t~x roll or latest~deed) If applicant is a onrpo.ra.tioja, signature of duly authorized officer. ...... ................ (Ram g(r~l title o~a6rporate officer) Builders License No .......................... Pl~r, ,.~ NO .... ~ ~.L/. ff .......... Blectrician~ Licemse No....//~-~..~.Z ......... ~r ~'s ~ ~ ..................... '. ~ti~ of 1~ ~ ~i~ ~ ~rk ~11 ~ ~ ....... ~:...fd~. ......................................... ............................ ................... ~, ,~ ~ ~. ,~ ~,i~ ..~e,.( ........ ~ ...... ~. ........ ~ ..... ~.~ ~vi~ .. ~/~/~. ~¢~ ............ ~,~ ~ ~ ................ ,~ ..~-.~... (~) 2. State o~sti~ ~ ~ ~ of ~i~s ~ inte~ ~ ~ ~ of ~o~ ~st~tim: ~HyAT~ ~ a. ~sti~ ~ ~ ~ ............ 'V" 'V' "5 ............ fl" '~V~ }L:~.5~;,VO",'-,':~'V~6~ ..... b. ~t~ ~ ~ ~ .... A'A~IVd.'.'..f ;:: ........................ ~.,~$t~i~eI. ...... 9= I0. II. 12. 13. 14. 15. l~tnre of ~ork (ct~c.k ~l:id~ applicable): 1~ Building .......... Addition .......... Alteration .......... Repair ............ lZ~nnval ............. Demolition ............ Other 14ork .................................. .(Description) Estimated Cost ......................... fee .............................................. (to be paid on filing this application) If ck~elling, no~aer of d~elling ~mits ............ llu0/aer of d~elling units on ead~ floor ................ If garage, ntmt)er of cars ...................................... If Ixmisess, c~mercial or mix~l occupancy, specify nature and extent of each type of use ...................... Dimensions of existing structures, if any: Front ................ Rear ............... Depth ................. Daight ......................... l~her of Stories ...................... l)in~nsiona of sam structure with alterations or additions: Front ............... Rear ............... Depth .................... Height .................... Nc~her of Stories ............... Dimensions of entire ne~ construction: Front ./xz~ ........... Rear ..//.~. ......... Depth .. ~.~.Zx. ....... lleight ...... Z~ ................ l~ber of Stories ....... fi. ............ Size of lot: Front .................... Rear .................... Depth .................... Date of Purdmse ..................... Nam of Former O~eer ........................................ Zone or use district in ~hich premises are situated ...... /~l~fd.~.~- · ....... Does proposed construction violate any zoning 1~, ordinance or regulation: ............. -,' .......... 14ill lot be regraded .................... I4ill e_~eess fill be ronoved f-ro~ premises: ~.S ND ~s of O~r of ~ses /m~..f.r.Z~.e.,. ........ ~ress. .~..../: ..... Ee/' ~¢t. n~ ~o .......... ~m~ o~ ~-O,i~e~t £X/~XP.Y...~..~S./. ................. ~ress m/~. ~/?...-5-~-.~.-//.~-~e--/- P"o~ ~o .............. ~ of ~r~tor ,O~X,.,,~X~..,.,.~~-...-. ........ .... ~- ..... Is this property within 300 feet of a tide1 ~tland? * ~ .......... bi0 .......... PLOT DIAGRA~ locate clearly and distinctly all buildings, x0hetimr existing or proposed, and indicate all set-hack dimensions froo property liees. Give street and block r~mher or description according to d~c~, and r~ho~ street nares and indicate x~bether interior or corner lot. ~FA'IE OF EI~'M GLI.1R l'f {~ ....................... .......................................................... being duly ~n~, deposes and says that he is tim applicant (bIare of individual signing contract) above hated, lle is the ................................................................................................... (Contractor, ngent, corporate officer, etc.) of said o~aer or o~ers, and is duly authorized to perform or haw perforn~d tim said ~ork at~] to make and file this application; that all star.rents contained in this applicatiou are true to the best of his kno~led~ and belief~ aM that the ~rk will be perforn~l in tbe maturer set forth in the application filed there~rith. B. IZABEI~ A SI'ATHI8 NOTARY PUBLIC. State of New Yc,~ No. 01ST6008173. Suffo~ P-dZu~f