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Home My WebLink About26062-Z FORI. I NO. TONN OF SOUTHOLD BUILDING DEPARTHENT TO~IN HALL SOUTHOLD, N.Y. ] 197! TEL: 765- ]802 BOARD OF HEALTH ............... 3 SETS OF PLANS ............... SURVEY ........................ CHECK ......................... SEPTIC FOR)t ................... NOTIFY: Dis~pp~l a/c .................................. CALL .................. biAIL TO: .................... APPLICATION FOR BUILDING PEP&lIT INSTRUCTIONS Date ................ ,19 .... a. This dpplleatlon'~ --~letely filled in by type~iter or in ink and submitted to the Building Inspector ~cit 3 sets of plans, seeurate plot ~lan to scale. Fee according to schedule. b. Plot plau six~iug lonation of lot and of buildings on premises, relationship to adjoining premises or public streets or mas, and giving a detailed description of layout of property ramt be draun on the diagran which is part of chis application. c. ~he ~rk covered by this application ~y not be eumeneed before issuauee of Building Pemit. d. Upon ~pp~oval of this ~pplieation, the Building Inspector trill issue a Building Permit to the applicant. Such permit ~all be ke~t on the p,'~ises available for inspection throughout the ~ark. e. I~ building fimll be oocupied or treed in vahole or in part for any purpose whatever until a Certificate of Occupancy shall hav~ been granted by the Building Inspector. APPLICATICi~ IS ~ ~ to the Building l]el~,~nt for the issu~mee of a Building Pemit pursuant to the Building Zo~ Ordimmee of the To~ of Southold, 9uffolk County, Ne~ York, and other applicable La~s, Ocdinances or P~ulations, for the eeustruetion of buildings, additions or alterations, or for remaval or den~lition, as herein described, abe ~@plieaut agrees to e~ply ~dth all applicable la~s, ordinances, building code, housing code, and regulations, and to mimlt authorized inspectors on premises a~d in building for necessary inspections. ~.~z./z.~....~&~.~..~./../c.~.~ .... (lqailing address of applicant) State ~nether applicant is o~er, lessee, agent, architect, engineer, general contractor, electrician, phl~er or builder. ........ z~.~ ./ ..................................................................................................... ,,,..., of ~t of pr,,,,,se, .... ~x,*.;.....d~,~.~ .... .zz..°/..d..'..'-',r,...~'..:z ............................................. (as on the tax roll or latest~'deed) If apl~lieant ia a corlao~_ .ti~, signature of duly authorized officer. ...... ............... (Nam ~ title ol~6rporate officer) Builders License No .......................... Plmtaers License Ilo .... ~r~ ~..ff../...~. .......... Elect~ia..$ Li~ ~o..../~. ~[ ......... Other Tra~'s License No ..................... ,. ~tion of l~ on whith p~ ~rk ~ll be ~ ....... ~L-.:...:./..ff[. ......................................... ~ . $$~- ~'-/~ . , . ..- ../__- z / ... ~ .......... ~/. ~.~.,r.. L,2,~ .Z'. ............................ 6:.~. ~y~../. ........................ Bouse Nm~er Street lt~det ~o~ty ~ ~,. ,~ ~tion ..Y..~,../ ........ Blo~ ...... ./. ........ ~ ..... ~.'....~.t' ~,~,,i~i,~ . . ..d//r./t/~. .,e.~ . /. ?. .~. . ............ ~iled ~ ~o ................ ,.or . .~. .zT. .-.'/ f. . . . (~--,.) 2. State oxlsting use and occupancy of pr~nises and intended use and occupancy of proposed construction: a. Existing use ~ oco,.,-lxmcy ............................................ ~.,.. ~........ ,.,, ............ b. Inteu~l~d use and occuIxmcy ............................................ .,.,.t~.,il-oa.,i. ~,!..',., ;i~ml .......... F;]t.re of work (ct~ck ~l,id~ applicable): 1~ Building .......... fiddition .......... Alteration .......... Repair P. em~al Demolition ............ Otber Work .................................. ......................... (Description) 15. Est ilmted Cost ......................... fee .............................................. (to be paid on filing this application) If &~elling, number of d~elling traits ............ N0mber of d~elling units on each floor ................ If garage, nun~er of cars ...................................... If txminesa, cum,ercial or mi~=d o~cupancy, specify nature and extent of each type of use ...................... Diwensions of existing structures, if any: Front ................ Rear ............... Depth ................. lleight ......................... blmi~er of Stories ...................... Dimensions of s~ structure with alterations or additions: Front ............... Rear ............... Depth .................... Deight ~ ................... Kmuber of Stories ................ Dimensions of entire new coostrnctio~: Front ./Z*~ ........... Rear ..//.~. ......... Depth .. ~-.~. ....... Ilei~t ...... Z~. ................ Number of Stories ....... /- ............ Size of lot: Front .................... Rear .................... DePth .................... I~te of Purchase ..................... Narc of Former Owner ........................................ Zone or use district in ~hich premises axle situated ...... z~l~ffd.~t-~-- ....................................... Does proposed construction violate any zoning 1~, ordinance or regulation: ............ '-/'; ......... W'II lot be ----nded Will e_~cess fill be removed frcm premises: YES NC) ~es o[ u~,e p .................. ~7" ~ '" 'X' IZare of Ardlitect ~/°///~Xi(2'.--ff--~ffl-/- ................. .Address M'~//~_/.~q.-..~-~-.?..~--~--/'f~'~''/~'''' Phone No .............. d. Is this pn~perty within 300 feet of a tidal ~etland? ~ ~/~ .......... NO .......... PLOT DI AGRAH Ix)cate clearly and distinctly all L-slidings, whether existing or proposed, and indicate all set-beck dimensions property lines. Giv~ street and block ~mnher or description according to d._~cd, and shc~ street nares ~ indicate M~ether interior or corner lot. .~FA'IE (~ I~%/ YORK, SS OSUN IY (~ ....................... .......................................................... being duly s~on~, deposes and says that he is tt~ applicant (Naue of individual signing contract) above hated, lie is tl~e ................................................................................................... (Contractor, agent, corporate officer, etc.) of said o~ner or o~ners, and is duly authorized to perform or have perforn~d the said work aY~l to make and file this applicati~; that all stat~,~ents contained in this application are true to the best of his knowledge and beliefi and ELIZABETH A STATHI8 NOTARY PUBUC, State of New Yodt No, 01ST6008173. Suffolk · -1'erin Expires June 8,~ that the work will be performed in tim maturer set forth in the application filed therewith.