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Home My WebLink About19242-Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Exa,nincd.-.-~,.~..~ .~-, 19~/-Q Disapproved a/c ................................. / ' ................................ .... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH ............ 3 SETS OF~ c~,LANS .... ,;.~.~-~ ..... o ...... /~ · · '.:?/~'.' ::.' h" '-' ' ' ....... t'.'..-,/.~,~~ CHECK SEPTIC FORM ..... 5.' ......... CALL ............ MAIL TO: ~'~' &~'/~, 7~'~ a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 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 streets or areas, and giving a detailed description of liwout 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. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit qmll 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 :hall bare been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of S0uthold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for iemoval or demolition, as herein described. l'l',e applicant agrees to comply with all applicable laws, ordinances, building code, housin~ code, and regulations, and to :~dmit authorized inspectors on premises and in building for necessar~Tnspections. ~ , ~ j ~4~. ,~ ¢ ¢~':/d,-'~'. ~, ~,:~.~.~~ ............. _-4, (Sign,~ture o~ applicant, or name, if a corporanon) / t5/ (.7 (Mailing address of applicant) ('J ' :tare whether applicant is ,owner, lc>see, agent, architect, engineer, general contractor, electrician, plumber or builder. ................. ,. /~/ ~ & .., ~ )_ ~ ,,. _ a. e of owner ofprem,ses...~.'~ ~.~ ~'~--1(, . . c~t~. Z. tr~.. ~-- ........ :/)Zl F .... :c~.. ~..(~ ................. (as on the tax roll or latest deed) !:' ::pplicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plmnber's License No .... /8/.~..'.'./~ ........ Electrician's License No.../.~..~..f ........... Other Trade's License No. '-- '~7~ ~-~ ~>~ Location of land on which proposed work will be done., i 7 ~. ~...~~~~ .... . .~=~ .... ...z:~-~ ...... e: ............................... ~~/[~.~:.. ~z ~ .............. llouse Number Street vHamlet ~ ' co,,tv ~, ~t~,~o.. .~ . ~000 s~,o,., ' ..... ....q0. .... ... mo,k 0 ~,.oo .... ~ot..D~/~ ~P.. ' .............. :s.q: v ]~(Name) ....... [~ "' State existing use and occupancy of psemises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ~ .... ~ .... ; · ~ ....... :.. .... ..;' ;...,. ~ ..... . .................... b. Intended use and occupancy .~.. ;~"~'-~~.~~~ ................. 3. Nature of work (check which applicable): New Building ~ ' Repair .......... Atldition .......... Alteration .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimate'd Cost.· ~...~..J('. ~..?.a.o.0..~...~...//. ~..~-$,7.e~0..0?.. Fee (to be paid on filing this application) 5. If dwelhng, number of dwelling units · ' ............ ellln n ' · . If garage, number of cars ... - --' g mrs on each floor .............. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . · .'-77T.... . 7. Dimensions of existing structures, if any: Front ...... - ......... Rear ....... -.---. ...... Depth '" Hei,,ht ................ Number of Stones ........................................................ Dhnensions of sac_me structure with alterations or additions: Front ...... ~ ........ Rear .: 7'. .............. 8. DD~mPtehnsions of entire nexv const~t}~ed~g~t''' '% ~ ~:, ..... ..[.- Num?e~_~,f~Stories.....--~-. ......... ..., ....... · · · .-~ --- · -,~ ..... t~ear ...~ ....-.c! ...... Depth. ,.,~ .,~.-7 .o ........ Height ............... Number of Stories .../..~ .... / ....~ ....................... >~. "~ ./.. · .... 9. Sizeoflot:Frontt2,.2~<..7.6.'~.2.0, ....... Rear ~ ~'~---O De t d,2r ........ q .... 10. _Date of Purchase ...d...//.3.././. "10 .... i .... '' Nan~'~ ~)f ro'r~e'r''~ ..... Cept~h :.~:~..~-~, ? .~ - 11. zone or use district in which premises are situated ' .j:'~/~. tJwner ./,,~¢,-tm'-'~'.. t_~-gdMid.;$ .......... 12. Does proposed construction violate an~ zoninr, I.~w' ~'-~-"-~-' ........ ,' '..' ...... CAd .......................... 13. Will lot be re,reded /,(-~ tt~/~' o -- , umm~nce or regumnon: ~ ............... 14. Name of Owner of Name of Architect ~z/~ ~t,-~,7~_D~/-~'.~..~. ....... ?~'~ th~-x-~./.a-~/t- :~&~Sf,?. Phone No. 'J,.~./.: ~-.7(]..'..'>-~.. Name of Contracto~¥~Ot/74_. ~. ~ ~ ~}~/ti ~?~;~''' ''' Phon . q<C/. · - ........ - ~ ~.~4. ..... *muress 0/~-~tMddX./Z ~- ~ ' :$ '~:" ' ' 15.Is thzs pronert*- lo¢ ,- ~ ,,~<u ~z[nzn ouu £eet oz a tidal t~etland* ~¥1~$ I~0 ~:" '' ~If yes, $outhold To~n Irustees Permit may be required. ... 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. STATE_OF NEW YORK .... :. / ~~ ~'~-'' ~rC'~/'~:(~ "~ "~'~'J'~ being duly sworn, deposes and says that he is the applicant ~ . (Name of individual signing contract) .......... above named. ' ..... .... .......... ' ................ (Contractor, agent, corporate officer, etc.) ................. of said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that work will be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this ........... ........ ........ ' ' '~'~~.. ~ .... County N~ 4~ ........................ ~ ~ ~ (Signature of applic~t)