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Home My WebLink About19245-Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:2 Exmnined · .-~. -1~.~.., 19~.~. Approved .......~.~.~ ~..~.., 19~ .~.Permit No.I .~.~.~."~. Disapproved a/c ..................................... ................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 'BOARO 0F ttk^Lf~ ............ 3 sETs o'~dAaN~ ,'aS;~ ...... SURVEY ..'~-: .... 2~%~6~'/ ............ CHECK ....... SEPTIC FORH ..... ~ ........... NOTIFY CALL · · .~. · · · 7'. ..... .~ ...... MAIL TO: a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~ets 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 laYout of properW 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 4ull 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 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 Building Zone Ordinance of the Town of Sbuthold, Suffolk County, New York, and other applicable Laws, Ordinances or Re=ulations, for the construction of buildings, additions or alterations, or for iemoval or demolition, as herein described. i'h¢ applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to ~dmit authorized inspectors on premises and in building for necessary/~.spection% c ,~.4.~..g(~.. .~g.~,.: ~ ............. __~, (Sign~ature o? applicant, or name, if a corporanon) / joo-:o ~ · (J .... .Jj ........ ~, ................... ~ ....... ' (Mailino address of applicant) , ~tate whether applicant is owner, le,ssee, agent, architect, engineer general contractor electrician, plumber or builder. ',",me o f ow ncr o f p re m ises ,-%/.u, ~a-,4~./-/. utt.~:'.~: ~. ~__.,~,-,-,.A') -. -12.%'9.g-v. .//57. 407 ........... (as on the tax roll or latest deed) l:' ::?plicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. Plu,nber's License No .... i8/< .~.. :' ./"7. ........ Electrician's License No... ]. ?..~..f ........... ther Trade s L,cense No ...................... O' I },~,.~ ~~ Location of land on which proposed work will be done... ~~~--.. ~.~.t~:..~. .... · ..................... llouse Nu,nl;:r Street ' ' J~q;,nlet ~.~ ............... Co,,nty ~.-,× ~,a,, So. I000 S~ction .... .q. 0 ......... : ~loc~ .... 0. &--. ,.O.O. ..... Lot..0..O./.: .O..O.... ,u...' · ....... bd,,,s,on.. ~.~t~,.e...//.~. ............... ~i,ed~,ap~o..~..?.6/; ~ot, [~. (Nan, e) State existing use and occupancy of.?emises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... .%...;..-7T':.. .... ;. ~ ....... ~.. ..... //~. ...... ~ ..... . .................... o=,.,,,, .... /.. ........... = .... 3. Nature of work (check which applicable): New Building .......... ~ Addition ........... \Iteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimate'd Cost.. ~...~..4//. ~'..D~,.a. op..~...~...z//. ~.~-J~¥/~0. .... *o Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units . .x.~ .~. ......... Number of dwelling units on each floor .~... ~ ....... Ifgamge, numberofcars ...:..' .................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .... ~ ................ 7. Dimensions of existing structures, if any: Front ...... ~ ...... Rear ..... .-z". ....... Depth ............... Height ....... ~ ...... Number of Stories Dimensions of same structure with alterations or additions: Front ...... ~ ........ Rear . ~ .............. Depth ........ ~ ............ Height ......... .--:., ......... Number of Stories ....--~'~.. . , , 8. Dimensions of entire new construction' Front ~ 5~- O ~ ~,,r 'X ~-'-:'o n. _',~.' '.?' '4:--' ~ ........ Hmght ............... Numb rot Stones / -' /. / 9. Size of lot: Front 5~,'~...7.~..-..0 ........ Rear..t~-d,~,... 7.o<-_ .--:-.Q .......n~,,tt, /?2r~.f.. ?.~."~. '--'~ .... I0. Date of Purchase . ..d...//.~...,./.:l~) ........... ,.,N~an{~o~ormerOwner I I. Zone or use district in which premises are situated...Z"/./.2. ................. ~. ........................... 12. D.o. es proposed constructio/n viol.ate ap~zoning law, ordinance or regulation: ~ ....................... 13. Wdl lot be regraded . ,,."'~[t.~ ..~, .... .,.. ~... Will execs fil_l be~remoyed from premises: Yes ,/' 14. Name of Owner of p~re.misexr.~)~..'/t.~C{'./~ 2/t~ ",g~{4. Address .~.55.--t/_~a~sfT.'r/~f.r~ .~'. Phone No. 2&-./'; ~-.7.[./ ...":~.. 15.Is this property located within 300 feet of a tidal {~etland? *¥gS .... *If yes, $outhold Town Trustees 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. 1~{'~6~6-,~ '6 STATE OF NEW YORK_ . ~ _ <°F .... / (Name of individual signing contract) ' ' ' ,~bove named. is the ..... .... .......... ' ............................ (Contractor, agent, corporate officer, etc.) ..... of said owner or owners, and is duly authorized to perform or have performed tile said work and to make and file this npplication; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in tile manner set forth in the application filed therewith. Sworn to bet'ore me this :: ....... 1.[~2.~~ ........ day_of... ~../~.//~ ......... !~/ No(a~ ~ s~ of N~ Y~ ................................... Ho. 4755734 OJ~fl~l In ~ 0~ (Signature of applicant) com~m E,q~ Hov.~ le,.~