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Home My WebLink About19247-Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c .................................. .../('-', APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF ~EALTh ............. 3 SETS OF PLANS x.~ ....... SEPTIC FORM ~" 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 layout 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 shall 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 shall 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 Regulations, for the construction of buildings, additions or alterations, or for ?emoval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessarg~h..spections ............. .._~, (Signature of applicant, or name, if a corporauon) / " Iv'"' State whether applicant is..own.er, lc?see, agent, architect, engineer, general contractor, electrician, plumber or builder· ,',[ ). o': . . . :: ,.-:'.'., ..... · ...... .--: . '...-. :,.,... ,'.".. 0. .-". .............. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. Plumber's License No .... Lff/.~.. 7.: ........ Electrician's License No... I ?- .~.-.~- ........... Location of land on which prop?ed work will be done/',, ~ ~ff~~..... ....................... ...... House Number Street tJt-lamlet C/ ....... County Tax Map_No. I000 Section ..... qQ ........ : Block ....(~.~. ~.(~.O. ..... Lot..t~..O./~..~..(?. Subdivision.. ff~Y~J:'.~d//Lg.../~.(1~.. · .............. Filed Map No.. ~.~..~. .... Lot~ .~.,/~.. t.,- (Name) State existing use and occupancy of~psemises and intended use and occupancy of proposed construction: a. Existing use and occupancYb. Intended use and occupancy 3. Nature of work (check which applicable): New Building .......... Addition .......... .~teration .......... Repair .............. Removal .............. Demolition .............. Other Wo~:k.: ............. (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling units . .-~ .~. ......... Number of dwelling units on each floor ' If garage, number of cars ... ~ .................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . ..--7'77.. ................ 7. Dimensions of existing structures, if any: Front ...... ~ ...... Rear ..... .=-7-. .......Depth ............... Height ....... ~ ...... Number of Stories ~ Dimensions of same structure with alterations or additions: Front ...... ~ ........ Rear ~ Depth ........ .".. ...... ; ..... Height ......... -Tr..~ .......... Number o,f Stories ....---~-. ....... , .... Dimensions of entire new construction: Front...'~ ~.0: .... Rear .. '.~ ~.'~.-. Q ......Depth . ~, ~?i .tgl 'i i i .... Hmght ............... Number of Stories . . ./. :~ . . / ~. .......... / ,, 10. Date of Purchase ...... /.~.../. l0 ........... : ..Name of Former Owner .~4~ .~. t~.~4M.~t~:~ .......... I I. Zone or use district in which premises are situated...~/./~. ................. (.7.. ........................... 12. Does proposed constructio/n viol.ate arc, zoning law, ordinance or regulation: ~<ff4'..~. ....................... ~ 13. Will lot be regraded . ,../~tS~O. fC~i~ ~ ',' '~ .... ~... Will exce~s fill be, rem~ed from premises: _ ,- Yes f No) 15.Is this property located within 300 '~eet of a tid~ll'~;}'l'~nd? *YE'S.'.J[~I~'.~'.':. *If yes, Southold 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 coruer lot. · 8. STATEOF NEW YORK~ ' S S C5~ OF .... ~.C"-'(--i~-ol ~ ' ,~ / (Name of individual signing contract) ..... above named. tte is the ..... .~..6~..zS/~ ~ .... . .~.o. ,z,¢/.-'~..~ .~ ¢-.=JT. O. ~ .......... ' ........................... (Contractor, agent, corporate officer, etc.) ...... of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; 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 the manner set forth in the application filed therewith. Sworn to before me this ......... ......... .... ........ ry blic .... (M?0~ 4,~-r,--~-~.. ~ .... County L/ I~ P~, $~ of N~ Y~t ................................... No. 47.~/34 OJaiflgl la ~ Om~ (Signature of applicant)