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Home My WebLink About19261-Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:2 ..... APPLICATION FOIl BUILDING PEIll'411T INSTRUCTIONS No~I~¥ 4/"~ (7 CALL ..................... MAIL TO: a~. ~~ ~.~ 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 ~hall 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 lluilding 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 removal or demolition, as herein described. i'l,,e 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 necessaryTnspections. ~ , ~ z2,L/. :.c..~.~'~': ./d,'~- ~, ~:~ ............. __0, (Sigaature of applicant, or name, if a corporanon) 1 " ' '~ '1"7 7 5tare whether applicant is owner, le,~see, agent, architect, engineer, general contractor, electrician, plumb~'r or builder· - ............................... ......................... : ......... ; ..... :..,~ ........... . (as on the tax roll or latest deed) [:' a;,plicant is a corporation, signature of duly authorized officer· (Name and title of corporate officer) Builder's License No .......................... Plu,nbcr's License No .... /8/. ¢ · ~'.: ........ Electrician's License No... I ?..~..f ........... Other Trade s L,cense No ...................... ,.~ · ..................... ............... ilouse Number Street u'Hamlet /~ ~ , ~ , ' ._~,... s.~,~,~,~o. ~:~¢~.:~:~: .............. ~,.d~,~o..~.¢.d: ~o,S~.:.~.¢... ' ' /~ (Name) ....... State existing use and occupancy o¢premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... "-'' ' '-- _ ,- t'~. ' . ~.4'''--77:" .... ; '~ ....... i.' ......' i ...... ~ ...... ........ . ............ ',. ',,,e,,,,e, ,,,, .... /.. ................. //6/¢ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... //r'~ ~o ~ ~.~,__ (Description) 4. Estimate'd Cost .. ~...~..3(. 7.~.a..o.o..~. ...... .~ '5~-~.a~.....°° Fee ...................................... .~ (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. Dimensions of existing structures, if any: Front ..... :. ·: ...... Rear ....... -~. ...... Depth · " Height ....... ~ ...... Number of Stories Dimensions of same structure with alterations or additions: Front ...... ~ ........ Rear ...---~ .............. Depth ........ .'7'.. ............ Height ......... .-z..,.., ........ Number of Stories....-~. ..... . ,, 8. Dimensions of entire new construction- Front -~ ~ O' n~,~ 'X ~7'--"o r~., 4 k:--' b ....... Heieht .............. Numbgr of Stories / --~,~ I /. · ~ ~ ' .... /'-:' ...... t"'t~'- ......................... ~4' · .'..ti .... 9. Szzeoflot Front/2~...7.~..~.O ....... Rear ~ ~-O n~,,th /)~..-a'~- 10. Date of Purchase ...0.. f./..~/./. :~0 ........... ...,N~an4~ of Former Owner .~4~ .~/. ,"~'~;}~ ......... . I 1. Zone or use district in which premises are situated...W'/L). ................ LT.. .................... 12. D.o. es proposed constructio/n viol3te ag~ zoning law, ordinance or regulation: ~ ....................... 13. Wdl lot be regraded . ,,./~a:LA~£~.g,a yy '.,' ' ':" "' ' ' Will excess fi[l_be~ remoyed from premises: Yes 14. ,N. ame of Owner of pnretmi,sef~?,0'J,..~-~.',: ~'~e3,~{,(.. Address ,.~,~.f..--t;ttdf~.z(.~ff/j. gf..~. Phone No. ~.~.c-./.-~.7// r~ame of Architect (.5/~43~d/.~f,,d2;4,~,.<~. ......... Address ~,-~l~JCft.4.,f..0~..~-t~- Phone No q~'~'." d4'44" Name of Contractox7/4.)~,....{~/24'~.~ ~.'... Address~-~z~i~i~ i i i Phone Nol i~.'~5~, i ~.~'.'~'.' ~ 15.Is this property located within 300 feet of a tidal ~etland? ~¥BS .... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buddings, 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 comer lot. ST.-\TF~OF NE\V YORK.~ _ S S , ' ":~'~~' ~~~~ ......... being duly sworn, deposes ~d 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 performed the said work and to m~e and Hie this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work will be performed in the m~ner set forth in the application filed therewith. Sworn to belbre me this ......... ......... .... ..... · ~ blic .... ~ ~.. ~ .... County ~ ~ ~ ~ (Signature of applic~t} .3AINO ~0731_.-I~IV03~