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Home My WebLink About19262-Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved .~.[P., 199. 9. Permit No. l?'~.~. ~. Disapproved a/c ..................................... ................................ ... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ' 'BOARD OF ~iEA TH ............ 3 SETS OF..'~P,~.~'~Nfi /'). ~ ... SURVEY _.~¢tz..:~f~ ;'i~... NOTIFY CALL ...~.'?.? ."./..~.~.~. ...... MAIL TO: Date ~ .// ...... a. Tiffs application must be completely filled in by Wpewriter 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 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 ~hall be kept on the premises available for inspection throu~out 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 ~luilding 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. Fhe 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 necessavy,Tnspections., .......... (.'.~J-; ~,"v ~ .¢ ;~. .v? .............. _~, (Sigr~ature of applicant, or name, if a corporauon) / · o .... t? ....... ; ................... C-' ...... (Mailino address of applicant) , State whether applicant is ,..owner,. l~ssee, agent, architect, engineer, general contractor, electrician, plumb~'r or builder. Name of owner of premises .~.'. "Z ~. ~At_g./.,t) - (as on the tax roll or latest deed) h' ::pplicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... . ........ lumber s License No .... , Electricians License No.../. ?..~...~. ........... Other Trade's License No '-- - . ...................... Location of ,and on which proposed work ,viii be done... ~'-/Z'.... · ....................... llouse Num herStreet VHamlet CV " Co,nt~a.~.la,,~o.,000Sect,on ....... .qg). ..... :B,oc~ .... o.~.,.o.o. ..... ~ot 0. o/.. oo , Subdivision.. ~_4~-.g~.-~. t.g_.dd~.~.. .............. Filed Map No.. 8.?.5..~.' ... LOt~' ................ t~ (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... 5.... ~ .... ; '~ ....... /-- ,, i ............ - ............ .. ,. "..:, 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. EstimatEd Cost.. ~...~..k' .... aPO. ~ "' . L ~.5-57-~,a~O. oo 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 ........ .".. ............ Height ......... ~., .......... Number of Stories....--~-'. .......... , ...... 8. Dimensions of entire new construction: Front .. "~ ~.:.07.... Rear ..'.3 .~?'.o. ...... Depth .~ ,.'~-. :.°i. i .... Height ............... Numbgr of Stories .../. :~ . ! ....n ........................... (.., .... 9. Size of lot: Front t24Z~... 7. aa.'7.-. 0,.~ ....... Rear ~."~. '~: 5/_~-.--7.O. ....... Deptl~ .d~.,-:>~ ? ~ - rl .... 10. Date of Purchase ...0..././..3..t./. :[0 .............. Nam~ of Former Owner . fl,,~4,4 .&/. ~~31. i i i i .... I I. Zone or use district in which premises are situated...~/t.~). ................. (ff...- .......................... 12. Does proposed constructiofi violgte a,n~ zoning law, ordinance or regulation: ~ ...................... 13. Will lot be regraded . ,,.~f-~/~L~6 ./,, ........... Will exce~s fill be, removed from premises: Yes f No) 14. Name of Owner of p,,re,mi%~)~0?-~-~h;~'.(~ 20-~.~t/.. Address ,,~,f..4;~..~.g~/.~.. Phone No. ~.~.-./: ~..~z(./.'..~..~.. Name of Architect (.~.tL',~?,,fl2;db,...tV~-._;../?~ ...... Address v~,~.a-..ff-~b'~..t~..~.aP:.. Phone No..//73.h'T.. ~.q. fi. cf.. Name of Contractor'/~.J0q,4. ~.'.~...0(~A.,t%{ (".~.'d.4... Address ' ~.augd~. jIf.~.~... Phone No. -q- Y.7. ·/.~ 15.Is this property located within 300 feet of a tidal ~etland? *YES .... NO.M'.}. · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate cle~ly and distinctly all buildings, whether existing or proposed, and. indicate aH set-back dhnensions from properW Hnes. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ,~/~ 0~ STATF..OF NEW YORK.. _ _ S S / COUnTy OF .... ~.c'.+:¢.'o~./~.. ' ,q ; ·: :~' ~~-"0' '~ -- ~C-~-~.~? .~- .~'.~.d-'. --?~. · .......... being duly s,vorn, deposes and says that he is the applicant -' (Name of individual si~,ning contract) above named. ..... .... .......... · .................... :o(C ntractor, agent, corporate officer, etc.) ............. of said owner or owners, ~d is duly authorized to perform or have perfomed the said work and to m~e and file this 2pplication: that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work will be perfo~ed in the m~ner set forth in the application filed therewith. ~ Sworn to before me this ~ ..... ·"7 ........ · ' ~ Public .... ~ ~.. ~ .... County ~ ~.8~a~m ................................... N~ 47~ ~fl~ ~ ~ ~ (Signature of applic~t)