The URL can be used to link to this page

Home My WebLink About19263-Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined....~.~P~.~., 199.O. Approved .~]~.~.~i 19c~.O. Permit No. } ?.''% "~' ~.~.~ Disapproved a/c ............................. ...~ (Building Inspector) ~PPklC~TIO~ FO~ B~I[~I~G PfiBMIT BOARD OF,--HEALTH . ~ ............ 3 SETS .... SURVEY -~-~-...I.. ~~.. CHECK ....... . . . . SEPTIC FORM . INSTRUCTIONS CALL ..................... MAIL TO: /OO- 30 x~. "~(,5~dfl-~/? ...... 19¢~ 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 S0uthold, 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 necessaryTnspectionst ~ , _~, (Sigrt~ture og applicant, or name, if a corporanon) 1 joo-. o t~' (Mmhng address of apphcant) State~,'.whether applicant is ,owner,, // ,~le.ssee, agent, architect, engineer, general contractor, electrician, plumb'e'r or builder. Az "; .... :');';E';";"," i5 ......... :i ........ ;' ................. Name of owner of remises "/..'c, m-~-ef~.~.~. ZC 2 i¢.,...~/, - 7~ ~._~;,.C - .. P ....................... ./.~. ..... ~. ~..'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 ....... ~. .................. lumber s License No... " Other Trade's License No. :T...~['. ............... 1. ocation of land on which proposed work will be done... House Number ' ' 'k;r;;; .............. t,Uamlet L/ ............... 1~ (Name) ..... 2. State existing use and occupancy of premises and intended use and occt, pancy of proposed construction: 3. Nature of work (check which applicable): New Building .......... Addition ..... ~.. i. ~ Alteration .......... Repair .............. Removal .............. Demolition ............. '. Other Work ............... (Description) .~ (to be paid on filing this application) 5. If dwelling, number of dwelling units . .-~ .7 ......... Number of dwelling units on each floor ' If garage, number of cars ... :. ".. iu' .............................................................. 6. If business, commercial or mixed occ pancy, 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 sam~_e structure with alterations or additions: Front ...... ..-7'7. ........Rear . ~ ......... Depth ...................... Height ......... ."7': v .......... Number of Stories....--~-~.. ,.' .... 8. Dimensions of entire ne~v construction' Front ~ ~ O" p~ ·X ~7'--"o ~, .,' ' 'd 2--' h"- ....... Height ............... Numbgr of Stories / -~ ! z - Date of Pu 0 / / · ~, · OJ ~-- ' ........ rchase 3 ~0 Nam of ' " 11. one or use restrict in wnicn premises are situated...fi;/./.2. ................. G~. ........................... 12. Does proposed constructio~n violate ar3~7 zoning law, ordinance or regulation: ,.~. ~. ....................... ~ 13. Will lot be regraded . ,,./,~xt~t~h, ~t~/~L~ ?:y ;''"'" ;''' Will exce~s fill be,removed from premises: ~ Yes f No) 14. Name of Owner of premisea/.~)0?.'5-~f6~. ~-~t~£~tlZ Address ~,f..-t~afaAzf'~.,~ ~,r~,-/ Phone No ~.5-/- ~..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 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 comer lot. STATEOF NEW YORK~ ' S S . (Name of individual signing contract) .......... above named. lie is the ..... .~..~../~. _t~- & .... . .~.O../,q..-'~..~ .~ r,2~JfT-. ~. ~ .......... ' ................................. (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 ~he work will be performed in the manner set forth in the application filed therewith· Sworn to before me this I.[.."~'.. ......... ...... ":'. .... : .......... OJ~llgl la Sulo~ ~ (Signature of applicant) lg~l 'ON ~! O00,%~ l.q.q?:l .40 d¥~l ~ ,l 6 'gPE .9 ,,Og ,10 .9l $ ,oo'~Z 3AI tO