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Home My WebLink About25362-Z ,-~, - · IfOflM Ne, 1 TOWN QF SOUTHOLD · BUILDING DEPARTMENT ~ TOWN HALL SOUTHOkD, N,Y, 11971 ": TE~d 7.65'1803 i~nn d..a,.,.rove_ a,c/ ,',. ,, ..... ,,,,, ,,, ,.,,, , . pat .... , ]9 2'8 INSTRUCTIONS - · : a. This application must be completely filled in bY Wpewriter or in ink ~nd ~ubmttted to the Bhilding Insp.ector, with 3 cs of plans, accurate plot plan to scale, Fee according to scheduler...~ b. Plot plan showing location of lot and of buildings orl pr¢l'ols~s, r~!atto~shlp to ~djoinlng premises or public areas, and giving a detailed description of-layout of property must b~ drawn on the diagram which is part of this appli- tion. c. The work covered by this application mii~, not b~ co_'mm~r, ced before issuance of Building Permit. d, Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant, Such permit ~11 be kept on the premises available for inspection throughou~ the work, e, No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy ]I1 have been granted by tho Building Inspector, AP~L, ICATION IS HEREBY MADE to th~ Building Department for the issuance of ~ Building Permit pursuant to th~ ildin~ Zone Ordinance of the Town of Southold, Suffolk County~ New' York~ ~d other appli~abl~ Laws, O~dinance. s o~' gulations, for the construction of buildings, additions o_r alterations, or for r~m~wal or demolitio,, ~s her~irl d~.scrib~, e applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and r~gulations~ and to mit authorized inspectors on premises and in building for necgss~t7 inspeNions? · ~ ~ --' (signature of ~pplicant, or name, if a ¢orpor~ation) (Mailing address of ~pplicant) ate whether applicant is owner, lessee, agent, architect, engineer~ general contractor, electrician, plumber or builder. .................................. ....... , ......... , .................................. ~me of owner of premises ..... ' (as on the tax roll or latest deed) applicant is a i:orporation,.signature of d. uly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumb~r's License No ........................ Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be' done .............. , ............ 5 o..q .cO. .ep,. ~ B .~. . .ctA~. : . . , . .p..~. . ~ ........ c c o a u ~- ............................. .~. ,~..,, ........ , . .., ....... llouse Number Street H~mlet County Tax Map No. 1000 Section .. II~ Block . · ' ' Lot ~ Subdivision ..................................... Filed Map No. ,,.,,;,,; ..... Lot ............... (Name) ,~, ,'. ,x~,: · State existing use and occupancy of premises and in tended use and occ. upan.cy of proposed construction:. a. Existing use and occupancy .. I, .4 .~., ,S.TL?..~5t. . ,xS~, ,t~.m:,' ,6,..lrt,oq..g~,, F./~.~. ?.0. ,g~.'. ,..~ ~ ........ b. Intended use and occupancy ...OC~. , ~OU~i~.PitTf ,IDI~ . .~, . .6f.~. , . .t~0. 0. -?.~. ........... 1, 11~ .... 3. Nature of work (check which applicable): New Building., ,', ,, ..... /~dditi0l~ , ' ' ' Repair .............. Removal' . ............. Demolition ......... .Al tc r a t ~'~*~occo-~_ .... ',',..;. ·. Other Work. 4 Estimated Cost .'~.].0, ,,.~.., ' (Description) 5. If dwelling, number of dwdling units .... ~?.~. Number (to b0 paid on filinl; ~hjs application) lfgarag numb of ....... ofdwelling units on each floor · e~ er CaxS ,.,, ..... ,, .... , ..... ~ . . ,.,,,. 6. If business, commercial or mt.xed occupaney, specify ~, 7. Dimensions of existing structures, if any: Front , .~, atq~¢ and extent of each [y, p0,0f 0se ,.,,,, ..... ~' ' t, , - ,_ . ,,,, - · ...... Roar ,,,z<0. ,.~.; ..... Depth ,~/.~.~' _e~ght . ,~.'~/ .......... Number ofStodes , ..... ,I, , ~t,.tr~ , 7_._. , ' ..... imensions of.sa,me structure with alterations or addit; .... 'd,~,'. '''"" '~ .................... ~ ,d(,i,,I ........ ~epth ..... ~/.'~ .-O~. i~ ,., .... --. -,,,,t ,, J ; i i. Rear .,.~,-0. ........... Heieht gq! . '" , ..... , ................. '..'Number of Stories .... I, b.~.~. 7_,'~. , . 8 Di i f ntire new¢ nstruction Fr ' · mensonso e o : ont,,,,,,, ........ .Rear D pth Hight . Numbe fStories , ................ ¢ ........... 9. &ze eliot: Front .... ~*,0, ' 'Rearl ~7.'~?o'.''" .............. ~',~'~i ............. 10 ............... '' , ................ Depth Date of Purchase .................... . ...... ',,, Na~0~0/~Former Owner 11. Zone or use district in which premises are situated .... ,, ,~ ;'r , .............................. 12 Does proposed construction violate any zoning law' ' ' ............. ordinance or regulation; 4/~ 'i .......................... 13. Will lot be regraded .... v. ~-.~.. .................... Will excess fiji be removed from p,r raises' Y s 14. Name of Owner of premises ~,~0-,¢,0,. $6-T, ,~,-Jq~ ..~ o_./~ n'om ~ a ' ¢ ~) Name of Architect ..'~, l~,,~, g~r~o,t~ ............. ~,uuress ,~O!' ,~P,q.. ~H,§ ~ I,~7.~ Phone No, ,?,- {B~-~,C?<,/,~. ;... Name of Contractor . ,. 9~.~, ,c-'~.;. ,'~, f~r~¢.¥, . · , ,,.,Adclres~ ....... , ,, .... ,.,,,,Phone'No, -. ........... 15. Is this property within 300 feet of a tidal {/~gla~d? ~¥es,,,~,,, No,, ..... " · *If yes, Sou;hold T,own Trustees Permit m~Y be required,' ~-??'AC~ '" .... _ . PLOT DIA~GRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicar~ all ~'et-Oack dimensions from property lines. Give street and block numbor or description according to deed, and show street names and indicato whether interior or corner lot. ' - - TATE OF NEW VO~g, 'OUNTY OF...:~.~ ~ .... S.S (Name of individual signing contract) ~ove named. being duly sworn, deposes and says that lie is the applicant is the ......................... ~6,~0~,' (Contractor, agen.t, corporate officer, ere,) ............ said owner or owners, and is duly authorized to perform or haw performed the said work and ~o make and file this )plication; that all statements contained in this application are true to the besl; of his knowledge and belief; and that th~ ork will be performed in the manner set forth in the application filed therewith. .yom to before me this .......... ¢0 d. ........ ..... , 'l atary Public, ~..~. ~. ,,,, ,~ ~, .'~,~'Cou nty ,' (Signature of applicant)