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Home My WebLink About24075-Z I~OR, M NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 24075 Z Rev. 6/30/80 FORI4 NO. TOI~N OF SOUTltOLD BUILDING DEPARTI4gNT TOI~N HALL SOUTUOLU, N.Y. ! 1971 TEL: 765-1802 A~PL/ICATION FOR BUILDING PER~IT INSTRUCTIONS BOARD OF UEALTH ............... 3 SETS OF PLANS ............... SURVEY ........................ CB~CK ......................... SEPTIC FOI~4 ................... NOTIFY: CALL .................. ltllL TO: .................... · Date ................. 19 .... a. This application mast be c~mpletely filled in by typ~riter or in i~k and sul~itt~d to tbe Building I~peetor with 3 s~ts of plans, ~urate plot plan to scale. Fee ~cordir~ to sd~dule. b. Plot plan sl~rlng location of lot and of Imildi~s on v,~ses, relationship to adjoining ~,~ises or lmblic st~ts or a~as, and giving a d~tailed descriptio~ of layout of p,u~erty rmst be dr~n on the dia~r~ ~ich is Imrt of this application. c. T~ ~ork co~d by this a~licatio~ may ~ot be c~,,,e,~-d befor~ issuance of Building Permit. d. UlXm ~w,,~al of this application, ~ Building Inspector will issue a Building Permit to tbe applicant. ~ p~it aball be k~pt on t~ p,~iees available for i~spectian throu~l~ut the ~rk. e. No lmilding shall be occupied or used in ~,~ole or in part for ~y pm-poee whateeer tmtil a Certificate of Occt~a~cy shall ~ berm granted by tl~ Buildi~ Inspector. APPLICATION IS ~ ~ to tl~ Building Del~t for the is~ance of a Buildi~ Pemit pursuit to the Building Zo~ Onli~m~e of the To~m of S~thold, Suffolk C~mty, l~v York, and oth~r applicable La~, O~inm~es or Regulations, for the constmctio~ of Imildi~s, additions or altoratio~s, or for .~al or rk~lition, as berein described. Tee applicant ~ to c~ply with all applicable l~s, ordinaries, Imilding ande, b0using cede, ~ re~ulatians, and to ~r~t auti~rized inspectors on pmais~s and in Imilding ~or necessary iusl~ctions. (Sisnature of applicant, or na~, if a corporation) (l~iling address of applicant) State ~aether ~pplic~t is ~or, lessee, a~mt, architect, e~ir~er, ~ral ~tr~t~, el~trici~, pl~r ~ ~il~r. If ~li~t is a ~ati~, si~ of ~ly ~i~ offi~r. ............. (~ ~ title of ~te offi~r) Builders Licimse No .......................... Plt~bers License No .......................... Electricians License No ...................... Ot~r Trad~'s Lic~s~se No ..................... I. Location of lard on ~/aich proposed ~atk will be doue /~-~/0 ~,Z-Z~-Ji/d/ .~...0,./~.,/'~ . a/. .............................................................................. ttmme Nmi~r St~et llamlet mO No. O00 S tlon. ........ Bio&. ............ ..3..2. ........... 2. State existing use ami occupancy of p~is~s and intended use and occupancy of proposed construetiou: a. Existing us~ Bud occupancy .................................................................... b. Intended use and occupancy ............................................................................. 3. Nziture nf ~o~k (d~eck uhid~ al~plicable): ~ l~Jihling ......... Addition .......... Alteration .......... I~ir ............ ~al ............. l~liti~ ~ ...... Other ~ .................................. ~ripti~) 6. Esti.~t~ C~st ............ ~ ........ f~ .............................................. flb~OLl~/~ ~ ~l~ ~, ~, (to ~ ~id ~ filing this'a~li~i~) If garage, mnimr of cars ...................................... 6. If lxmi~ss, ~mrcial or mi~l ~oq~, s~ei~ ~ture ~1 ~tenE of ead~ ty~ of m ...................... 7. I)i.~nsi~m o~ ~isti~ stnrtu~s, i~ any: Fret ................ ~ar ............... ~pth ................. I~i~lt ......................... ~mimr of Stories ...................... l)i~i~m ~,~ atn~re oith alterati~s or ~iti~s: Front ............... ~ar ............... ~pt, ..... :. Yg.~. J..~. mig,~ .................... n,,i~ or sro~i~. ............... 8. Diuensi~ of*~im m,~t~i~: l~t ................ ~ar ............... ~pth .............. . ~.'.~ ......... ~nlmr o~ S~ories I~i~tr *~ ' '~'~ ..................... ,0. ...... ................... II. 7~ or u~ district in ~,id, pr~i~s a~ si~t~ .... ~(~.~ ~(.~.~ ................................... 12. ~ pro~m~l c~mln~ti~m violate n.y zxming hm, ordinance or regularly,: ........................ 13. 9ill lot I~ r~rm~ .................... ~ill ~ess fill Im r~l fx~ ~i~s: ~ ~ ~ o~ Ar~xit~t .................................... ~lress .............................. ~ ~ ............... 15. Is this p~r~ ~ithin ~ f~t of a till ~rl~? * ~3 .~ ....... ~ .......... PI.OT DIAGRAH locate clearly and distinctly all buildings, ~hether existing or proposed, and indicate all set-back dimensions f~a, property lines. Give street and block nmimr or description according to deed, and sl~a street nmaes and iv~licate uhether interior or corner lot. ss / c?~ ........... ~...(..5. .............. .~...~. ................ I~ing ,h,ly ~n,, depots and mqys that Im is tim appZitm,,t (~ of ilxlividtml, signing c~tract) I~ is the .~.~~.:..x~..r ..................................................................... ~ ,~,t~ct~nt, ~r~rate officer, etc.) of ~id (~r or~a,~ is (h]ly ~tlK)ri~ to perfom or h~ perfo~ tl~ ~i(I ~rk all to m~ a[xl file this al~)lication; that all stata~nts c(mtai~ in this al~licati(m are tn~ to the Imst of his k~l~m and Imtiefi that tl~ ~)rk will I~ ~rfot~l in lira ~m~mr ~t forth in O~e al~lic~ti~) fil~ tire--ifil. f~)m to Imfe~ ne this (Sight:ute of A~licant) plml~V~~Nsw W'k ~