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Home My WebLink About7594-z FORM NO. 2 TOWN OF $OUTHOLD EUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7594 Z Permission is hereby granted to: ~t premise~ Iocoted ot .... , ............................................................................................. · -. ................................................................... ,~;~.~.~..~..~.~.~..z ............................. '~ ...... pursuant to application dated ................................... f..~....q~:r.., l~..~.., and approved by the Building Inspector. Fee$ .~.Z~ ..................... ~ Building inspector ~OEM NO. I TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. proved ................... ,erm,t Disapproved o/c ........ ~.~.0-.....-. ..................................... (Building Inspector) Application No. T~'-~' ~) Y . APPLICATION FOR BUILDING PERMIT Dote // INSTRUCTIONS a. This application must be completely filled in by typewriter or, in ink and submitted in triplicate 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 ofproperty must be drawn on the diagram which is part of this application. 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 issue 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 Southold, 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. 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 buildings for necessary inspections. (Address of applicant) i I -/ i~. O State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. A6 Name of owner of premises ........ ..~.....~...!...~...~.'~ ........ ~. ........ '~.~.~:~.Z.....~ .......................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No .................. : .............................. Electrician's License No .............. : .............................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Mop No.: I I ~ ~/ Lot No. J -~-~ ....... Street and Number ............................... : ....................................... .......... ,,.,. ........................ .................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy V'..~.C b. Intended use and occupancy ........... .~.....t~....k.~. ......... .~'..'.~....~f)..!..~....~. .......... .~.~..~. ~ ...1:.?. ~..~.!.~ ............................. 3. Nature of work (check which applicable): New Building. ................. Addition .................. Alteration ................ Repair ........ Remova ................ Demolition .................... Other Work,.:t^.. .................................................. . · ~/~. (Description) · O0 4. Est,mated Cost .................... ~.......~.~. ...................... Fee ............... .z... ...................................................................... (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 ..... ..~....?.~ ............ Rear ......... (_g,.....g,. .......... Depth .......~....~:~/~ .......... £ Height .................... Number of Stories_ ............ J.. ....................................................................................................... 9, Size of lot: Front ............ .3....~,,...O.......~..~ ........ i.. Rear .......... ..~......~....'.~......~.~ ........... Depth .'.~..~(~.Z.....~.../...~.. ...... / .......................................... 10. Date of Purchase ............................................. : .......... Name of Former Owner ......... 11. Zone or use district in which premises are situated .................... ,~',..~-...~..../...~...~,..~...../,./.,,~,..,..~.,...?.,....5~.)....~..~.~ ............ 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ I3. Will lot be regraded . ........................... Will exces~s fill be removed from premises: ( ) Yes (~'No . I~h/t~l:>~'l~ ~'r ~,0~ - 0'7 14. Nome of Owner of prem.ses ,..~-. ....... ................................... Address ..~/V.~e~,~...ti~.E,i~e.k/. Phone ~o. ...................... Name of Architect .............................................................. Address ......... ??,y.~.~;....( ..... Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... 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 corner lot. STATE OF NEW Y~RK/.J,.~/ ~S~ ~ 7~/('~ * ' ' ' ' deposes and says that he is the applicom ................................ ._~, .............................................................. being duly sworn, (Name of individual signing contract) above named. (Contractor, agent, corporate officer, etc.) of seid owner or owners, and is duly authorized to perform or have performed the said work and to make ~nd file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this (SignatUre of applicant) JUDITH T, BOKEN SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services Reference Number APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE~ SEWAGE ,DISPOSAL SYSTEM AND A WATER SUPPLY 1 Applicant ~.,~::~ ,~.~,,,~,~ ~, phone Address ~ c~.~:~ ,¢~¢) ~,~.t~'~,~_~, 2. Property Location ~,,~,?,~ ~ ~,~, L>~j~ i '[ .... t 7. Lot Number ., 8. Private Well ~ ~ ~ 9. Public Water Village ~.-~' ~..~.~.~..~,,~ ~:~. Township .~..~:~ 3. Public Water ComPany Name~ .... ~ ~,, ~ :~'Distance to main 4. Lot size: Width, feet ~ Length ~ feet lO. ll. Sewage Disposal System: A. gallon septic tank: ~ / Prbc~t ~quivalent , Block B. Leaching pools: Number of pools Precast ~'0 Block Special__ I~:priva~well, fill i~n the fol- lowing blanks: A~ Tank j~Q:~pacit~ Z .~'~a'~'lons B~ Pump C. Tot~l~ wel~pth :B. gep[~ to ground water E. AmOunt of water in well (For Health :Services Dept. Use) The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health Services' current standards thereto." This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Building Department Permit is in effect. FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based on the information presented here- with, it is the opinion of the Department of Health Services that an adequate and satis- factory Sewage Disposal System and Water Supply can be installed on this plot. APPROVAL DATE /~9/z?-/? ~ SIGNED S-15 Rev. 4/1/73 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION o Building 40 State University of New Yor~ Stony BrooR, New York iL794 E~ick G. Baust, Jr. lA Wi_ndsor St. Centereach, New York 11720 September 26, 1974 Re: Petitioo No. TW-15277-0059 Your p~tition for a Tidal Wetlands 14eraCorium Perml~ has been'~ by this office. As a result, we have determined' that construction of a house on Pipes Creek, in Arshamomogue, Torn of Southold, Suffolk County, Neff York will have no adverse affect upon adJaceet :idal we:lands. . No construction or fill beyond the limits of the existing cleared Therefore. pursuant to Section 25-0292 of ,ths~gnviro~a~nt~lw''' Conservation Law and 6 L~CRR~ Part 660.3 (c), you are hereby netified the: no permit will be n~ceesa~y. I copy of this deCemtmttm~st be,avallabte'at the site a~ all tt~s d~tng conat~uctt~ activity. · ~ ~incerely yours,~ Dent~/ J. Larkin Local Tidal Wetlands permit Admtnfstrat or DJL:~CC:n Corps of Engineers, New York District Louts M. Concra ,iT