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Home My WebLink About25206-zFORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 25206 Z Date SEPTEMBER 25~ 1998 Permission is hereby granted to: ROBERT J MCCARTHY P O BOX 842 SOUTHOLD~NY 11971 for : CONSTRUCT A NEW SINGLE FAMILY DWELLING :RED FRONT AS APPLIED FOR. at premises located at 2705 County Tax Map No. 473889 pursuant to application dat~ Building Inspector. Fee $ _4./Q3~ ~0 32~ 20 Rev. 2/19/98 EXT SOUTHOLD 079 ~ )02 Lot No. 011 3 19! and approved by the ORIGINAL Building Insp 'iEL~ ""' ' .... ~ .... COMMENTS .,.,.s. :....,_o,~ liD,,,=. I[ FOUNDATION (2nd ROUGH FRAME & .PLUMBING' INSULATION FERN. STATE ENEROY CODE f 'FINAL &DDITION~L COMMENTS: SUFFOLK COUNTY DEPARTMENT O17 HEALTH SERVICES OFFICE OF WASTEWATEI~ MANAGEMENT ~ , ~-~ SUFFOLK COUNTY CENTER ~VE~IEAD NEW YO~ 11901 (516) 852 2100 ~" APPLICATION FOR EXTENSION~ ~NEwAL OR T~NSFER OF E~STING PE~IT T0 CONSTRUCT SEWAGE DISPOSAL AND WATER SUPPLY FACILITIES FOR SINGLE FAMILY DWELLING Before co up eting tiffs application refer to "Instructions to Renew, Extend or Transfer an Existing Pe~it for Single Family Residence" ou reverse side of Otis applicati0u. (If number is prefixed with 93-; 92-, 91-, ere., a new applicat~u tbrm [wwM-o~9] is also required.) 2. TAX MAP NUMBER: District [~O Section: 7~ Block (lfnane is diCferent ~m original applicm~t, see ins~fuctigns forl~afisfen'ing a permit and complete s~t~ 6 below.) - 5. DA~OFOmG~PROV~ ~ ~g-~5 ~mo~eflm6y~sol4a~app~on~ 6. T~NSFER OF PE~IT: I hereby transfer all righB ~d interest in the ~bove referenced permit to the ney applicant nmned above, . SIGNAT~ OF ORIG~ PE~T HOLDE~AGE~ P~NT NAME DATE. ADD.SS PHONE Application~is hereby made to [ ]extend, [ ]renew, [ ]transfer a pennit t0 construct a water supply and sewage disposal system for a single family residence in accordance with the applicatiofi, surveys and plans submitted. I hereby certify that I have examined the complete application and the sl~atemcnts therein are tree and correct; and that all work shall be done in accordance ,with. all applicable Town, County, Statue and Federal Laws and Codes. Any false statem nt made he~'ein is punishable as a misdemeanor, purs/ag~at to S21 ¢~.45 of New Y~rk State Penal Law." If you are making' substantial revisions or modifications to a:project flaa~ has already received a permit to Cpnstmct from the Depamnent, or if the permit is more than six (6) years 01d, a new application as explained in 'Submission Requirements;For Single, Family Residences' to may changes in standards enacted after the approval date of. the original permit. :subject JUN 1 g 1998 DEPARTMENT USE ONLY Permit is Extended/~,~'~ Until ~te_"7"~ } Z~)~ [ Number o~l~drooms APproved N//~ signatur¢ofVepm'tmCntRcprCsgntatiw /~~~ Date ~ 2 ~--¢~ . ~WM-104 (rev. 11/97) ' INSTRUCTION~ TO RENEW, EXTEND, OR TRANSFER AN EXISTING PERMIT FOR SINGLE FAMILY RESIDENCE EXTENSION OF EXISTING PERMIT - A permit to constraet issued by tile Department may be extended for a period of three years, provided that tile request for extension is prior to the date of expiration, as indicated on the previously approved plans~ and tbere are no changes to tbe proposed project. This includes situations wbere constn ct on oftbe project may or may not bare started. Permits will be extended ouly once and a new Department permit nnmber may be assigned. Only one extension will be granted after whleb applicants must sabmit a new application. The following items must be submitted to extead a permit: 1. Application form for E~tension, Renewal or Transfer of Existing Permit for Single Family Dwellings (WWM-104). One (1) original. 2. IF the original application was submitted prior to 1994 (for example, reference numbers prefixed with 93-, 92-, 91-, etc.), submit a ne~ application form for single family residendes (WWM-059) and three (3) new prints of site plans. 3. IF cbanges to the ong~0al pl~ are required, bav~ been made or if additional copies of the permit (approved site plan) are needed, sub~it three (3) new prints of site plaus signed and sealed by a design professional. 4. App cat on fee $50 check or moaey order payable to Snffolk County Environmental Health. RENEWAL OF EXPIRED PERMITS - If your existing permit bas expired, it may be renewed for a maximnrr} of 3 years beyond the date of expiration, provided that there are no revisions to the proposed project, or snbsequ~.nt clmnges in Department standards. If either oecnrs then the project will be treated as a new application. The follow~hg items must be submitted to renew au expired permit: 1. Appbcation form for Ext~nslon, Renewal or Transfer ofExistlng Perm't for S' ~gle Fam'ly Dwell'ngs C¢/WM-104). One ( 1 ) original. 2. I._E the original application was submitted prior to 1994 (for example, reference nnmbers prefixed with 93-, 92-, 91-, etc.), snbmit a new[application form for single family residences (WWM-059) and three (3) new prints of site plans. 3. IF changes to the orig!nal plans are required, have been made or if additional copies of the permit (approved site plan) are needed, si~bmit three (3) new prints of site plans signed and sealed by a design professional. 4. Applieatlon fee: $50 cl~eck or money order payable to Suffolk County Environmental Health. REVISIONS TO EXISTIN~ PERMITS - If you are making snbstanfial revisions or modifications to a project tbat bas already received a permit to construct from the Department, a new application will be required. Follow the Instructions as explained in ~ubmission Requirements For Single Family Residelmes' (WWM-041). The followtng are exam?les of cbanges thai eonstitate snbstantial revisions or modifications: 1. An increase in total wa~tewater design flow (e.g., number of bedrooms). 2. The addition or reloeati6u of a proposed sewage disposal or water supply system(s) which was not shown on the approved site plans. 3. A clmuge in bnilding gross floor area or location. A elmnge in tile propos&l method of sewage disposal or water sapply. 4. Change in any propose[t struetares or improvements (for example, driveways, tenuis courts, swimming pools, cabanas, etc.) At the d scret on of the Department, some minor rewslons or modifications may not reqmre complete new apphcahons or fees. For these sitnatious,[a minimnm of Three (3) revised site plans must be snbmitted for approval with a letter explaining what chnnges areiproposed. TRANSFERRING A PER~T INTO A DIFFERENT NAME -If you are transferring a permit into a name otber titan that of the original appliicant and you are not revising tbe project, then submit the following items for review: I. Application form for 8ingle Family Residences (WWM-959): One (1) original. 2. Application form for EX'tension, Renewal or Tt;ansfer of Existing Permit for Single Family Dwellings (WWM- 104). One (1) original ~opy wltb tbe'0rigiaal apphcant's signature. 'cTb~ee (3) new prints ol~tll'e s~ite plan..' '. Apphcahon fee: $50 ql!eck or money order payable to Soffolk County Environmental Health. 4. FORH NO. I TOI~N OF SOUTBOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 1,971 LICATION FOR BUILDING PERItIT 3 S~.TS OF SURVBY NOTIFY CALL ItAIL TO: .... INSTRUCTIONS a. Ibis application mint be c~pletely fil led in by ty~riter or In ink taxi 3 ~ts of pl~, ~ate plot pl~.to ~le. F~ ~i~ to ~hle. . b. Plot pl~ ~i~ l~ati~ oE loL ~ of ~ildi~s a~ ~i~s, ~iati~dp to ~joini~ ot~ts or a~an, md 8ivi~ a ~tail~ ~ription of last of ~rty ~t ~ dr~ this alii lent i~. c. ~ ~rk ~ ~ fltis a~licatia~ my mt ~ c~M ~fore isle of ~ildi~ ~fit, : d. ~ ~al of ~is al~licatJ~, t~ ~ildi~ Ins~ctor will is~ a I~ildi~ ~mit to tl~ a~lic~t. ~mlt ~m[1 ~ ~pt ~ tl~ ~i~s ~ailable for ins~tia~ theft fie ~rk. e. ~ ~ildi~ atoll I~ ~iM or ~ in ~le or in ~rt for ~ ~ ~mt~r mtil a ~rtifi~te of ~ droll I~ I~n ~tal I~ tie llnld'~ hm~tor. :,: ~ r~ ~.1~ IS ~;~ ~ to t~ ~ildi~ ~r~t for t~ isle of a ~ildi~ ~mit ~ildi~.7~e O~i~e off tim ~ of ~tl~ld, ~ffolk (a~nly, ~e York, md otlmr a~hcnble I~, ~lati~, for t~ ~st~ti~ of ~ildi~, ~itims or atteratims, or for ~al or ~liti~, ~s ~re~ ~ri~. 1~ ~limt ~s to ~ly with all ~li~ble 1~, ordi~es, ~ildi~ ~lati~, ~ to ~t ~i~ i~tors ~ ~s ~ in ~ildi~ for . t~' ~ grate s~ether applic~t is o~aer, 1.camde, a~nt,~f architect, engineer, ~eneral contractor, electrician, pltmber or.., ' .................................. J.Lt.J.~: ;'.: ........................................................... (as on tim tax roll or latest deed) / : Dail~ Plumbers License No .......................... Electricians License NO ...................... Other Tra~s Licanse No ..................... I. Ix~ation of land on ~ich Im clone. C~nty Tax 14ap No. I000 Section ... ~: .... Block .' ............ lot ............ S~liviMo~ , ,; ................................... Filed llap It~ ................l~t ............... State.existing use and occupm~'y oil p.~mises n e occu o ~d construction: a. Existing tree and occt~mcy ............... 4/-ff'V''~:; '~': --" ~' ........... ....... z. ::.:z ..................... b. lnten~d use and occupancy .' .................. ~..~-.f--~- ............................................. 3. P;4tm'e of ~[k (d~wzk ~hid~ ~l~Ricable): Ne~ IkJilding ...... ~lici~l .......... AlLeraCi~ 4, Estiu~t~l ~aE . : ........... r~ ............................................ , -. / (t'o 1~ ~id ~ ~ilin~ this appl fl.'r, ~lf lmi~n~/'~ mercial or m a~ ~Zl~l~, s~ci~ ~tu~e mil ezEen~ og eadl t-ylm of ~ .......... 7, I)lllEflSl~la;q~ ,tuEl~ nt[t~tu~, l~ mE. F[~L ................ ~ar ............... ~pth ............. 'r--' ' l)}n~m~m O~ m stnmtuceiHILh alteratl(Xm or ~lLlolla: Frolic ...~ .......... I~ar ............... ~ I~ntl ...... ~-? ........... I~1 dlt .................... ~li~r o~ 5~orlull ........... 8. ~ Ihu~l~m o~' Ire [~ ~E~txa~= i~t ...... ,.. l~ur ......... [~ptin .... . . Ih~t ......... .~ ........ ~... ~r o~ Sto~xen ..y...~.~ ............ /~ - m.~,,~ ,,~ ~,~,~ ....... ' ~ .~'"'"'"" ~.~ o~ ~o.,~ ~__~ ....................................... I I. 2~ or u~ district in ~fid~ pmm~8 are ~i~r~l ....... ~.-~. ............ 12, 1~ prOl~ ~mt~tim v/ol~ ~y ~i~ l~, ordinate or regulari~: ''~ 13. Hill lot ~ ~r~ ....... ~. I ....... ~ill ~[e~...ill I~ r~ f~on ~mi~n: . z, ~ d~ 16. ~ o[ ~r o~ pm~l~ .... res~ .. ~ ~ ~.,,~ ..~ ~ ................ ~,~.~ .~r~, ~~~. ~. , ~.~ 15. 1~ thi~ p~r~ wiQdn ~ ~t o~ a till ~tlm~g ~ ~1~ .......... ' ~ A.~ ...... ULOT l~a[e cl~rly ~ dis~i~l~ all ~ihli~s, d~l~r ~isEi~ or pro~, a~ i~ica~e att ~ prol~r[y li~s, Gi~ s~ ~ bl~ ~t~r or ~scrip~im~ ~cozdin8 ~o ~, a~ d~ stree~ d~tler interior or co~r loC. ~ . , ,,,~,, ,,, ..~t~ ......... : // ............ ,,,,,, _,. ,_, ,,, (Cx)~LracLor~ ~llel~l~, corlx}rnte officer, eLc.) of maid *~er nr (~ers, taxi is (July aqLhorizg~ t~ I~rform or Imve ix~rl'omtg 1.1~ mfi(I ~rk aiKl tO nlq)licacion; LI)m. all. aLaLo~enta'(:c~taif~ in Lhis alq)/icati~) are tn~ Lo me I~.~ o~ his ~1~ .... in Lhe npplic ~i(a~',NfiJ~l Liege tl~ ~)rk .LIt I~ i~rfont~l m ~llm m~)lmr ~t: l.o[UI nppH~i(a¢,fH~l 0 L