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Home My WebLink About21800-zFORM NO.$ TOWN OF $OUTHOLD BUILDING DEPARTMENT TO'I~N ~ $OUTHOLD, N.Y. No_ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Date ............................................................. 19. ~2'/"~' 21800 Z Permission Is hereby granted~ to: .... ........................................... ~~'~..~.,.,,Z....'. ....... .,..z~.. , CounlyTax Map No. 1000 Section ........... .~'..~?. ...... Block ...... ~ .............Lot No..... ,/,,..~... ............. pursuant to application dared ......./~.~m.. .................................... 19..?,~,. ...... and approved bythe Building Inspector, Fee ~.:~..~,..~ ~,' Rev. 6/30/80 FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL NOV i 2 1993 SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined Approved ....... 19~. Permit No. Disapproved a/c ..................................... BOARD OF HEALTH ......... 3 SETS OF 'PLANS .......... SURVEY ................... CIIECK .... CALL · · . HAIL TO: ~ (~41dmg~vfpect or) APPLICATION FOR BUILDING PERMIT Date ................... 19... INSTRUCTIONS t a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 e~s 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 m 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 cbmmenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit hail 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 hall 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 luilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances cr ~.egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. ?he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for necessary inspections. -- (Signature of applicant, or name, if a corporation) (Mailing address of applicant) ~tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~lame of owner of premises ...~l~.~..~. .... .~...~.t.: .~.~.~...~. ........................................ (as on the t.a~ roll or 1.atest deed) f applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No...7 .~../'~.~..'~...~.~ ....... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... · Location of land on which proposed work will be done .................................................. ..... 0.. House Nulnber ...... ~treet ''~' H~;~'l;t' ........................ County Tax Map No. 1000 Section ...... .~.0. ........ Block .....~.. .......... Lot .... i'..~ ........... Subdivision..~..~...~...~..l~Jc-~).. .......................5 FiledMapNo ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~C~ ~ W3JO.I%,:~)~ ......................... ~ '~'w ~t~ ~'~'"" ' ~'¢",,~' 'vq~ :~ ,',~ ......... b. Intended use and occupancy ................ y~,~.,.;-~ ~; ~,.,~ ,~ ,h~,,,, 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ....... Repair .............. RemoVal .............. Demolition .............. Other Work.. ~ .~... 4. Estimated Cost .e.~ r.~r~.' (Description) .... '~F .... i ...... Fee ! (to be paid on filing this application) 5. If dwelling, number of dwelling qnits ............... Number of dwelling units on each floor ................ · If garage,, number of cars ..... i. .................................................................. 6. If business commercial or mixedl 7. ' ' , . -lU~upaa~y, specny nature and extent of each type of use ................ D~mens~ons ot exmting structures:, if any: Front .... ' .... t~ ........... Rear .............. Depth ........ Height ............... Num er of Stories ..... ' .... Dimensions of same structure witoh alterations or additions: Front ................. Rear ................. Depth ..................... i. Height ...................... Number of Stories ..................... 8. Dimensionsofentirenewconst~ction: Front .......... R.~r. pth Height ............... Numt~er of Stories .......... Size of lot: Front · · · Rear ' ~ .......................... Depth ..................... 10. Date of Purchase ..... "' ' .......... I ........ ' ......... ~name ct former owner ......................... 1 1. Zone or use district in which premises are situated ......................... i ' . ' 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ' i i ' · 13. Will lot be regraded .......... i .................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .... I ................ Address ................... Phone No ................ Name of Architect ................ Address Phone No Name of Contractor .......... ] ............. Address ................... Phone No ................ 15. Is this property within 300 feet ~'f' a tidal wetland? *Yes ........ No ......... · If yes, Southold T,,wn Trustees Permit may be required. Locate clearly and distinctly all property lines. Give street and block r interior or comer lot. PLOT DIAGRAM ~uildings, whether existing or proposed, an& indicate all set-back dimensions from ~mber or deseriptioh according to deed, and show street names and indicate whether Foot /400s 765-t807 9 A~ ~ 4 P~ FO~ TH~ 1. FOUNDATION '~0 REOUIRE~ FO[~ POHR~D OONCRETE 2, ROHGH ~ FRA~A]G & PLUM~ING 4. FINAL. CONSTRUCTION MUST BF COMPLETE FO~l /ALL CONSTRUCTION SHALL MEET STATE CONSTRUCTION & ENERGY CODES, NOT RESPONSIBLE FOR DFS[GN OR CONSTRUCTION ERRORS ;TATEOFNEW¥..ca-R~ £ff~ /'7 .. I :OUNTY OF... ..... .... c ...... bo .(Name of individual signingJcontra'o'ti T£ . . T. L is the !' (Contractor , agent , corporate officer , etc . ) said owner or owners, and is duly authorized to perform or l~ave performed the said work and to make and file this ~plication; that all statements containea r ........ ~-r ....... n are true to the best of his knowledge and belief; and that the ork will be performed in the manner set forth in the application filed therewith. ~om to before me this I ......... · ,~ .~.~..day of~ .¢~" ..... :... . ...... .......... being duly sworn, deposes and says that he is the applicant MIDDLE ROAD MOH , ,.¥4;o.' ,,,o.,o.. LOt ~) (C. R. 48) NORTH OR MAIN ROAD N 71' 28~ 20" E 75'04~ SCENIO BUFFER LOT ~) ~A = 20,714 sq. ft. · pared in accordanoe with the minimum ~uoh u~# bY rh~f~w Y~rk St~t= 7'.00' S 75' 31' 23" W SURVEY OF LOT 3 ;BDI WSION OF~ CEDARFIEL DS F/LED JUNE 27, 1990 FILE NO. 8966 AT GREENPORT TOWN OF SOUTHOLD ~UFFOLKCOUNTY', N. Y. '000 - 40 - 05 - P/O01 Scale 1" = 30' July 11, 1990 July 25, 1990(found.' /oc.) Nov. 16, 1990(final) BENNETT ROAD H. S. REF. NO. gO - SO - 52 , " l .'.,, ~'Xo[ ' h ~ ~. .~',~ H',l .. ~ . ..~,~ \ ,.,'., PECON~ SUByEYOR$, P.C. P. O. BOX MAIN ROAD SOUTHOLD, 86-