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Home My WebLink About19230-Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ·. · .~!-~ ..~.., 19~.O. Approved ...~,. ,,~ ~ .., 19c/.0. Permit No. ! .~.~. ~,~ q.~.-~ Disapproved a/c ..................................... ................................. .......... (Building Inspector) APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ...._....,.~". ....... 3 SETS .OFkPLANs 'f%~..4 ~.'::~/'--' survEY . .,~ ~o~.: .,.'~.~ '~j~ ~ ~ ~ c ~ E c ~ . ¢~. ~, ~ ?:../. ~ ....... SEPTIC FORH / INSTRUCTIONS NOTIFY //~7 lv . ~ ~.--~. CALL ~;' 1/~ /-o--~ MAIL TO: / O0- '~ O ~. .~ d~ a. Tiffs application must be completely filled in by tYpewriter or in ink and submitted to the Building Inspector, with 3 >:ts 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 of property must be drawn on the diagram which is part of th.is appli- cation. 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 issued a Building Permit to the applicant. Such pemfit ,hall 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 ~uilding Zone Ordinance of the Town of S°uthold, Suffolk County, New York, and other applicable Laws, Ordinances or V,c~ulations, for the construction of buildings, additions or alterations, or for ~:emoval or demolition, as herein described. The 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,Tnspections / .,"' ,'/ ' , _~, (Sign, ature ol applicant, or ~a'n~e', if'a'c'O~;o'ratlc;n')'/ ' /oo-:o :'. ~ ¢7 .. ' ........... (Mailing address of applicant) (J , State whether applicant is owner, lessee, agent, architect, engineer, general contractor electrician, plumber or builder. ' , ,.- . ....... ............. :d :hm, e of owner of premises . -{'_,~,~..L:[ ~:. ,~.; (*_. .-...~,.,(.{j.._6~.L../_./:ii://y./..~:.f'_..~.. ........... (as on the tax roll or latest deed) Is' .:;;plicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. Plumber's License No .... /8/?.. T./~' ........ ther Trade s L~cense No ...................... I, Location ofland on whichproposed workwillbedone / ~ I ~ ~ ' ['-~J.~ ?ti llouse Num bet Street oHamlet ~ ...... County Tax Map No. Subdivision.. [~ (Name) ' ' State existing use and occupancy of~jemises and intemtcd use and occupancy of proposed construction: a. Existing use and occupancy .... Z.... ~ .... . 3. Nature of~vork (check ~vhich applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) If,....- co ~/ ~ e-- 4. Estimate'dCost. ~.. .~. .3(. 7.,.?,.a.o.o. .~. ....... · .,~ J~-~ pOO ..... Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units . .-2.7 ......... Number of dwelling units on each floor...'T'~-..... ~ ....... If garage, number of cars ...:..' .................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of nsc 7. Dimensions of existing structures, if any: Front ..... ,-; ·: ...... Rear ....... ----. ...... Depth ............... Height --'- Number of Stories Dimensions of same structure with alterations or additions: Front ........ -"7. ........ Rear ...--'m. .............. Depth ........ ~ ............ Height ........... ', .......... Number o,f Stories....---m--. ....... 8. Dimensions of entire new construction' Front ~ ~ o" Ro~ 'X ~5'- o n,~-, '~ ;<~ ;J ........ · · · '~ .................. ',~ ~ ........... e~L~ ~ .~a .......... Height ............... Numbpr af Stories .../. :~ ...... / ....4 ................... / 9. Size of lot: Front ~..7. ao.'~.- 0 Rear t0.4~.~ '/5'~- O n,,,m )'~',L~;,~; ' ~ :~:2, ;-'r) .... 10. DateofPurchase 01/3 // :/O ~,T.~ ....... ,(~57 .~./ )9~ ;'.~'~.~?,~; ......... · . · ...... / ...../. ............ ....,,,m:= m vurm=~ uwner . qxtr~'t~.. {_.O '-3do.5~?,' .......... I 1. Zone or use dmtnct in which premises are situated...~:'/.LD. ................. Gq. ........................... 12. D..o. es proposed constructio/n viol?e apz zoning law, ordinance or regulation: ~ ....................... 13. Will lot be regraded . ,-.-"~(~/~t.~.~ ./,~ ........... Will excess fill.be, remoyed from premises: Yes 14. Name of Owner of pnr%miseff~2~;.~./~-i~.g].. Address ,~ttJ~7./?j./~/..~. Phone No 25'/' ~..7// _N_ame of Architect t.~_z~.~,~[~(j.',4~?;,.'d..~j.../?,t..~..' Address~azt~/../¢fl.~..0~..~.~/.. Phone Nol .~.~-J~-~ i Name of Contractorr ~./~g4., .e3-3~. ~...~/3[~g...&.~.'Z~.... Address ~.~ ~'~-i-~.~.~... Phone No..~. Y.~../.? .57.&.. IS.Is this property located within 300 feet of a tidal ~etland? *¥E$ .... NO.~'.'.. · I[ yes, Southold Town Trustees Permit may be required. 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 comer lot. FYI bsc.. ST..\TF~.OF NE~V YORK~, _ _ S S county ' / · 5.~ ,~4~~. ........ being duly sworn, deposes =d says that he is the applicant (Name of individual signing contract) ' ' .~bove named. ..... .... .......... '.....: ............................ ile is the (Contractor, agent, corporate officer, etc.j of said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e and file this application; that all state~nents contained ~ this application are true to the best of his knowledge and belief; and that work will be perfo~ed in the m~ner set forth in the application filed therewith. Sworn to before me this ......... ......... .... ......... .... cou.t ~ ~,8~~ ................................ N~ 47~ ~fl~ ~ ~ ~ (Signature of applic~t) MIDDLE ROAD (C. R. 48) NORTH AREA = 21,695sq. ft. ~ SURVEY OF LOT 1 SUBDIVISION OF CEDARFIELDS FILED JUNE 27, 1990 FILE NO. 8968 A T GREENPOR T TOWN OF SOUTHOLD SUFFOLK COUNTY, tV. Y. 1000 , 40 -. 05 - PlO Ol Scale I' = 30' July 11, 1990 July 25, 1990(found. loc.) SCENIC BUFFER LOT (~ 35' F'OUND A TION 25. 0 ' EO ' 15 ' I I OR MAW ~OAD 75.20' $ 75' 31' 23" W ~ ..... ~. --- ~0.45' BENNETT ROAD S 71' 28' 40" W BLDG. DEPT, TOWN OF SOUTHOLD AREA = 21,695 sq. ft. MIDDLE ROAD (C. R. 48) .ORrH o~ MAW BUFFER SUFFOLK COUNTY DFPARTMENT OF H£ALTH SER¥',CES ~ ~4GL~ FAMILY D~V[LLJ~G OHLY The sew~Be disposal and weter SL~ggJ~,' fcc[l~iec for this location have C~e~ Bureau of Wastewat~r Management 8 T~$ '- " '-'- / '( 7~.207~.20'S 75' ~1' 2~" W SURVEY OF LOT 1 SUBDIVISION OF CEDARFIELDS Ft~ED JUNE 27, ~0 FI~E NO. A T GREENPORT TOWN OF SOUTHOLD SUFFOLK COUNTY, N Y. 1000 .- 40 -. 05 - P/O 01 Scale 1" = 30' July 11, 1990 July 25, 19gO(found. loc.) Nov. ~, l~O(fi~al) BENNETT ROAD 40" W H. S. REF. NO. ~0 - SO - 50 MAIN ROAD $OUTHOLD. N.Y. 11e71 86- 521 (1)