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Home My WebLink About19232-Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF HEALTH ,.'/.. ~.?.~,~.,... 3 SETS OFiPLANS"~"/j;~ ' '~- , ~' 7.J-' '/)" ,! ..... SURVEY ' ';'l'~d-: · ~' ·; · · "-' ....... c~c~ . ~ ~ SEPTIC FOR~ ~/ ~ Approved .~-..~., ,99.0. Permit No..I..~..~. 3 ?..~ Disapproved a/c .... ........................ ~-~: (Building Inspector) APPLICATION FOR BUILDING PERMIT NOTIFY /¥'¢~7 .. /3 ~'"~. CALL ..................... ~A~L To: ioo-'~o ~.:¢~:! I SVu cwo s a. This application must be completely filled in by typewriter or in ink and submitted 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 o' ' ~, cation, oiVmo a detailed description of layout of property must be drawn on the diagram which is part of this appli- e. 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 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 ~:emoval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housin~ code, and regulations, and to admit authorized inspectors on premises and in building for necessary?qspections. - 4' (Sig/lature ot applicant, o(/¥r~e', if'a'c'o~o'rfitYn')'/' ' (Mmhn° address of applicant) , State whether applicant is owner, lessee, agent, architect, engineer, general contractor electr' ' . " /v ..... /" , ,q ./_ , ~cmn. plumber or builder. ,~ L5'/ £/''~'..'~' - /?.:?,a ' '" ........... : .............................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ' Electrician's License No... J. ?..~...~. ........... Other Trade's License No. '--- Loca,o. or,and on which proposed wor will be done.. House Number Street "~"'-" ?~:;;'1;;'' ,z.'. ~ ................ County Tax Map No. 1000 Section ..... V~... ' 9 ,' , ...... Block .... Subdivision.. ~¢~.-f~',.4¢¢(,~ LE,~d~,¢~.. ........... Filed Map No.. ~..?,~...~. .... Lot~-.~./.7~. 1~ (Name) State existing use and occupancy of,,p.~?~m, ises and intended nsc and occupancy of proposed construction: a. Existing use and occupancy .... ."-.... :~ .... ;)' .... : ' ' :' '~": ~-~~4r, ' ' 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimate'd Cost.. ~...~..J('. ~..?.a.oA .---Z~...~...//. ~.~-$~-ep/h~. ~0 Fee .~ q. (to be paid on filing this application) 5. If dwelling, number of dwelling units..,,~ ........... Nnmber of dwelling nnits 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 .... .77. .................................................. Dimensions of sam.~e structure with alterations or additions: Front ...... ~ ........ Rear..-zn.. .............. Depth ...................... Height ......... ~ -,. :, ........ Number of Stories....--~-~... , 8. Dimensions of entire new construction- Front "~ 57~ fl' Rear '.~ ~.-<~-.Z'o De-th ' ¥' ~5:--' ~" ....... Height ............... Nu,nb~r of Stories ' ' ! .~3' ' ',' ' '/ ,:. ............. 'v .,-',:...; ....... 9. S_.ize of lot: Front ~:'0t,r... 7- 5.'7'.-.,0, ....... Rear~.-~' 5/~'-i-f ;~ ........ b;;[l:' ~J~¥'~/~, "] '~ "-'r)v .... 10. uateofPurchase 0//$ // :[0 -~a~'~- ' .... Z ..... ,C~'7 '~, '.:"~L; :"" ........ ~ ,. · ..... y ...../. .............. y~ me o~ former owner . ~/,,a--t4~.-c/ ~2a~ 11. zone or use restrict in which premises are situated...~,/./.~. ................. 67. .... i i i .-" ............ 12. Does proposed construction violgte a,n~ zoning law, ordinance or regulation: ~ ........................ 13. Will lot be regraded . ,,.4'~'~/~t.~'~ ;<~; .......... Will excess filJ be, remoyed from premises: Ye 14. ~ame of_ Owner of ~5.mLse.~0?.~/~'~. t~'~t/.. Address x~,2~..~./~.(7. ~/~ IZ ~ Phone No ~.5-/- ~ame of Architect ~4L'~J'~g;~C,4~, .~.. , Address 07, ~, /¢fi.~_~"b3,~;/' ,,~ _ ' ?~ k.'d2" .-'hi:d/" Name of Contractor' ;./o99. ~...r(~,d.~ { (.eg. ff~.... Address ~V,~'~..,q/.~.~... Phone No. -~- ~-7. ·/-?.?&.. 15.Is this property located within 300 feet of a tidal ~etland? *YES .... N0.~'.i. · If yes, Southold Town Trustees Permit may be required. ... PLOT DIAG RAM 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. STATE.OF NEW YORK... _ S S CouNTy OF .... ~.C,.xc~ol.~.. · /~ ,. '~~~' ~~'~~ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) .......... above named. Itc is the ..... ~ff~ .... .~ ~ ~ ~ ~O. ~ .......... ' ................................. (C ntractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have performed the said work and to m~e and file this application: that all statements contained N this application are true to the best of his knowledge and belief; and that ~he work will be performed in the mmner set forth in the application filed therewith. Sworn to belbre me this ........ ......... ...... County ~ ~ .................................. MIDDLE ROAD (C. R. 48) ~:~r, o~ ~ ~o,~o LOT ~ AREA = 20,714 sq. ft. SURVEY OF LOT 3 SUBDIVISION OF CEDARFIELD$ FIL~ ~ 2~, ~ FI~E NO. ~ ' A T GREENPOR T TOWN OF $OUTHOLD $~FOLK COUNTY, N. Y. 1000 - 40 - 05 - PlO 01 Scale 1" = 30' ~Uu~y 11, I~90 25, 1990(found. loc.) ,or (~ BENNETT ROAD TOWN OF SOUTHOLD MIDDLE ROAD (C. R. 48) NORT, OR ~AW RO,~O · or (~ AREA = 20,714 sq. ft. ,or (~ I 31' 25" W , ..... ~:.~o ,,. ,:~ T HEALTH SFRVICES .~ ~-.~"u ONLY IOC2,~0~ ~l~Ve ..... other a~eme~and C~ef ~ Bureau of Wastewater Manasement LOT (~ SURVEY OF BENNETT ROAD LOT 3 sue, vo TOWN OF SOUTHOLD July July 25, 1990(foun~.' Ioc./ ~~ ~.o. ~x