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Home My WebLink About19233-Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined' i .' .~i ' '~'~q'' 19(~'O Approved .~1~., 19~'D. Permit No. ! .~.~.~. 3 ~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS OF 3 SETS NOTIFY a. This application must be completely filled in by Wpewriter 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,vmo 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 ot' this application, the Building Inspector will issued a Building Permit to the applicant. Such permit .~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 qull 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 fluilding Zone Ordinance of the Town of S0uthold, Suffolk County, New York, and other applicable Laws, Ordinances or P. cgulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. Yhc 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 necessaryTnsnections 1.7 ~SJ (Mmhng address of apph~ant) ("J'-' , 3,~tc whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) h' ,;:~pl cant is a corporation, signature of duly authorized officer· (Name and title of corporate officer) B ildcr's Li N U cense O. . ........................ , . ........ lumber s Lmense No .... Electrician's License No... } ?. 5[4 ..~. ........... ther Trade s License No ...................... Location of land on which proposed work will be done.. __ · · · ................. :k;?.~ ../)r..~_.. _-~Z-_ -,5,-- - ~ /') "2.. . ~ n. -- /I ................ .................................................. .~.~-;r_, ,-%-'v,,~g? ...... v</. :' .A(~.. llouse Number Street ~f~lmnlet C~~ ............ ax .......... Block .... ~). ~. ,.f,).Q ..... Lot..O.O./(.; .fi)..O. .... '.. ''s'on. (_~.-t,., .'(~Cff.,.~ff~.~lZ~.. ........ Fil~dMapNo..8.?~.~' Lots .~. t~ (Name) ' ' ' ......... State existing use and occupancy of~p..remises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... T.... i..-':~.../7; ................ ;' . u ' . .', ::,:.~.',': -.2 6/ /1// 1~ - l/IOtA'::_/ I / 3. Nature of work (check xvhich applicable): New Building .......... Addition .......... /alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... · z//· ~ (Description) 4. Estimate'd Cost ..~...~....¥.~.?.o. op..~...~.. .o~-j~-~.....a° Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units . .,2 .~. ......... 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 ...... ..'77. ........ Rear ~ _D.epth ........ ."T. ............ Height ......... .-':.., .......... Number of Stories....---~.... '' ',.' '~ ...... 8. Dmlensions of entire new construction: Front ~ ~ t:)" ~.~r 'X 'q"--"o r~, ~,~, '¥ ¥--' ~" ...... · ' '~ ~. · .............. ~ ~" .......... ~e~.~ -~. I-~. · L' ........ Height ............... Number of Stories .../. -~ / 4 9. S~zeoflot:FrontdJxz'~...7.~..-.O ....... Rear t',~V~. ~'~-Q Deptl) d.2r~,~%r-' 10. DateofPurchase 0//3 I/ ~[0 "~, u"o~'" 'j. ..... a .- ,.~'-:-~5~: ......... ~ . · ..... ~ ...../. ............ ...?~ame or former uwner . t,Jpqm'-'~ ..~. l_~b~' .......... I 1. ,'one or use district in which premises are situated...~,/./fi. ................. (..7.. ........................... 12. ,D, , .o, ,e s, pr.oposed constructio~ viol.ate a~)~ zoning law, ordinance or regulation: ~ ....................... 13. ~vn, ~o[ oe regraded . ,,.--~-.~(/.[t../,,..~ ,<~ ....... ~... Will exce.,ss fi!J_be, remoyed from premises: Yes 14. Name of Owner of pre.miseff.[jO?.'i.~_fJ/. /~ Xtg.~i"ffctt/ Address ~,~ t, ~ 4~ ¥~4-/2~-~ ~h,,,,,. ~,t^ '75"/-;¢~1// Name of Architect (.~4t/'~g..~gaC;4/..~,~. , Address t'~ .#_ffld. f_ _4~._ .'~,~ ..... /'~ ' ~-- ContractorT/]o'74-..~. ,,.' ' 'f~ i ~/J.~.~'; ..... .~...~ ..... ,o_.o~-s_mje~.,.~.._..~._,~..,~,,~,.~...t.t .... rnone mo. ·/. ,~..1.. o~.7. Y.l... Name of Address 0.Lg~.a4g~. ,7/.~.~... Phone No..cZfY.7../.~.-~..(~, .. 15.Is this property located within 300 feet of a tidal ~etland? *YES .... NO.M".]. · If yes, Southold Town Trustees Permit may be required. ._ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate ail set-back dimensions from property tines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. £TATF..OF NEW YORK ..... COU~NT~Y OF....~.(2.'lL:~.'olj~:~.. ~'~ -- / ' ;-'~~' ~~'~~ .......... being duly sworn, deposes =d says that he is the applicant (Name of individual signing contract) ..... .... .......... ' ................................. (Contractor, agent, corporate officer, etc.) 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 3pplication; that all statements contained ~ this application are true to the best of his knowledge and belief; and that ~he work wtll be performed in the m~ner set forth in the application filed therewith. Sworn to belbre me this ......... ......... .... ' "'7 ...... ·~ blic .... ~~.. ~ .... County W ~ ()~ .............................. ~fl~ ~ ~ (Signature of applic~t) 0 0 ~o~ ® ~.oS ~ SURVEY LOT 4 st~,~%. ~ c~o~,~os AT GREENPORT TOWN OF SOUTHOLD 1000- 40 OF AREA = 22,227 sq. ft. Scale 1" = 30' Jj~lyy 11, 1990 25, 1990(found. loc.) 0 0 H. S. REF. NO. 90-S0-53 (0. roAO) · , SUFFOLK COUNTY ~EPARTrvlENT OF HEALTH SERVICES ' · L~_- ~I~,LEF,6MILY DWELLING ONLY The sewage d~?~osa] ~nd w~tar su~p~y fa~;:~es for th~s location havo b~¢ ns~,ecf~...,,~ ~y thru DeFartment and/or other a~enoeA ~nd foAnd t~satJs~ry. ~e~ Bureau of Wastewater Management ~o~ ® SURVEY OF AREA = 22,227 sq. ft. LOT 4 SUBDIVISION OF CEDARFIELDS FILED ~ ~7, ~ ~I.E NO. ~ A T GREENPOR T TOWN OF $OUTHOLD SUFFOLK COUNTY. N. Y. 1000 - 40 - 05 - PlO 01 '~, Scale 1" = 30' July 11, 1990 . July 25, 1990(found. loc.) ,.;7~:..:':-': . ~~8, P.C. P.O. MA~ ROAO I $OUTHOtD, 86- 52 4)