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Home My WebLink About19234-Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-180:3 Examined . · · .'~ ~-~.*,~/,~., 19 ~.O .... ..... l)isapp~oved a/c ......~' v ............................... ................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEAL?H · - ~_.x- ........ 3 SETS OF PL'A~I~ ~ ~ : ..... e.oVEY i . ~F[ ~.~27r-'~-' ' ' o .... ~'t ' ";c' ............ CHECk: .... f....a ,x ...... sEPTrC r0 m . .,.': ..... a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 ,ets 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 properW 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 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 -i~all 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 Sbuthold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. i'he applicant agrees to comply with all applicable laws, ordinances, building code, housin~ code, and regulations, and to ~dmit authorized inspectors on premises and in building for necessary,Tnspections., ." .','~ , ., q j -4, (Sigaature of applicant, or name, if a corporanon) / :hate whether applicant is owner, le~ssee, agent, architect, engineer, general contractor, electrician, plumber or builder, (as on the tax roll or latest deed) !:' applicant Js a corporation, signnture of duly authorized of~cer. (Name and title of corporate officer) Builder's License No ........................... Plu,nber's License No .... /8/.~.. :'./? ........ Electrician's License No... I ?..~..f ........... Other Traae's License No. 2 · ."/-~. · · ............... Location ofland?n which proposed work will be done. ~.. _ - ......... i ....... louse Num- .......................... ber Street o~;mlet'/~ ....... d"': '~" ~'L/ ............... Cou qO Block nty Tax blap_No. I000 Section ................. Subdivision.. ~2~.~-,~,'(~-/t.f..d20~.~. .............. Filed Map No..~..~61 .~. .... LotS...~~.. ].~ (Name) State existing use and occupancy of~pjemises and intended use and occupancy of proposed construction: a. Existing use and occupancy . ' b. Intended use and occupancy /~ ~] [I. . 3. Nature of work (check which applicable): New Building ...... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimate'd Cost.. ~...~..,t(. ~. .?.ap.o. .~. ~ ........ ~ . ~. /~.~-~.~l~. oo Fee ' (Description) (to be paid on tiling this application) 5. If dwelling, number of dwelling units . .,,~ .~. ......... Number of dwelling units on each floor...'7-~..... } ....... If garage, number of cars . . . :..' ...................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ... :~... ' ......... i i. 7. Dimensions of existing structures, if any: Front ...... '-- ·: ...... Rear ....... ~ ...... Depth Height ....... ~ ...... Number o! Stories .... .'77'. .................................................. Dimensions of sam~_e structure with alterations or additions: Front ...... ~ ........ Rear .; :.. _Depth ...................... Height ......... ~ · v' :, ........ Number of Stories....---~--. ' ", ......... 8. Dimensions of entire new construction: Front...'~ LS--. :.O: .... Rear.. '.~ ~.~.-'.jo. ...... Height ............... Number of Stories .../ .~ ! ~ 9. Sizeoflot:Front~,Z~. 76 ~0 Rear /~/.~ '7<'~ O ~ '~i''~';'>~"~"~'':* .... ~-'~ ....... · ,' .............. ~.., ~ .'v ......... oeptr) 10. DateofPurchase //3 t~ ~'~0 ,,_ u ~- ~ ,~: ,~'.:.~;: ......... .... · '. .... .7 ...../' ............ ....i~ame oI Pormer uwner . ,.,,--v~.,.-: ~ ' * '-¢dda~i ~'. 11. z, one or use Cllstrlct In which premises are situated . .~./t ~ [~_ 71 i'' -"' ............ 12. Does proposed construction violate ar~Tzoning law, ordinance or regulation: ~ ..... 13. ' . ...-'~l,l~/g ...^ 'z ', .......... Wdl exc~s fill be. removed from premises: Yes f ~o, Will lot be regraded ~ L~.~; ~ ' .................... 14. Name of Owner of p~re/mi~se.~t~;.~-~,~i (~.L~.g~.~.~tj.. Address .~f.-t~f~..f~ ~.-~ Phone No Name of Architect ~4t~tC;a//[ .~.' . Address t'~, '~L,,.~_ _~_' _"~h~;,' ' ,,, - ' k~ ~.'i--~'' -4~,;;t~ ' ' Nam ~ -~:<, ..... ~/ ,- ..... ~_-,~i-..,r~,:,,~v...tj ....rnone no..z,~.4., a. TV.L. e of Cont,ractor~.)~7~..~. ~,.. 5[~/J~.. ?.~.'.~d'... Address ~t*~.~?'... rhone No..q2.7. Z3. 57&.. 15.Is this property located ~*ithin 300 feet of a tidal {~etland? *¥F.$ .... · If yes, $outhold 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 corner lot. STATEOF NEW YORK ' S S · ,e . , . . of individual signing contrac't5 .......... being duly s~vorn, deposes and says that he is the applicant above named. .... .... .......... - ............................. Hems the (C ntractor, agent, corporate officer, etc.) .... of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this 'apPlication; that all statements contained in this application are true to the best of his knowledge and belief; and that ~he work will be performed in the manner set forth in the application filed therewith. Sworn to before me this No. 4755'7~4 .................................. tl~lllM la ~ ~ (Signature of applicant) LOT (~ cor ~ · , suRVEy OF · LO'T fi . TOWN~ ~ 'soured ~FOLK CO~TY, July' 11, 1990 LOT (~ cot ~ cot ~ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES L ,ILY ONLY REF. NO. qD~%~x~ The sewage disposal and water supply facil~t~e~ for this location have been inspected by this Department and/or o~erd~n~ and~und~..sat~toCy. Chi~ of Bureau of Wastew~ter Management AREA = 28,921 sq. ft. H. $. REI~. NO. 90-S0-54 SURVEY OF LOT 5 SUBDIVISION OF CEDARFIELDS FILED JUNE 27, 1990 FILE NO. 8966 A T GREENPOR T TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y. 1000 - 40 - 05 - P/O 01 86- 52;(5) Scale 1" = 30' July 11, 1990 ....... ~ ~ 20, 1990(found. loc.) ~/.~7~ ~ " ~ . ~. o. ~x ~