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Home My WebLink About19248-Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 BOARD OF ~EA'LI'H ............ 3 SETS O~e ~--P'LANS . ,.~.~,~ ...... SURVEY c.EcK .......... \_.C.~..... SEPTIC FORM ................ CALL ..................... gxamincd....~..~h.,19{~.~ MAIL TO: /OO-XO ~~ Approved ...~.~.,19~Pe=itNo.[g~SJ~.. ~' a~*~ /'/17Z~ U Disapproved .............................. ~~ ................................ ...... (Building Inspector) ~PPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. T~s applic~'tion must be completely flied in by ~pewfiter 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 pl~ show~g location of lot and of bulldogs on premises, relationship to adjoining premises or pubic streets or areas, and giv~g a det~led description of layout of proper~ must be drawn on the diagram which is pa~ of t~s app,- cation. c. The work covered by t~s application may not be commenced before issu~ce of Bufld~g Pemit. d. Upon approval of this application, the Building Inspector will issued a Build~g Pemit to the app~c~t. Such pemfit shall be kept on the premises av~able for ~spection throu~out the work. e. No build~g shall be occupied or used in whole or in part for any purpose whatever until a Ce~ificate of Occup~cy :hall have been grated by ~e Bulldog Inspector. APPLICATION IS HEREBY MADE to the Build~g Dep~ment for the issuance of a B~Iding Pemit pu~uant to the guilding Zone Ordinance of the Town of S0uthold, Suffolk County, New York, ~d other applicable ~ws, Ord~ces or Regulations, for the construction of bufld~gs, additions or alterations, or for ~emoval or demolition, as here~ deschbed. Fhe applicant agrees to comply with all app~cabte laws, ordinances, bufld~g code, housin~ code, and regulations, and to 2dmit authorized inspecto~ on premises and ~ build~g for necessa~spections.~~. . .~"7 ~ ~/~,~;~ ~ ~'~~.~ ............. ~ (Sig~0ture o~ applicant, or name, if a corporanon) / ~ t~' (Mailing address ofapplic~t) ~ , State whether applicant is,owner, lessee, agent, ~chitect, engineer, general contractor, electrician, plumber or builder. .... :zv~-5:.,.::,~r~:~ ............................................................... (as on the tax roll or latest deed) h' a;,plicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........................... Plumber's License No .... LSl ~. :'./"7. ........ Electrician's License No... L .9..~..f ........... ther Trade s L,cense No ...................... o' -7(05 ~ Location of land on which pro, posed work will be done... ~~.~. .... · .,.~..~. ~ ~~.:.. ~/~,~,~,,~ ~- ~ ilouse N~jr' ............ Street ...................... ~/~I.~ ;~'l J; ...... ~ ................ County Tax Map No. 1000 Section ..... .~.O. ........ ] Block ....0.~. ,.O.O. ..... Lot..~..L~. Z: .~..~?... J.. 9 ~ , - 'd' /.~ (Name) State existing use and occupancy of~jemises and intended use and occupancy of proposed construction: / ~ ~. ~,~,,,~u,, ~,~ o=,=~ .... ~. . . ~ . . ~./ ~ ........ ~ ....... ~ .. .... ~ ......................... .... ..... ......... . .....,,;,,~..~: -... ~~ ~ . 3. Nature of work (check which applicable): New Building .......... J/C Addition Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimate'd Cost.. ~.. ?..&/. ~..3~,.o.o.0..~...~.. L ~.o'--j~.a~. 0o Fee .................................... (to be paid on filing this application) ~ - 5. If dwelling, number of dwelling units . >,2.7 ......... 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. :-7-... .......... Height ....... .":'W. ...... Number of Stories .... .~. .................................................. Dimensions of same structure with alterations or additions: Front ...... ~ ........ Rear. m .............. Depth ........ ~ ............ Height ....................... Number of Stories....--~-~.. 8. Dimensions of entire new construction: Front...-.~ .k-..-~a 7 .... Rear.. '.~ ~.~'~.(q ...... Dept~' i,~ Height ............... Number of Stories .../. ~. ...... / ....~. ............................. (.., .... 9. Size of lot: Front e~,,.,~-lTr<..7. ~.'~r O. Rear t0.eV~,. 7~-'. O Denth /).4t~-" ~. '7 0 { '" : ......... ~ .............. ~ -: -,:~2 ' ~,~I> .......... 10. Date of Purchase ...... ,/.3. .I./. ?0, ............. N~ame of Former Owner . ~t~-~.< t_~WW,.d, g2L~ .......... 1 1. Zone or use district in which premises are situated.../¥./,). ................. 67...." . ........................ 1 2. Does proposed constructio2a viol.ate agyTzoning law, ordinance or regulation: ~. ....................... 13. Will lot be regraded . ,,./~a~/~./~t.~.~ ~y .... .~.. ~... Will excess fill be~removed from premises: Yes f No) 14. Name of Owner of premi.se~0?~-~:~. ~'L~e~ff~tJ.. Address ~f.4~.tt~. ffff. g~..~. Phone No. ~..~.-./: ~..~(./.'..¥~.. Name of Architect '.~4I.,',.~JCx/)~C'~:¢.-~.>..i?,t..,... Address~'~ta.~l-..'.~).44(..~.ff~,.~..~f.. Phone No..~].~.~... ~.q. ~/.~.. Name of Contracto[ ?J~7~., .~q~. {...r~A.~.~ (.~Zd.~.... Address ' ~.~h~'a~. ~.~j.~... Phone No..q. ~.~.. IS.Is this property located within 300 feet of a tidal ~etland? *YES .... *If 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. STAT~,O,F NEW YORK .... S OF .... / · ~:[~. t~. ~.2~_~'../~/~'~ ' ~~,~~ .......... being duly sworn, deposes ~d says that he is the applicant (Name of individual signing contract) .~bove named. ,, ..... & .... .......... ' ................................. (Contractor, agent, corporate officer, etc.) of said owner or mvners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e and file this app]ication; flint all statements contained ~ this application are true to thc best of his knowledge and belief; and that ~he 'xork will be perfo~ed in the m~ner set forth in the application filed therewith. Sworn to before me this ' *Public, :.a~..~ .... County ~ ~ ~~ (Signature of applic~t) MIDDLE 792.24' 774. 4~' ROAD (C. R. 48) ~o;r, oR mA~ RoAo SURVEY OF L 0 T ,19 SUBDt VISION OF CEDAR£1EL DS FILED JUNE 27, I~0 FILE NO. 8966 A T GREENPORT TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y. I000 - 40 -,05- P/O Ol Scale I' = 30' July 11, 1990 July 27, 1990(found. loc.) AREA = 20, 115 sq. ft. MIDDLE ROAD (C. R. 48) NORTH OR 792.24 ' LOT SUBDIWSlON OF CEDARFIELDS FILED JUNE 27, 1990 FILE NO. 896~ A T GREENPOR T TOWN OF SOUTHOLD SUFFOLK COUNTY, N Y. I000 - 40 - 05 - PlO Ol Scale I" = 30' July 11, 1990 ~ July 27, 1990(found. loc.) ~ Nov. ~, ~~ BUFFER LOT SUFFOLK COUNTY DEPARI'MENT OF HEALTH SERVICES SINGLE F/,~IILY DWELLING ONLY The se;rage disposal and water supply facilities for this location h~','e been inspected by this t}~;:artment and/or other agej]cms And found to be satislacto~y. Chief ~f~ureau o~ Wast~'~t~r~la'~ment 86 -