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Home My WebLink About19249-Z FORM NO. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL -,eOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ....4,~6,..~..a4. ~.. {~., 19 c~.o. ' 19~.0.. Permit No. Appro,'ed . .~..~.¢., J.52~.i.'i .... Disapproved a/c ................................... ................................ ....... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 'BOARD O,F HEALTH~...~ ...... 3 Sr. TS ~F 3'La~ /,~b,. ~-:~7'. ...... SURVEY i.~a.0.- · 1)Y. .~. ~L ~ .... SEPTIC FORH .... ~ ........... NOT~F¥ /-/'9(7 - CALL ..................... a. Tiffs applic.~tion must be completely filled in by typewriter 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 property must be drawn on the diagram which is part of this 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 throu~out the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy q~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 '3uilding Zone Ordinance of the Town of S0uthold, Suffolk County, New York, and other applicable Laws, Ordinances or P,e,_zulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housine code, and regulations, and to admit authorized inspectors on premises and in building for necess/arg~spection~ .e'c.& ............. _~, (Sign, ature /0o-.3o ~/c~ · · ~ .... ',~' ....... ;, ................... d ....... (Mailin~ address of applicant) , ? tare x~hether applicant..-? · /7 ,?_is .owner, le,.ssee, agent, architect, engineer, general contractor, electrician, plumbe'r or builder. ............................................................ ....................... , [ ?~, .-,,.meofownerofprem,ses . . ./u//~.~ ~ -; . ~,~s~.5:-X. ~ ~. .~.~.,. ..... 5t~.Z-{. .-. . .'~ . ~:,Z, i/.. ~ O. .~. .............. (as on the tax roll or latest deed) i:' .;;~plicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........................... . ........ lumber s License No... Electrician's License No... I .9..~...~. ........... Other Vrade's License No "----- . ,.~ ...................... ,_,. 3o · Locat,on of land on which proposed work ,rill be done. · .............. "~. ..... llouse Sum~er Street ' &;,'.'l;;'' '"' i7 ................ qO Cotmty Tax Map No. 1000 Section ................. .............. t..- (Name) 0,70 State existing t,se and occupancy of~pjemises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... .'-..'~..~ ............... . _ (/ ' ~ :'"" ..... ' ............. .- .... 3. Nature of work (check which applicable): Ne~v Building .......... Addition ........... Uteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... · ? ~--- .... Fee ...................................... 4. Estimatc'd Cost . ~..~..3(. ~..?.,.ap.o.~..~..,./. ~.~ '5~'t~. Od (Description) .~. (to be paid on filing this application) 5. If dwelling, number of dwelling units . .,~ ......... 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 . ~. 75 ................ 7. Dimensions of existing structures, if any: Front ...... ~. ·: ...... Rear ....... ----. ...... Depth -- Height ....... ~ ...... Number of Stories .... ~ Dhnensions of sa~me structure with alterations or additions: Front ...... ~ ........ Rear..-:n.. .............. Depth ...................... Height ......... .'":w .,. :, ........ Numb%_~f. Stories....--~--. ........ b'" ....... 8. Dimensions of entire new construction: Front ...5 ~.~ ..... Rear ...~ .... -]o. ...... Depth . ~ ~-~ Height ............... Nu.m_..b,~r of Stories / ~? ~ ~. ..... ....... 9. Sizeoflot- Front/Z,.2-O.- 75 -0 .............. 'x'".. .... .... 10. Date of Purchase ---'ff' ?'fi i~ '/'? ¢) ...... ~x~ar..~,~¥./~. ~ .7/-4 .,;. ..... ~Dept~ ./~.,L~-:~.~ ?. ~ .-.fl. ..... ., . . ' ..... ~ ...../' ............... marne o~ vormer uwner IL,m-t'<.4.~ t:5~,~.gaf.~ 11. z~one or use aisrrict in which premises are situated /;'//~ -'~ ...... ~ ........... 12. ,D, , .o, .e s. proposed constructm~n v~ol,~te a¢~ zoning law, ordinance or regulation: ,.<'. Lx~. .............. ~.~_~ 13. wm lot be regraded . ,,../,~x,_~ ~/~ .,:~ ........... Will exce~s till be~removed from premises: Ye f ~o~ 14. ~ame or Ow.ncr of p~r%mise~t~o~t~.. ~-2~¥.{~.~{~. Address ~.~t~.--fl~. ~ -/~' Phone No ~.5'/- ~[1 '~ ~ame of Architect ",, 4t~ (~ O, .4~j. d ~ ~ " ' ' ' '~' ' ' /' ......'~' ' ': ' ' ' · ~ , .......... Ad ress -/~.~..(ff~..~ p - a 6 -- · ........ '~.~- ..... auuress ¢/5~.~. j~.~.~ ... Phone No..~. ~.~../.? ~-'.~,~ .. 15.Is this property located within 300 feet of a tidal {$etland? ~YBS .... NO.~.}. · If yes, Southold Town Trustees Permit may be required. ... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. jT__~TATE O F NEW YORK- OF....-..q.c,;-(-i¢.ol (Name of individual signing contract) above named. ,,eisthe ..... .... .......... ' .............................. (Contractor, agent, corporate officer, etc.) ' ' ' of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that ~he work will be performed in the manner set forth in the application filed therewith. Sworn to before me this · · ....... day_of .... /~. ... ,19. ,. No, ~/r~4 .............................. Gu~tl~l In ~ ~ (Signature of applicant) CEDARFIELO$ OPEN SPA GE PARKLAND ,or (~ LOT (~ SURVEY OF LOT 20 SUBDIVISION OF CEDARFIELDS FILED JUNE 27, 1990 FILE NO. 9988 A T GREENPOR T TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y. 1000 - 40 - 05 - PlO 01 Scale 1" = 30' July 11, 1990 July 31, 1990(found. loc.) j-- AREA = 20,446 sq. ft. G£DARFI£LO$ 576.53~ OPEN SPA CE PA RKL A NO SURVEY. OF', LOT 20 FILED JUNE 27, 1990 FILE NO. 89e6 A T GREENPOR T TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y. 1000 - 40 - 05 - PlO 01 Scale 1" = 30' July ~ 11, 1990 .July 31, 1990(found. loc.) Nov. IS, WgO(finaU AREA = 20,446 sq. ft. H. S. REF. NO. 90 - SO - 60 oRIVE~ L SUFF~}.L.K .CO_UNTY D_EPARTMENT OF HEALTH SERVICES The sewase dispnsa amd water su~ory location have been inspected hy ...... ~., ~ .~,. ~;~d,'or other ~nc ~ and found to be ~ ~. c~. ~[,_ ~hie/of Bureau of W~tew~r [~anagement ~uFFER LOT ~ OF $OUTHOL I~ · N.Y,$. LIC. NO. 49~18 .." YOR$, p.e. N.Y. 17977 86- (20)