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Home My WebLink About19250-Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 SURVEY ?i~'?~-q~. · ..~..,~ c ........... · '"'"~ (.~ ~? '~ ,'t,,' ' ~ ~ ,'~ CHECK ...... ........ SEPTIC FORM ... ............. Disapproved a/c .......................... ..--....[.. / ............................... APPLICATION FOR BUILDING PERMIT CALL ..................... MAIL TO: ..... INSTRUCTIONS a. This application 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 .4~all 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 d~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 SOuthold, 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. Yhe applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to Mmit authorized inspectors on premises and in building for necessars:~hspections _a, (Sigr~ature o~ applicant, or name) if a corporanon) / · :;,,ate whether applicant is ,owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. - , . ......................................... ........................ .: ........ j ..... .,? ........... // . (as on the tax roll or latest deed) ['.' ;q~plicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No .... /~}./. ¢ . 7./~ ........ , ctr,cian's License No.../. ?. ........... Location of land on which proposed work will be done... ~~r~:~..-~..'~. .... · .'-. ........... +'o#...'-:'~...~.~..~..'~:'..~. ....................... ,,~e'~, yy~. ...... ~. ~ ~ ........ ilouse Number Street v'Hamlet ~ ....... i si°n.--:>--~[:(:<~+{ ...........--'' Filed Map No..~.~.~' ......... Lo,, ~' State existing use and occupancy of~jemises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~ ...... ~ .............. ;'~ ................................ /.. . b- Intended use and occupancy ~ ''~''''v U ' ": 7".". .. " .-- 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimate'd Cost · ~...~..X.//"'- ay ~ 0o (Description) ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units . .,,.~ .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 Height ....... ~ ...... Number of Stories .... ~ .................................................. Dimensions of sam~_e structure with alterations or additions: Front ...... ..--'7. ........Rear. ~ ............ D.cpth .. ..................... Height ......... .-': .f. :, ........ Number o,f Stories....--~-. .... , ' ' 8. Dm~ensmns of entire new construction: Front '~ ~ a re, ar '~ ~;'-- o ~ _,. 4 k'-i ~'~ ....... Height ............... Number of Stories .../. :~ / ~ 9. Sxzeoflot: Front g/./~...7.6..:,0 ........ Rear ..~. 2'_~ -O Dept[) 11. Zone or use district ~n which premises are situated..~./~. ................. ~.i~. i ................ 12. Does proposed construction violate anyTzoning law, ordinance or regulation: ~ ....................... 13. Will lot be regraded . ,,./~7~/gf~ ./y..,.... ....... Will excess fill_be, remov, ed from premises: Y_e~ f No) 15.Is this property located within 300 feet of a tidal. ~etland? aYES .... NO.'ff/~. · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRA~ 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. STA,;,~z..~3FTE..O NEW YORK ' S S ~ CO/,'~-L'9 OF .... ~.c,.---(-:~o l ~ . ,, / (Name of individual signing contract) above named. ..... .... .......... ' ................................. iIe is tile (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 the work will be performed in the manner set forth in the application filed therewith. ~ Sworn to before me this Nota~ Pub,~c, ~ta~ of New Ymk ~'/ No. 4755734 ................................. Ouaifl~ I~ Suflo~ Cour~ (Signature of applicant) AREA = i2.63' LOT 2~ 20,039 sq. ft. TOWN OF LOT 2~ SURVEY OF ~ L.OT 21 ~'~' °' SUBDIVISION OF CEDARFIELDS ~o1~ FILED JUNE. 27, 1990 FILE NO. 8966 G,qEEI4~T A T GREENPOR T TOWN OF SOUTHOLD SUFFOLK COUNTY, N Y. 1000 - 40 - 05 - PlO 01 Scale 1" = 30' SePt. 28, 1990(found. Ioc.) i2.63' H. S. REF. NO. 90 - SO - 61 AREA = 20,039 sq. ft. LOT ~ pRIV ¢, oo" ~ ¥ o_ tot ~ ,? LOT SURVEY OF L.OT 21 N/O/l= SUBDIVISION OF CEDARFIELDS FILED JUNE 27, 1990 FILE NO. 8966 Gj~EEI¢POR1' A T GREENPOR T TOWN OF SOUTHOLD SUFFOLK COUNTY, IV. Y. 1000 - 40 - 05 - P/O 01 Scale 1" = 30' July 11, 1990 Sept. 28, 1990(found. loc.) CERTIFIED TO .' FIRST AMERICAN TITLE INSURANCE COMPANY OF NEW YORK TITLE NO. 505 - S - 8728 SOUTHOLD SAVINGS BANK its Succeeeor & or Aeeigne JULIE P. COSTELLO 86- 52ff£ )