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Home My WebLink About19251-Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 U.~amin~d..~.'~..(~.., 19 ?.O. Approved.. · .'~- .~.., 19(~Q. Perrnit No. ~.~ Disapproved a/c ............................... ...../ff')/ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 'BOARD OF HEALTH .. ~ 3 SETS OF PLA~S ,'ad"~.% ........ SURVEY ~,.i\%..'~;~..,.~.~ .... cHzc~ :. .... 5 MAIL TO: /OO-'~O ~. ~! 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 giving a detailed description of layout of properW 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 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 ,.hall 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 S0uthold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for iemoval or demolition, as herein described. ['he 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 necessary>~,spections. _~. (Sigrtature of applicant, or name, if a corporanon) / (--J fY' (Mailing address of applicant) (J , ?~tat¢ whether applicant is owner, le.ssee, agent, architect, engineer, general contractor, electrician, plumb~'r or builder. (as on the tax roll or latest deed) h' ::pplicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... . ........ lmnber s License No... therTradesLmenseNo ...................... O'. ...................... House Number Street ' o'~amlet ~' ............. County Tax Map No lO00Section ...~ ..... Block ...D.~,.on ..... .............. 1~ (Name) .............. State existing use and occupancy of~jemises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... 5.. }. ~ ....; ................ ;_ ................................ ,. .................. 3. Nature of work (check xvhich applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) //"~- o ~o ~ / ~- .... Fee ...................................... 4. Estimate'd Cost.. ~...~...k/. 7.~,.a.P..~ ..... /. ~..~ 3.~-~. oo (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 .~ ................ 7. Dimensions of existing structures, if any: Front ..... 2;.- ...... Rear ..... ~ ....... Depth. F~-;.. .......... Height ....... ~ ...... Number of Stories .... .-'7 .................................................. Dimensions of same structure with alterations or additions: Front ...... ~ ........ Rear . ~ .............. Depth ........ ~ ............ Height ......... ."7: ............ Number of Stories....--~--. .... . 8. Dunensions of entire new constructmn Front ..."~ .~.-.t:} ..... Rear ...~ .~.-.o. ...... Depth .~ .,fi-. :.a ........ Hei ht Numb r of Stories ~, / /. / · ~' ............... ~ .~ ..... ,...,..~. ........................ :~: ......... 9. S,zeoflot:Front/2,.~q~...7.~..:0 ........ 'l~;.~r ~ )'..~-0 Depth ~trz4 O / I ' : '"'.; ' 'd .............. ;-,St~'~?? .......... 10. Date of Purchase ...... /.'3..../. l0 ............ .,N~ame of Former Owner . ~.~/. ~_,0 '-f-da2~2,~ .......... I I. Zone or use district in which premises are situated...~,/.L). ................. ~....." . ...................... 12. Does proposed constructio)a______..violgte a9~ zoning law, ordinance or regulation: ~ ...................... 13. Will lot be regraded · ,,./~a-~5~xr~/gt.{?6 .~ ....,.. ~... Will execs fill be, remoyed from premises: Yes f~o) 14. Name of Owner ofpremise~.~)0?.'9~?~./t~J.0-~.~t/ Address ~t~..43~J~. ,~'z~~. Phone No · /, ~ 'c, ~(LT_ ' ' " O " ';' ' / ~ ........ d" Name of Archttect ~.0/~?,~C~4¢ .... ./?~. ,... Address~4!-..t~JZ/,~..0~..~...~... Phone No. ?.~.~.. &q. ff./... Name of Contractox/ fl./fi'/4. ~...ta,~//~.e, ('.,43.V.~.... Address ~. '~..~./~.~... Phone No..q.Y.7- · /. 2.'. .ff. ,Y,, . . IS.Is this property located ~ithin 300 feet of a tidal {$:etland? :~¥I~$ .... lqO.~.~. · If yes, $outhold 'roan Irustees 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. STATE OF NEW YORK ~ S OF .... / (Name of individual signing contract) above named· - ,,eist,, ..... ,q. e.., .... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed tile said work and to make and file this application; that all statements contained in this application are true to tile best of his knowledge and belief; and that the work will be performed in tile manner set forth in tile application filed therewith. Sworn to before me this ..... .... .... .... Nomq P~*~, ,~,~ N~YMk ................................... I~o. 47~q7'34 (Signature of applicant) SURVEY OF LOT 22 SUBDIVISION OF CEDARFIELDS FILED JUNE 27, 1990 FILE NO. 8988 A T GREENPOR T TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y. 1000 - 40 - 05 - PlO 01 Scale I" = 30' July 11, 1990 Sept. 28, 1990(found. loc.) 17' ~ "40. 00' DRIVE .J TOWN OF SOUTHOLD 5GEHIG LOT (~) AREA = 20,007#q. ft. ~ ' Prepared in a~c~d~ce with t~ MA~ ROAD 80UT~D, N. SURVEY OF LOT 22 SUBDIVISION OF CEDARFIELDS FILED JUNE 27, 1990 FILE NO. 8966 A T GREENPOR T TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y. 1000 - 40 - 05 - PlO 01 Scale 1" = 30' July 11, 1990 Sept. 28, 1990(found. loc.) March 1, 1991(final) ~ F g F iF_.. L,DS DRIYF-' 2=40. 00' LOT ~ H. S. REF. NO. 90 - SO -95 LOT (~ LOT (~ i}UFFER AREA = 20, OO7#q. ft. CERTIFIED TO, FIRST AMERICAN TITLE INSURANCE COMPANY OF NEW YORK t~ ~ 'ENPORT r,r,E ~O. ~o~ - s - ,,, ~.~ JAS~ C. LEONARD ,~ : : ' . ~ ............ } - : .... ~~ ~' .... . ~ .... ~:,,.- ~ Pre~ acc~e w, th the ~ 86 - 521 (22)