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Home My WebLink About19252-Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~oOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined..-~..~. ~,.~o., 1990. Approved ...~~..,,~..~P., 19c~.PennitNo. j.q25~,~.'~ Disapproved a/c ................................... C-" (Building Inspector) 'APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH' . ........... 3 SETS O~( PLANS .... -~ ..... SURVEY ...~ -,'4-"X.~., ...... CHECK ........ /...,kc. ~ .... SEPTIC FORM ..... .~. ~4 ~. ...... .OTIF¥ . .z/99 CALL ................... MAIL TO: a. This application must be completely filled in by typewriter 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 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 shall 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 shall 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 ~:emoval 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,argTnspections; __~, (Sign,attire of applicant, or name, if a corporauon) t · d .... 'LI' ....... ; ............... ' .... d ....... - ' (Mailing, address of applicant) , State whether applicant is owner, le~ssee, agent, architect, engineer, general contractor, electrician, plumb~'r or builder. ... .:. : - Name of owner of prem,ses .~.'. .............. ' ~ /,.u-, :'d:? ~.~.c~l:.f.. . (~.:. ~.,~. (~. .,~.~. ....... ~" ¢.' . ~.." '""~" ~": > ..................... " V..~. ? .-. . 'f~./~ _ : .L7: ~.,..~. . :(L..M~ O/ .~. . : .............................. ..... . .......... (as on the tax roll or latest deed) If applicant 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 ?..~-..~. ........... Other Trade's License No '~ - ~^ , / :~_0', ~,~ .- ...................... ~ %0 C_~_~.~ L ' ~ ~ ~ ,9~ ~ · ocation of,and on which proposed work wil, be done .... ...................... -,- ...... .... House Number Street ' ;~;~'1;; .... ~r ................ County TaxMa) No. IO00Section ....... [ ......... 2 Block ...D.~,.rpn ..... Lot..Oa Subdivision.. ,:~~ [.~.~, ................. Filed Map No..~.?.~ .... Lot~~'~ ~' /~ (Name) ~. E~i,ti.~ .,, ~,~ occ,panc~ ..... ~~:u ~ ~~: ''y ...... "~'' .... ')~' '" ':'~ ..... ' ........ ' ............ .... ............. .... b. Intended use and occupancy 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repa/r .............. Removal .............. Demolition .............. Other Work ............... 4. Estimate'd Cost . ~...~..J(. ~. .~.aoo ~ ~ ../. ~..~ '$,,.a~. .oo. . . (Description) . . ........... Z '- 7 Fee ...................................... .~ (to be paid on filing this application) 5. If dwelling, number of dwelling units . .'~ .7 ......... Number of dwelling units on each floor .:77. ..... } ....... 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.epth .. ....~ ................ Height ......... w':..,. ;, ........Number of Stories ....---.~.. saxmens~ons otentire new construction: Front ~ ~ O ~r 'X <---:'o ~,, .~' ' %' ;c-' ~"- ....... .................... ~. ......... ~epm . ,.,q :). 7 ......... Height ............... Numbgr of Stories . ./..~ ! z ,' Slzeoflot:Front~...7.~ -0 Rea~ /)~-a~ t/,,-- ,~ . ,~ ./~.;~:~..~..;, .... 10. Date of PurchaSe 0//3'/'/ ¢) .......... ~'7~lJ"~/~'-"~'Z ..... ~Dept?) .c~:~)~5~.-.t~. ..... ..... · '. .... v ...../- ............ ...?_amp ox eormer owner . tt.a:r't4~ ..~. 1 I. z. one or use restrict ~n which premises are situated..,~/.2. ~ _'. _ ~ ............. 12. Does proposed construction violate an~ zoning law, ordinance or regulation: ~ ......................... 13. Will lot be regraded . ,../~~?~ ./~; ...... ;... Will exce3s fill be. removed from premises: _ Ye . [ No 14. ~ame of Owner of pnr%mi~se_x/~.~j?7~_~b' ~i~}-g~{/.. Address ~X~t.t.~. ~ ~Y~/ Phone No 25-/. .~.~l/ 'r~ N~° dame of Architect ~' 4Z,t-.L ~ (~' -qUt_ p '. ' ' ' '/' ' /, ...... .~ ....... x, ....... '~ ~ 5~e~ ~d~ '~'~/; '/)x '. T'' Address~3~_~4~-./~.t.~..~..~.~... Phone No.. 2* h'-7 o~ ~. ~(/. ,~mne m~onrractor ¢,u~'t.+.~,.'x~.~. a~/.tg4*~.~..t~2 Addr~ 2¢/'Ir~'7,/,:~?"~47~~ ~, , ',:7;-,'~' 'S'-3',';-:,' ' ' -- -,- - - - ' ' 'i ..... '-'-'-' ~o~ ~~./l. ,,.- .... rhone do..,/./../.~..~.4~ .. 15.xu ,.nxs property rotated ~,ithin lOtl feet of a tidal {~etland? *¥g$ .... · 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 comer lot. ' 8. 0.~_7~TATE_OF NEW YORK ' S S ' ~'~ . (Name of individual signing con};a~}~ .......... above named. ..... .... ........ -..' ....... (C ntractor, agent, corporate officer, etc.) ' ' of said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work w/Il be perfo~ed in the m~ner set forth in the application filed therewith. ~ Sworn to before me this ......... da ~f .... ~ ........ , 19. , . ........ County,} ~ ~ ~ ~ 4~ ............................. ~fl~ ~ ~ ~ (Signature of applic~t) SURVEY OF LOT 23 SUBDIVISION OF CEDARFIELDS FILED JUNE 27, ~990 FILE NO. 8968 A T GREENPOR T TOWN OF SOUTHOLD SUFFOLK COUNTY, N. Y. 1000 - 40 - 05 - P/O 01 Scale 1" = 30' July 11, 1990 Sept. 28, 1990(found. loc.) C~DA t~FIEL AREA = 20, 124sq. ft. N/O/F I5' O0~ E 14.1~, $CEN/C Zor J ~Prep. ar?d? aC. cordance with the minimum the I:.I.A.I...S. ~ approved and adooted r~,,,_eu~. ~ ua? ~_)~ The New York State Lend MAIN ROAD SOUTHOLD, N Y. ~97~ SURVEY OF LOT 23 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 ~x~'~~ Scale 1" = 30' ~.~~ July 11, 1990 . Sept. 28, 1990(found. loc) M~ch 1, 1991(fin~) (~ 803 ~4. ~' H $. REF. NO. 90 - SO - 96 AREA = 20, 124sq. ft. SCENIc lOl' .LIC. NO. 49618 86- 52~(23)