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Home My WebLink About19253-Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~eOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined....~b~..~..~..,19~..O. Disapproved ale ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 'BOARD OF ~EkLT'H ............ 3 SETS o'~ 7~ANS ...~,:~ .... SURVEY . :',,.~ .,,~ :x.~,...,~'-~ ./~ .... C~EC~ .~...ii. sgvz~c rOaM ...... ~ ....... CALL ..................... MAIL TO: a. Tlfis 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 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 guilding 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 removal or demolition, as herein described. i~I:¢ applicant agrees to comply with all applicable laws, ordinances, building code, housin~ code, and regulations, and to .:dmit authorized inspectors on premises and in building for necessary,Tn, spections: ~P,:4j. ~ ~._.e'~.: ./~.<.~-,n, ~ ~.~.~ ............... ._~, (Sign,;ture · ~/.t ..... N ............................ (~'. ...... · (Mmhng address of applicant) ' :~tate whether applicant is owner, le~ssee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... , ................ ......... ....... ............. ....................... </'z <. ",~ '~, >:::me of owner of premises .~; .~'~'.~ (-~. ZC. <~,~. ~...'~..J"..'..-.. 5j~J4~-<~d.'.~.-:. ~_,~; ~.]...'~: ~.~.-~.. ........... (as on the tax roll or latest deed) h' ::;'plicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. Plumber's License No .... /S/~. 1'./~ ........ Electrician's License No.../?..~..f ........... Other Trade's License No. ;.~.. Location of land on which proposed work will be done· .. ~ ~~.~v~ .~~~ ....................... ............ House Number Street . UHamlet ~' < '" Co~n, >,,~o ~000S,,,, n yTax~l't_ - "'o ................. . ......... :.~.]:.. ~ (Name) 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimatc'd Cost.. ~...~..J(. ~..?.a. oA .~...~.../.~./Y.~-$~'~pPO. 0o Fee (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 ...... -r.: ...... Rear ..... .-r-r-. ....... Depth ............... Height ....... .-75'. ...... Number of Stories .... ~ ...... Dimensions of sa~me structure with alterations or additions: Front ...... ~ ........ Rear . ~ .............. ~D.epth ..... ~. ................ Height ........... .~. :, ........Number o,f Stories ....--~_ ~ , 8. ta~mens~ons o~ entire nexv construction: Front ~ ~ ~' ~. "Z <'-_ o ~, ' '. :' ' 'd '_,3-' ~," ....... rxetgn£ ............... Numb;er of Stones .... :~ / z ..... 't ....... 9. S_.ize otlot: Front {]~.2~....7.. 6.--.~. 0, ....... Rear :'}~' ~3-'-~'b ........ b;;;t~ '~,~?' g, :~ "~ L'r~* .... 10. uateofPurchase 0//3 l~ :lO '"'~;_'U''.~ ' .... f.. ..... ~ '~'? ~'z.;~.'~.~.~ ........ 1 1. Zone or use distr' ~ "' ' "'Y; .... /" ...... L' ...... : .?~ame o~ eormer owner . t/xtr-t4~ .~/. t'~& .......... mt xn wmcn prem:ses are s~tuated...~l./fi. ................. &q.. ............... 12. Does proposed construct/i~violate a~ zoning law, ordinance or regulation: ~ ...................... 13. ~ill lot be regraded .... ~./~t~[C.?p 7~ ..,...., . .: . . . Will excejs fij_l.be, remoyed from premises: Yes 14. ~ame of_Owner of pnr%mise~/.207~.~/~;l~.~i~g ,i~{/.. Address .~)7.~t~c&~A.~. ~ {c~.~ Phone No 2~/' ~..7// '~-~/ aarne of Architect ~ ~3~Y.g ~ (~ ~ P " ' ' ..... /~' ........... N .... '~ ~-'xZ~ ~4,45 '-'- ' '/?x,' "'' Address~-~l".t~L~-- '°~' -~./j~- · · Phone No..7. g..~.. ~.qff. q... amc ox contractor t'aff~.~...~/JffLe, O~.~.'d.d.... Address ~t*f'rd~. ~f.~.~... Phone No. -~. Y-7. ·/.? .ff.&.. 15.Is this property located within 300 feet of a tidal {/etland? *¥g$ .... · I[ yes~ $outhold Town Trustees Permit may be required. PLOT DIAG RAM 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 corner lot. £TATE.OF NEW YORK... ~ , o c, COU,~Ty OF ....~.C2.-~-.~.o1 ~°'° . · ;:?~ff. z.7~...<r..A~.. ~.~.t~ .~...~.~.?..~.. ......... being duly sworn, deposes ~d says that he is the applicant ' (Name of individual signing contract) ' above named. ..... .... .......... · .... (C factor, agent, corporate officer, etc.~ ............................ of said owner or owners, ~d is duly authorized to perfom or have perfo~ed the said work and to m~e and file this application; lhat all statements contorted ~ this application are true to the best of his knowledge and belief; and that the Work will be perfo~ned in the m~ner set forth in the application filed therewith. Sworn to before me this ........ ~ 47~ .............................. (Signature of applicant) AREA A T GREENPOR T TOWN OF SOUTHOLD 1000 - 40 - - Scale I" = 30' July 11, 1990 Sept. 28, 1990(found loc.) HIOIl Prepared in a.c. cordanee with the minimum ~. LIC. NO. 49~18 e. t~.dar.de. .fo. r lit~ *w~ye e. eat~e~ ~,~.,.,.,.,.~.,,--,.,.,~,~ [~S~.~~~. ~ ~ ~h u~e by T~ ~w Y~k St, t~ L~ Title Aee~it~fl. P. O~OX:.~ ~A~ ~0~ SOUTHOLD, N. )'. 11971 0 AREA = 20.068eq.~ f.t: SUR VE Y OF LOT 24 su~o,v,s,o~ o~ c~R~,oS FILED JUNE 27, 1990 FILE NO. ~966 ~ T G~NPO~ T TO~N OF SOUTHOLD SUFFOLK COUNT~ ~ moo - 4o - ~'- PlO o~ Sca/e 1" = 30' Sept. 28, ~90(found. loc.) H. S. REF. NO. SOUTWOLD. N Y. I~71 86- 521(24)