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Home My WebLink About19254-Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Appro,,ed ..~. ~fi.l~..~.b., :,~.~. Perm, No. J~.~.~'~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF tJEALT~fl . . : ......... 3 SETS OE),q~ANS~ .............. SURVEY ~/~._/.[..~,'~....,...J'! ......... CNECK .' ...... ~.(. [~ ..... SEPTIC FORM ................ NOTIFY CALL .. ~'?.? :./.C?: ...... MAIL TO: a. Tlfis 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 lhyout 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 qmll 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 ~:emoval or demolition, as herein described· The 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 necessar,yTnspections.. ~ . .., ..,' ..,, ,;¢ j ._/,, (S~=n, ature o~ apphcant, or name, ff a corporauon) / · -' t., (Mailing address of applicant) ~ , :';tare whether applicant is owner, le,~see, agent, architect, engineer, general contractor, electrician, plumb~'r or builder. (as on the tax roll or latest deed) I," :: pplicant is a corporation, signature of duly authorized officer· (Name and title of corporate officer) Builder's License No. ~ Plumber's License No .... /8/.~.. 7./~ ........ Electrician's License No... I .9..~...~. ........... O£her Trade's License No. :'7.. .................. C~ ~ ~.C~_~a ~ ~'t~ ~-au~MJ°-,. . ~ ~ . ~ ;~ ~' , Locat,on of land on which proposed work will be done .... ~~:.. ~~~~~ .... ............ ....................... ilouse Number Street ~amlet~r .............. ~.~,,.,,,o... O_~a.~.ZZ~ .............. ~,,e~ ,~, ~o.. 8.?.~ ...... ~o,~~.. t~ (Name) Slate existing rise and occupancy of p~emises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~ ..................... ; _ - · .... : ............. . ............ b. Intended use and occupa,cy .... /.. · ,':~~,.~ ................. . ' ~' "...' '1::;;/::: ' .., d~¢~ 8 - 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair ............... Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimate'S Cost.. ~...7. .3(. ~..,~,.a.o.~. ~ ~ . .//. 5.5-J7/~.....°° Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units . .,~ .q. ......... Number of dwelling units on each floor...-.'-~-..... } ....... If garage, number of cars .... :.x.'. ................................................................. 6. If business, commercial or m,xed occupancy, specify nature and extent o f each type of use 7. Dimensions of existing structures, if any: Front ........ '---: ...... Rear ..... .v-7'. .......Depth Height ---- . Number of Stories Dimensions of same structure with alterations or additions: Front ........ --7. ........ Rear . ~ .............. Depth ........ ~ ............ Height ......... .--r .,. ,., ........ Number %f Stories 8. Dimensions of entire new construction: Front ...'~ .,5.:.0 [ .... Rear . .'.3 .~.-..o ..... ' ' ' "~-" ........... ' ....... · Depth .~ ,.'~-..' ~ ........ Height ............... Numbgr of Stories / -~ / ~. · ~ ' .... :":' ......l-' e~'"- ......................... :..4 ..... * .... 9. Sxzeoflot:Front(_.~.):~...7.'~..:0 ...... Rear ~ ~-0 Depth /24,~-~" c/'3.'~.~-~ 10. Date of Purchase 0I/3 t/ qO ' "Nan4'~gfFo'r~e'r'6~v .... 3"~"? ~"~"~J~')') ......... .. . · ..... v ..... /- ............ :., ~, ~ her . ¢~r'*~.. t ~ .-¢4o_~. ........... I 1. ~one or use district in which premises are situated...~,/././. ................ ~ ................... 12. Does proposed constructio/n viopte a~ zoning law, ordinance or regulation: ~ ................ 13. Will lot be regraded . ,,."'~O,~t.~.~ ./~ .... ....... Will exc~s fil_l_be, remoyed from premises: Yes 14. Name of Owner of p~re,mi.se~.~)~;i~./.~2/}-&~.~tlfl... Address ~,~.-t~..~./,r~.~.. Phone No ~.2T/-~-.7 [/ .N_ame of Architect .~4V~/~,~,~(~34:[,..~...../? ....... Address~-~/~-..~Jf~..ff3f.~./~/.. Phone Nol .~4~.~.' i o~iq.' Name of Contractorr/~&774-..~f47~...r-~,,q, RI, g, ./6.~.ff~.... Address ~~. j~f.~/~.~... Phone No..q.Y.~../.~ ~.~L.. 15.Is this property located within 300 feet of a tidal ~etland? *YES .... 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. ST..\TF.~O F NEW YORK COUnTy OF .... ~.c'.--[--'-f:ol ~ S.S ~, / · '-z~'~''c~'~'''''f~'~' ffCP~'['~'~.'.q..'L..//"~.. .......... being duly sworn, deposes ~d says that he is the applicant " (Name of individual signing contract) .~bove named. ..... .... .......... · ........................... (Contractor, agent, corporate officer, etc.) ...... of said owner or owne~, ~d is duly authorized to perform or have performed the said work and to m~e and file this application; that all state~nents contained ~ this application are true to the best of his knowledge and belief; and that work w/Il be perfo~ed in the manner set forth in the application filed therewith. Sworn to before me this ~ ~ ~ ~ (Signature of applic~t) Lor (~ AREA = 25,217sq. ft. SURVEY OF LO'T 25 SUBDIVISION OF CEDARFIELDS FILED JUNE 27, 1990 FILE NO. 8986 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.) LOT Lor ~ 15.00' $ 58' 15' 00" W N/O/f: viLLAGE OF G~REENPORT PEG"~Tdl~?'-~J~ ~il~S, P.C. P.O. B~ MAIN ROAD ~OUTHOLD, N.Y. 11~XI H. S. RE~ NO. 90 - SO - 98 LOT (~ AREA = 25,217sq. ft. SURVEY OF L. OT 25 SUBDIVISION OF CEDARFIELDS FILED JUNE 27, 1~0 FILE NO. 8~ 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). / / $GE. HIG i~UF:FER LOT (~ LOT (~ 15.00' 5 58' 15' 00" W IV. y. 11971 LIC. NO. 49618 86- 521(25)