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Home My WebLink About19255-Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1B0:a Examined.-.4.4~ -'~.-~. ,19~-O- Approved ..~. , 19~O.. Permit No. J. !. ,.~._i ,~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEAL4r'H !,,~.),.:i~,¢~... ..... 3 SETS 0r PLANS d.~.....~. .... su~v EY .... -~...'.~ .~.,~ ...... CHECK SEPTIC FORM~.~.' .......... NO~ ~'~--/Z~-~ ..... CALL ................ MAIL TO: /00- ~0 ~ ~ ...... a. Tiffs 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 pe~niit 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 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, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessarY?nspections. ~ ·, ~/ ~, (Signature of applicant, or name, if a corporanon) l State whether applicant is ,owner, le.ssee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .'-.</~../i~.~/~,~&~.~/. c('JLS'.~.,~,~-. 7~..'.&'.~ .'~. ~.'~-~..-;'.Fw. ~/~2~.//~.Z.~/.~.~-q/. · ........... (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 ........................... Plumber's License No .... /ff~ ./O.. :../? ........ Electrician's License No... ~..~..~...~. ........... ~D ~ ~ ~ Other Trade's License No. 2..'f-~... ............... J~o~S ~O~~ ~ · ~-~ ~ .... ~ .~ ~ -, ~ _ . ..................... z ff, .............. House Number Street vHamlet ~ ' County Tax MapNo. 1000Section ...... ~ ....... : Block ...P.~, OO .... Lot..D~/q~P...f.. Subdivision.. ~_~~.ff~ .............. Filed Map No. ~.q~ .... Lo~.. /~(Nan,e) ~ State existing nsc and occupancy of~jemises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... ~ ..................... : . ............................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimate'dCost..~...~..3(. V..2,.a. oA Y-; ...... '.r. ~.~'$7~avt~. . . . .°° 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 ...,.." .................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of nsc .... 7 ................ 7. Dimensions of existing structures, if any: Front ...... -. ·: ...... Rear ..... ~ ....... Depth., ."7. .......... Height ....... ~ ...... Number of Stories Dimensions of same structure with alterations or additions: Front ...... ~ ........ Rear. ~ .............. Depth ........ .'7. ............ Height ........... ', .......... Number o[ Stories....---~--. ...... . , 8. Dimensions of entire new construction' Front ~ .fi~.- a" R~.~r '~ ,,.<~.- O rt,,th ,~, ~:-' ~J ........ Height ............... Nu.m_..b,er of Stories .../. :~.~. ...... [.?..,: ................. 9. Sizeoflot:Front~2oX/~...7.~..-.O.~ ....... Rear..D-d~...~---O.. '~)ept~ /),cr,;~f'~,"7.~;"t) .... 12. Does proposed constructio/n viol,ate a,n.~7 zoning law, ordinance or regulation: ~ .................. 13. Will lot be re~raded //~n ~.g~/~/g. ......... ' ...... o · .... .W~...~,../7,-.,,:~ ./,~ ........... ~vm execs nn.0e~remoyed from premises: Yes f No) 14. Name of Owner of premiseg_~d0q.:~t-~/5~': ([~-2,~}.,~.fdP-dt} Address .~,~.,~eA;{~ ~/~ g.r~.~ Phone No ~.L7/' iS.Is this property located within 300 feet of a tidal ~etland? *YES .... · 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 properly lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ~/~ C) ~-,.,Z---- STAT .E.OF NEW YORK.~ ~ ~ S S ~ COUNTY OF ~.w+:O-'oJ~ ' ~ / -- (Name of individual sioning contract) .,bore named. ,ei, the ..... .... .......... ' ................................. (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 .... i. ' ~..'~..~ day.of ~.. t~.[,.~ ...... 19.62.~/~ .... r" · ' tary Public .... ~ ~.. ~(d,,d.~.oa'"r20 .... County L,/ ~ Pub~. $tm o~N~ Yat ............................... I~o. 4755734 ~ill~l M ~ ~ (Signature of applicant) AREA R = 40.00' L = 64.23' = 24,589sq. ft. SURVEY OF LOT 26 SUBDI VISION OF CEDARtELDS FILED JUNE 27, 1990 FILE NO. 8986 A T GREENPOR T TOWN OF SOUTHOLD SUFFOLK COUNTY, N. OY1. 1000 - 40 - 05 - P/O Scale 1" = 30' July 11, 1990 Sept. 28, ~990 (found. loc.) LOt (~T) LOT ~ SCENIC BUFFER ¢1OIl Prepared in accordance with the minimum P.O. BOX 909 MAIN ROAD $OUTHOLD, N.Y. rle?l LIC. MO. 4~618 - 40.00' = 611.2 LOT (~ AREA = 24,589sq. fL H. $. RI=. NO. 90 - SO- 99 SUR VE Y OF LOT 28 SUBDIVISION OF CEDARFIELDS FILED JUNE 27, I990 FILE NO. 8988 A T GREENPOR T TOWN OF SOUTHOLD SUFFOLK C_%U5NT- 1000-40 Yj:,/No'~' Scale 1"= 30' July 11, 1990 Sept. 28, ~990 (found. loc.) LOT ~ tOT ~ 8CEN~ ~O~-$-sllvt t40R~ INC.(A ~ANK OF NEW YORK CMPANY) ~3tli~L I~ WALDEN WALDEN .Pre.par.ed_in a?o. ordmn~e with the minimum emn~ar~le for ~ ~vepe P. MAIN SOUTHOLO, N. Y. ~Ie71 86- 521(26)