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Home My WebLink About19256-Z " '"' FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved .~.~., 197.O. Permit No. [~..~. ~v. ~-,. r vedac ..._../ ) l)isapp o / .................................... ................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 3 szTs oF .L~NS ''4-q~'' SURVEY ..... ~)~,j~-. ct..'. ~ ....... CHECK CALL ...~.....~ ............. MAIL TO: ~o~~ ...... a. Tiffs application must be completely filled in by Wpewriter 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 ,)r 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 droll 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 .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 !luilding 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 necessargTnspections __~, (Sigrtature o~ applicant, or name, if a corporanon) / · ~ ..... ~. ........................... ~ ....... (Mailin= address of applicant) ' c;,::te whether appl,cant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ·. :role o I owner o I premises . ."j.u //. ~, ~.4,q4~.!-::. C,t~.~:' ~.. ~,%. ~ .... '.. ..... t.~/xc..r .~. .-v. ..~:tt.. ,-. :,.. '.~: .............. (as on the tax roll or latest deed) [:~ :~pplicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....... ~ .................. I'lumber's Lkense No .... /S/..~. · "./'/ ........ Electrician's License No.../?..~..f ........... Locahon of land on wluch proposed work wdl be done .... /..z=...~r/-; .,.~..~.... ~.~:~f-.;~:t~/~'..~.~r..-~'C-. Z ~ . x: ...................... ......... llouse Number Street vlqamlet d/ ....... County r,~ ~l,,pg~o. lO00, Section, ...... q..O. ........ mock .... O. ~,.O.O. ..... Lot..D.O./.: .O..O... ,' .............. . /... (Name) .......... State existing, use and occupancy of,premises and intended use and occupancy of proposed construction: ~ 7 a. Existing use and occupancy ..... ~...-;-~ ........ . ....... .;,~.' ..... : ..... . .................... .... ' ................. ~' d " ' ~";,'" , 3. Nature of work (check ~vhich applicable): New Building .......... Addition~... ......... Alteration .......... Repair ' Removal .............. Demolition .............. Other Work ............... (Description) 4. EstimatEd Cost .. ~...~..}('. //"'- co ~ ..... ??.. Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units . .,2.7 ......... Number of dwelling units on each floor ' If garage, number of cars ...:..' .................................................................. 6. If business, com~nercial or mixed occupancy, specify nature and extent of each type of use ' 7. Dimensions of existing structures, if any: Front '~- Rear ~ Depth ~ Height ~ Nmnber of Stories ~ Dimensions of same structure with alterations or additions: Front ~ Rear . ~ .............. Depth ........ .'.. ............ Height ......... .-':. ;. ..........Number o[ Stories ....-~--'. ........... · ....... 8. Dimensions of entire new construction: Front ...~ ~.0 7 .... Rear .. '.~ ,~.~'7.-..o ...... Depth . ~ ~.'-7 .a ........ Height .............. Number of Stories . ./ :~.~ .... / /. / , 9. S,ze of lot: Front ~... 7. ~..:.0 ........ Rear..t0¢+~.. 7D~.-'..O. ....... De-th ~i/:.~-.~'.. c%.. ?..~ .'- a. ..... 10. Date of Purchase ...0..././(..~../.fi. ~0 ........... :.,N~am~ of Former Owner . 7,~ .-¢~. ~'~~...: ...... ! 1. Zone or use district in which premises are situated...~,/./). ................. C7.. ........................... 12. Does proposed constructiofi viol.,ate a~n~7 zoning law, ordinance or regulation: ~. ....................... ~ 13. Will lot be regraded . ,~./lga:Z.X~.~C~ .~, ........... Will execs fill.be, remov, ed from premises: Yes /~ No) 14. Name of Owner ofp_remiseff_tj0?'.~.-AJ/_~'./~-2~g.~!g.q/... Address ~l~fl'~t.t~.~. ~¥ Phone No 2D-/' Name of Architect ~.~.,~,/~}~.%~../? ....... Address,o~-~-'~.~..~..'~.~i~:: Phone No: .7].',~:~: ~i~ ~/?/.' :: Name of Contractorr [.i~Y~..~c~z~. ,,.. [~:~/24~.e, (~'.~.... Address ~ ,~'~jTf.~.~... Phone No..6{2.7../.~ .57.~,.. IS.Is this property located within 300 feet of a tidal {~etland.? *¥g$ .... lqO.~.]. *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 corner lot. {]/~ ~/~ ~ ~ STATE_OF NEW YORK~ , S S _ .... lc. · ; / ,/.~~' ~' ~c~'~ct~2-~'~ '~(~-?- ./C'~. · being duly s~vorn, deposes and says that he isthe applicant : (Name of individual signing contract) ........ above named. .eisthe ..... .... .......... ' ....................... (Contractor, agent, corporate officer, etc.) .......... of said owner or owners, and is duly authorizcd to pcrform or have performed the said xvork and to make and file this application; that all statements contained in this application are true to thc best of his knowledge and belief; and that ~he work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........ .I., . .-~.. .......... day.of .... ~.../~. [L4 ......... 19 .c2.~~~~~~ ry Public .... ~ c~¢-~C-,... ~ .... County L/ NomO, Pubg~ $'m~ o~ N,,,. Y~ ................................... Ho. 47~57~4 Ou~lbd In SuBOlL Ooum'd~ (Signature of applicant) LOt ~ LO:/' LOT ('~ SURVEY OF LOT 27 SUBDI VISION OF CEDARFIEL DS FILED JUNE 24 1990 F~E NO. 8966 A T GREENPOR T TOWN OF SOUTHOLD COo ~ _o. 1000 - 40 - Scale 1" = 30' July 11, 1990 Sept. 28, 1990 (found. loc.) AREA = 22,205sq. ft. N..KS. LIC. NO. 49618 P.C. P.O. MAIN ROAD SOUTHOLD, N. Y. 11~71 SCENIC BUFFER rtlOIl LOT ~'~* .FI. $. REF. 90- $0 = ~00 LIDJ" LOt ~ SURVEY OF LOT 27 SUBDIVI$10N OF CEDARFIELDS FILED 'JUNE 27, 1990 FILE NO. 8966 A T GREENPOR T TOWN OF SOUTHOLD SUFFOLK4o COUNTY, NoYf 1000 ' - 05 - P/O Scale 1" = 30' July 11, 1990 Sept. 28, 1990 (foufld. loc.) AREA = 22,205sq. ft. SCENIC BUFFER OioIl