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HomeMy WebLinkAbout19257-Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined..--~.h-.~., 19~.Q Approved · .~..(4.., 1999. Permit NoJ.~...23~'.. Disapproved a/c ................................. "F, ................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ' BOARD OF HEALTH . . . j%~.. ~t;~W'~. 3 SETS OF PLANS: .. [YJ~.'~.. .... ~', '1 _ ' ../' SURVE~ ...... ..~... ~,~'~.~. SEPTIC FORH ....... ~. ....... CALL ......... a. Tiffs application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 qets 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 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 ,hall 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 removal 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 necessary~, .spections. ,~.~d-.~¢: ,<~. ~ ............. _._~, (Sign, ature o£ applicant, or name, if a corporanon) ' 0 ', ' t~ ~")/' (Mailing address of applicant) ('J ' 5:tare whether applicant is owner, lqssee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... !? ~/, .A.~. : : .: /©~.,.::~ :~ ......... ~ ............................................... N:,me of owner o£premises .q././~/~..(_,,(~&f?v. ~.~;~-'.,~.~_.../~.-./'.'?? .'7.5/~.~ ,2.4'.c(-:. ~/~:,~.//~. ~.-~Z?.~'./. ........... (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/.~.. 7./~ ........ N - /.~ ,;/,- Location of land on w ,ich proposed work will be done.. ~ .~r~..../.~.. '~.4..MLle..... I~.~..'.'~.~(r. ~.~~ ~ - .,._~ ~ ........... . .~ ~-:-¢- .~¢ e~. ~..~ ~ ~ ~ ..................... ~v6~/~ .~ 2z ~. Iiouse Nu;~ g~r Street " vmmlet O' .............. County Tax Map No. lO00 Section ................. ~.~,~,,,o,.. ~_x4~/,.jZ~: .............. ,,,., ~,~,o..g.?.d~ .... ~o,~'. J~ (Name) State existing use and occupancy of~jemises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ~' · · .~ .... ; .~ ........ . .... ,. :~........ ~ ......................... .... ................. 3. Nature of work (check ~vhich applicable): New Building .......... Addition .......... Alteration .......... Repair ..... '. ........ Removal .............. Demolition .............. Other Work ............... (Description) 4. EstimatEd Cost.. ~.. ff..3(. ~'..?.a.o.0. 7~...~...//. ~.3--57-~..a.o.. 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 ...'TTT.. ................ 7. Dimensions of existing structures, if any: Front ...... ~ ...... Rear ..... v-w. ....... Depth..7-7.. .......... Height ....... .'77. ......Number of Stories - - Dimensions of same structure with alterations or additions: Front ...... ~ ........ Rear . ~ .............. Depth ........ ~ ............ Height ......... .'7z..~ .......... Number of Stories....---~-'. ..... . · 8. Dunenmons of entire new construction: Front ..."~ ~ ~ ..... Rear ...~ ~.~.-.o. ...... Depth ,37, ). 7 .O ........ Height ............... Numb rot Stones / ~ ,:. · ~ ..... :Z~ ...... /. · ~ .... ..................... ~ ..... * .... 9. S,ze of lot: Front/.~,A'~...7.$..'-..0 ........ Rear..~4,~.. ~,_~-.-..O. ....... Det~th D~a'~.~'~. 63?..~ 5.0. ..... 10. Date of Purchase ...0..././.~..I./. ~(~ ........... ...,N~an4~e of Former Owner . ,~ .~/. ~_~'~ .......... 11. Zone or use district in which premises are situated...~/./). ............... ~. .................... 12. Does proposed constructio~n violate a~ zoning law, ordinance or regulation: ~ ...................... t3. Will lot be regraded . ,,.~ ./~. ~.~. ~.~ .......... Will exce~s fill be. removed from premises: Yes [ No) ,4. N~me of Owner of px~m ~se~.t~oT~.~';. ~':a,'.~,Z. address ~&X~.~:.~.q/.. Phone No. 2 ~./: ~? (.~ :..'--~. · Name of Architect c.,~g~,/,~'~C,,~C4b~, .~...../?,. ,-'. ^ddress,~-.~4..4.~.._.e~.~ .~:.. Phon~, No. /Z~.~. ~.q q.q... Name of Contractor' ,~Ja74~ .a-fl/,...c-K3/2,R.(../~'d.,4.... Address ~x-7~-~jV.~.~... Phone No..qZ7. ·/.? ~..& ·. 15.Is this property located within 300 feet of a tidal ~;etland? *YES .... · 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. STATF&,OF NEW YORK., ~ . , cOt~Ty OF ~.o,+:~-t/-' S.S / (Name of individual si~ning contract) above named. ..... .... .......... ' ................ (Contractor, 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 tMs a~plication; that all statements contained ~ this application are true to the best of his knowledge and belief; and that ~he '.vor~ will be perfo~ed in the m~ner set forth in the application filed therewith. ' Sworn to before me this, ......... .......... .... ........ ~ ~~o~y~ ................................... H~ 4~ ~ ~ ~ ~ (Signature of applic~t) ×'r. wASHINGTON Id 73* 58' 10" E FODNDi~ TIO' OCT 2 1990 BLDG. DEPT. TOWN OF SOUTHOLD LOT LOt ~ LOt ~ AREA = 25,078sq. ft. SURVEY OF LOT 28 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.) SCENIC BUFFER t~lOIl Prepared in a.~.corclance with the e?~.dar.de_ for_title aurveya ae eetelMehed Dj, the L..LA.L.$. ~,auE. n uee. ($1e) xes - ~o2o P. o. BOX ~ /~ MAIN ROAD SOUTHOLD, wASHI ToN 73' 58' 1;9: 75.00' 10" E a SrO~¥HoUS~ H.S. REF. NO. 90 - LOT SO- 101 LOT ~ LOT AREA = 25,078sq. ft. SURVEY OF LOT 28 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 Scale 1" = 30' July 11, 1990 Sept. 28, 1990 (found. loc.) June 12, 1991(final) SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES $~NGILEiF~(LY DWELLING ONLY DATEJ~UL ,, ~- Y'"AI.S I~EF. NO. ~ Tt~e sewage disposal and wa~er sup~,i.~ · ," · :ac~,~t~cs for this location have been respected uy ' ,.- "= · tn ~ -~Pa¢~ment atld/Or other a~e~and fo~d to~e satisfactory. Chief ~ B~reau of Wastewate(~,,~ana~ement SCENIC z rtlOIl Prepared in accordance with the minimum sta~dardm for title eurveye ae eetabliehed by the LIA.L$. and approved and adopted for. e _u~ uee by The New York State Land Title Aeeo~letion. BUFFER NY. ,' JUN 16 tSS; ~EALTN S£RVmCES IN.Y.S. LIC. NO. 4N18 86- 52 (2 )