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Home My WebLink About19258-Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1B02 Examined ....~ . .'~..¥., 19 ?.O. Approved.~.~4~ ..... .~.t~., 199.0. Permit Disapproved a/c ............................. ........................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH . 3 SETS OF PLa~S..[[(.~C'. ...... SURVEY ..... d~J/.~...~.ff.~ ....... CHECK ..... ..J~..../.~ NOTIFY ...... MAIL TO: /OO-Xo ~. ~?~f~:! a. This 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 o' ' ~ o,vm, 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 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 iemoval 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 necessars?h, .spections. .......... [.~.. ~-~ ~ .. .................. _~. (Sigrk;lture of applicant, or name, if a corporation) ~/' (Mmhng address of apphcant) ('J , State whether applicant is owner, le.~see, agent, architect, engineer, general contractor, electrician, plumber or builder. ... .: ..... Nameo (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) udder s L~cense No. . ' ' /81.9..:'./? ........ lumber s Lmense No .... Other Trade's License No. :T..':': ............... 31/55 (~,_)~~ ~ Location of land on wifich proposed work ,rill be done... ?'.~ .~.: ~~~ House Number ...... ~ir;;i ..................... ;~;,[',;; " '"' ~' ............... County Tax Map No. ,000 Section ..... qO. ......... Block ....O.~..O~ ..... Lot..O~/5~p " .............. 8 ... ,... . [~ (Name) ' ' State existing use and occupancy offset)scs and intended use and occupancy of proposed construction: a. Existinu use find neeun.no~ ~ ~ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimate'd Cost ~.. ~. j(. ~...~,. ~o ~ / ~ ,.__ 0o (Description) ..... a.°A .--~ ....... /. .o J~'/~. Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units . .,,.~ .~. ......... Number of dwelling units on each floor ...'7777..... ~ ....... If garage, number of cars ... r ~ .................................................................. 6. If business, comlnercial or mixed occupancy, specify nature and extent of each type of nsc ... ¥ .' ............ 7. Dimensions of existing structures, if any: Front ...... -. ·: ...... Rear ....... ~ ...... Depth '" Height ....... .--Z'. ...... Number of Stories .... .'77. .................................................. Dimensions of sam~_e structure with alterations or additions: Front ...... ..-%'. ........ Rear .-r.". ............ ~D.epth .. ....: ................ Height ......... v'..~. ;, ........ Number of Stories ....--~--. , " 8. u~mens~ons otentire new construction: Front --'g ~ a' n,,~ '"~ <7--"o ,-, ' '.;' ' '.4 2,--' L', ....... ne,grit ............... Number of Stories / -f4' / ,: ..... ; ....... 9. Size of lot: Front ~,:-0~...7. S.--.-. 0 ........ 'l~;,~i'~' 7~'.'-."'b ........ ~,'~'-:d ' ~/~f ' ~ "9 "~ '"-'r) * .... 10. Date of Purchase O//~ / / :~0 '' x,~2J' '_~,- ' ....,~, ..... ~cptj~ ~r~.,t? .,..................~,~,/[.~ ........ .... ' '. .... 7 ...../- ............ ....,~_ame ut t~ormer owner . tJ, ctr-t4~-¢-.. Il. ~one or use a,stnct m wh,ch premises are situated...~/./~. ................. (~..'.. ii ........... ' ........ 12. Does proposed constructio~n violate ao~ zoning law, ordinance or regulation: ~ ............ 13. · ,-' ~/~ -~.p ./~ .... ., · ·: . . . Will excess tHl_be~removed from premises: Ye Will lot be regraded -< .~ t.£k~ · ~ ' ......... 14. ,N, ame of_ Ow.ner of pnre~mi,se_s(~t;.~5.045~'/.~L0-~a{/.. Address ~,,~,f.-t~.A;{.-- f~ Z..~. Phone No 257. .~.~'// ~ame of Architect (/~-'A~,~(~,-O~ .C~. ., Address ~'-' - /¢t't.~_ .~_' _''~)~;f ' ,-~ ,, ' ?.; Name of Con*fac,,,/~. ).a.t,L~_) iff~'~',;; '///,;;/' ' ' ,~:,-5~.T~2..~.;~/~(... rnone mo../.,~..}., a. 7. V.L.. .... r~'= ' '-"' '~'C~:"t '~"~?'' · · Address O-gg-d,'t~(..7/.e'~.~... Phone No..6f~.~../~-.~.... IS.Is this property located within 300 feet of a tidal {~etland? *YES .... NO.~.~. · 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 comer lot. - - STATEOF NEW YORK ' S S ' · ~.~' ~'~?. ·. ~-72~. ~.?..~.. being duly s~vorn, deposes and says that he is the applicant (Name of individual signing contracti .......... above named. " ,eistbe ..... .... .......... ' ................................. (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 ~pplication; that all statements contained in this application are true to the best of his knowledge and belief; and that ~he Work will De performed in the manner set forth in the application filed therewith. Sworn to before me this No~y Pub~, St~ of N~ ye4 ~ no. 47,~'/34 ............................. _?~, ,[~_ In ~ OQunllt (Signature of applicant) gl~t'l¢ ~ AVE LOT ~ N/O/F 51, ApLI~5 LOT ('~ NIOIF pkUI. AREA = 23,495sq. ft. SURVEY OF LOT 29 SUBDI VISION OF 'CEDA RFIEL DS FILED .IUNE 27, 1990 FILE NO. 8966 A T GREENPOR T TOWN OF SOUTHOLD SUFFOLK .COUNTY, N. Y. 1000 - 40 - 05 - PlO Ol Scale 1" = 30' July 11, 1990 Sept. 28, 1990 (found. loc.) SCENIC BUFFER NIOIF Id,ARjORii ~ F. EiLIH¥OH & i~iARJORI~ I~I;uN¥oN tuOIf LOT ~ NIOIF pAUI- cOi~WIN LOT ~ AREA = 23,495sq. ft. SURVEY OF LOT 29 SUBDI VISION OF 'C. EDA RFIELDS FILED JUNE 27, 1990 FILE NO. 8966 A T GREENPOR T TOWN OF SOUTHOLD SUFFOLK COUNTY,F,/tVo0. oYj 1000- 40 - 05- Scale 1" = 30' July 11,1990 Sept. 28, 1990 (fOund. loc.) Nov. 16, 1990 (u.c.) SCENIC BUFFER NlOIF NiARjO~I~ f' I~UN¥ON I~IDuNYON i~kl~jol~l~ ' H. S. REF. NO. 90- SO- 102 $OUTHOLD, tV. y. 11;77 86 - 52'~ (29)