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Home My WebLink About19260-Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 'BOARD OF HEA~TH .-.~...~...~ .... 3 SETS or ~'LANS SURVEY ...... ~'~)' · ['~'~' ff~ z ~ ' CHECK ...... ~ .... ~~.. SEPTIC FORM ................ Examined · . . .~.~a,~ .,i~.6,.., 19 9.0 Approved ....~-~ . .~..~., 19~/.O. Permit No. 1 5,~'~'6 ~--~ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This 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 layout of property must be drawn on the diagram which is part of this appli- cation. ¢. 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 ~luilding Zone Ordinance of the Town of S6uthold, Suffolk County, New York, and other applicable Laws, Ordinances or Rc,2ulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. i'he 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 necessa~j~nspections; ~,,ii ,;',.c,~ ~?.g.,: //'5 .~ n ,,:,'.~, L./j g~. ~/.~'; .~. . ~.~ . . f,%./,; ~-~ ,~ ..~r. .~.~ .............. · (j ..... n ............................ r, ..... .._5 t~ (Mailing address of applicant) ,o , :;tare whether applicant is.?wner, le~ssee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................... ........... . ........ ............. · .~ n ,'Z //)1 ' / ,. ~, ... ...... . ,,n~ or owner or prem,ses ...{L ¢. ~ ~.,(~..z!.. ~(C. ~.. i ........... .~.~,,~. ~ ~ .... _-.,i. < .~ ................. (as on the tax roll or latest deed) [',' .pplicnnt is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........................... Plu,nber's License No .... /.(5)/?. · 7./-'': ........ Electricians License No... 1 ?. -~...~. ........... jO cio ~ 'k;.~,~ A ~ Other Trad~ s L,cense No ...................... ~l~lO~ '~ ~ v~' . . , ~ ~ q ~,, i~ ' ~ Location of land on wluch proposed work wdl bc done... ~.. ~,~-.-~%~ ~ ~...4 ~ .... ...... -~ _ .- ................................... ~-~%~e.e~ .... ~/. J/~ ............ llouse Number Street uHamlet ~' ' Co,n,~ r=~ ~,=,, ~o. ,OOO S,~,,o. ........ ~.0 ..... : ,~o~ ....O. ~,.O~ ..... ~o~..~/~ g.q .... '.. .............. ,o. ..... /~(Namel 3J State existing use and occupancy of pjemises and intended use and occupancy of proposed construction: a. Existinguseandoccupancy ..... ~/ ~~ " ~ , ~.; ' ~ .... ~ D~" 3. Nature of work (check xvhich applicable): New Building .......... ~5 Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimate'd Cost.. ~...~..J(. ~..,.~.a. op..~...~....//. ~.,~-J¢~,a~.....~° 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 ... r ..'. ................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use - 7. Dinmnsions of existing structures, if any: Front ........ ~ ...... Rear ....... ~ ...... Depth Height -'--- Number of Stories Dimensions of same structure with alterations or additions: Front ........ ""7. ........ Rear . .-w:.. .............. Depth ........ ~ ............ Height ......... .--:., .......... Number of Stories....-~'-. ......... . , ..... 8. Dimensions of entire nexv construction' Front ~ ~ t~" [t'onr "~ 'q"--"O Fit,nth .1~ ,,c~_ O' ' ' Height ............... Numbpr of StoNes .../. ~ ...... / ..../. .......................... / ,. . 9. S..izeof½.ot: F. ront~.~.;?.~.'7'.-.,O,}._...:.. Rear'.-7.~.TffT2..O. ....... Deptl~ 10. ~Jate o~rurcnase ..... !./..'3/././(/ ........... ...,Name of Former Owner . ,~xt~ .~. CLb '~--d.L~5$ .......... 11. Zone or use district in which premises are situated. · .~l./). ................. (ff. ........................... 12. D.o. es proposed constructio~n viol?e a~n~7 zoning law, ordinance or regulation: ~. ....................... 13. Will lot be regraded . ,,./,~t~0 ./~ .... .,.. :... Will execs fill be~removed from premises: Yes f No') 14. Name of Owner of p~r%mi,seS{j~tTfj~,~l~. 0~'Ltt~{/.. Address ,~,~tt.~ ~. f//j.l~.. Phone No. ~..~.c-./: ~.. 7 ./]..'..~.. Name of Architect ~4t/~C;4~ .~7~._:..,, ....... AddressO'~.fi/-t~,L4~..~..~.~f.. Phone No. /2,~.h'~'.. ~ff. ~/.~.. Name of Contractor//,J~{...~/J/~{ ~V.~.... Address ~~.~f.~j.~... Phone No..9{~.~.. AL.'" .~'.~.,.. 15.Is this property located within 300 feet of a tidal ~etland? *¥~.S .... · 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. ~ O STATE_OF NEW YORK ' S S ~' '_.~' ~. '/3~- · .'~./~.?../~- · · · · i .... being duly sworn, deposes and says that he is the applicant . (Name of individual signing 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 t~s application; that all statements cont~ned N this application are true to the best of his knowledge and belief; and that work will be perfo~ed in the m~ner set forth in the application filed therewith. Sworn to before me this ~ ~ ~ ................................... ~ h ~ ~ (Signature of applic~t) SURVEY OF LOT 3'1 aREA .2r, r==e~ ft. SUBDIVISION OF CEDARFIELDS A T GREENPOR T ~""~1~~"""~_.,~ TOWN 'OFSOUTHOLD 1000 40 05 P/O ~-~,~ ~.~:~ t,-,--:..- sc~e r"= ~o' ~(~_r:~?~?]!!"!~ July rr, r99o '~ ...... ~ ~ ~ ~~ July 27, 1~orfou~.loc.) H. $. REF. NO. 90-S0- 63 CERTI~.D TO, FII~T ~ Trt;.E INSURANCE AREA =21,152 sq. ft. SUFFOLK COUNTY DEPAR'FM~_NT OF HEALTH SERVICES -" .... SINGLE FAMILY DWELLING ONLY DAT~IH,s. REF. NO. The sewage disposal and .water suppJy facilities for this location have been inspected by this Department and/or other ag~e~s~,Jo~j~d to Chief o~ Bureau of Wastewater Management SURVEY OF LOT 31 SUBDI VISION OF CEDARFIELDS FILED JUNE 27, I~90 FILE NO. ~ A T GREENPORT SUFFOLK COUNTY, N. Y. 1000 - 40 = 05 - PIOus01 Scale 1" = 30' July 11,. 1990 . July 27, 1990(found. loc.) $OUTHOLD, N. ~'. lIB7! '86 -