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Home My WebLink About19267-Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ~.~a,nin~d ·-~?-~-..a.t~., 19 ~.9 , ) . Approved .... .'~. ~.., 19C/.O. Permit No. I?.'4 .Q ................................ ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 'BOARD OF HEALTH,,/).. '"""~'" k2, .... 3 SETS OF, rLA~ISI[:--::"-:.~. ...... SURVEY CHECK ....... ,, ;- ~ ~ r ~ --r' ',~:,'-'LY-' '-: .... SEPTIC FORM . i . ~ ............ No'rIPY z/'97 - CALL ..................... MAIL TO: /00- ~0 ~. ~-.! ...... a. This application must be completely filled in by Wpewriter 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 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 Sbuthold, 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 admit authorized inspectors on premises and in building for necessary~, .spections. ~5<.~ ,~.~,.~ : Fd;~- ~, ~ ~.~.4. ............. _.~, (Sign, ature of applicant, or name, if a corporauon) · u .... ~Y' 'ih'~hiA=;,;fiAie'sl g~i~ii~;/)'''c ..... :' State whether applicant is ;owner, le,,ssee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . . ,:'e. ¥ .-. . .......... ..................................................... f ii" ,"I ,2' ' , Name of owner o f premises ."- .~.'u i.g~"~,'~'. ¢/~-: ~-. '~, ,--~' ...... ~.'~ ' ~.-' ....~::~. ~.". ~?~. ............. (as on the tax roll or latest deed) I£ applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No .... /8/-~- · "-/~ ........ Electrician's License No... ] ?..~..f ........... Other Trade's License No. ~..~"~. · · ............... 1. Location of land on which proposed work ,rill be done... ~~~-..r...-~~~...~~ . ..................... House Number . Street OHamlet ~' ........ County Tax Map No./~ ,000Section~ , ,, ..... ~ ....... i Block ....0.~,.O'~ ~// ..... Lot..~/,'~..:.~...,' .............. .... 1~ (Name) ~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... L ~ (Description) 4. Estimate'd Cost.. ~..~..3(. ~..~.,.ap.o..~...~.. ..~,.--0.~. oo 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 . ~ .... ' ..... .. ' 7. Dimensions of existing structures, if any: Front ...... 'r.' ....... Rear ....... ~ ...... Depth Height ---- Number of Stories Dimensions of same structure with alterations or additions: Front ...... .~... iiiiiii i ;il "' .............. Depth ........ ~ ............ Height ......... .-w .~.., ........ Number of Stories....---~.. .... , ......... 8. Dimensions of entire new construction' Front ~ ~ o' ~r '~ <'-:'o ,-, '.~' ' '.4 ~:-' ';,', ........ · · .......... ~x~a . . ...~ ~4. ........ l. Jeptll . oq ~;).: ? ........ Height ............... Numb3*r of Stories.../. ~ ! , , 9. S~zeoflot'Front/,]/~. 7~ -0 Rear ~.4Z ~ _O - _, /~._-t.. ~'.-~'--~''.; .... Oate of Purchase qO .............. of Fo ner Owner ';5 i'3 ......... 11. Zone or use district in which premises are situated .~/t L9 r'f ................. 12. Does proposed constructiofl~ viol?e, a~}7 zoning law, ordinance or regulation: ~ ......... 13. Will lot be regraded ~ ~. t.~.r, ~ W' fi .' ............. .... ~ ]~ '-/.-p -/, .., ...... ~... I11 excejs 11 be. remoyed from premises: Yes ,4. ,N, ame o!O. w,n.e.r of pnr%mi,s%~qi~54L?6{,;/.~21~.g,~ff~tij.. Address O~4~flf.~t~)[~..//ff.g~.~.. Phone No. ~..~.'c-./2 ~-.7(/ '..~.. ,amc ot Architect .~ .~J~,~.~j,,';~C;4/~..,~,. ,... Address~,a~,l-/~_/.~..07-~..~./-~. Phone No '].4~ ~.. ~ q.' Name of Contractorr ~d0r~., .r24~. ~...r~/24~.~ (.~.V.~.... Address ~'~ ~.~.~... Phone Nol i~57. i ~ ~.';~ 15.Is this property located within 300 feet of a tidal {~etland? *¥gS .... · Il? 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 inte~or or corner lot. ST..\TF~.OF NEW YORK~,_ _ S S COU,'¢TY OF ~.C, +:~ot g. · ~ / t4/r/' ?Z(~...~r.~..~., ......../Z~ ~ ~', ~-/4 ~ //*' '' ":~ ~'" vc~.~'t~'c~ -/(~'~"'"'-J.i~-~..~- .......... being duly sworn, deposes and says that he is the applicant '" (Name of individual signing contract) .~bove named. " ,e,s,he ..... .... .......... ' ................................. (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 work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ; ........ I.~..-~.. ......... day.of .... ~../~. l~ ......... 19 .~.~.a t~ltl,d ~ ~ 0~ (Signature of applicant) -E i,,1, ! JUL 3 0 1990 ii[I TOWN OF SOUTHOLD SURVEY OF. LOT 38 SUBDIVISION OF CEDARFIELDS FILED JUNE ~?, I~0 FILE A T GREENPORT TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Z~ 1000 - 40 - 05 - PlO Scale 1" = 30' ~A~t~ 11, 1990 25, 1990(found. loc.) NO. O£NN TT R 58' 10" W LoT ~ SUF.F.O.L..K. C~..UNT¥ D_EP.A,~TMENT OF HEALTH .-- .~NCL. E.~,~LY DWELU,C O,LY D^T~PI~ 3 0 I§§IH.S. REF. NO, The sewal~e disposal and water supply facilities for th location have been inspected by this De; other a~,~,,~___~nc e and fo al. to ~isf;j~,"~ry.. Chief ~f Bureau of Wastewater Man~ement AREA = 21,145 sq. f~t. H. $. REF. NO. ~O - SO- 65 CERTIFIED TO, DIME SAVINg8 BANK OF NEW YORK. FSB FIRST AMEI~CAN ~ ~A~ C~A~ ~ ~W Y~ TI~ ~. ~ - ~ - LA~A SUR VE Y OF LOT 38 SUBDIVISION OF CEDARFIEIDS FILED JUNE 27, I~90 FILE NO. 8986 A T GREENPOR T TOWN OF SOUTHOLD SUFFOLK COUNT_Y,p/~ YO~ 1000 - 40- 05 Scale 1" = 30' July 11, 1990 Ju~y 25, 1990(found. loc.) Nov. 16, W~O( .. c.) · LIC. NO. 49618 TttleA~ SOUTHOLD, N Y. z~971 86- (38)