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Home My WebLink About19268-Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved .'~...~., 197.O. Permit No..;~'.~ !a<j.'.~. Disapproved a/c ................................... ..~/ // ................................ .... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEALTH .... 3 SETS OF ELANS, ~ ........... SURVEY A ~.'-- ~ CHECK ........ ~..~ ........ SEPTIC FORM .../. ............ NOTIFY CALL . . .~.././..~./..o.~ ~ ...... MAIL TO: /O0'XO ~~r' ..... a. Tiffs 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. e. 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 qlall 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 4mil 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 Rczulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described· Fhe 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~hspections. ._~, (S~=n,ature ot applicant, or name, ~f a corporanon) / (' (Mailing address of applicant) (~ ' 5tare whether applicant is owner, le,$see, agent, architect, engineer, general contractor, electrician, plumb~'r or builder. , ................ ?7 ......... 3')3' ;:"'.,"", ..... .') ......... : ............... .............. . ;,tree of owner of premises .~.~.~ff;.~/l-,~./(:. ~L~.-'Z. ~.. (~--/.~../'.&.'..'5..~4~ l~-.6~.gr. ~:ff~://;.~-O7( .~.. ........... (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 .......................... Plmnber's License No .... /8/.~.. ~..~. ........ Electrician's License No... I ? -~..f ........... o,, r ............... Location of land on which ~ro osed work will be done ~ ~ - - ~:/_~..~-~--~~--~_ ~ ~/. ~. ,..~.-, _~ -,.~,, ............. · ,'-- ......... ~../...C~lA'x.'f¥..~'.~?"'..~< .~.'~'~. Y ................. ~.~at.q~.~,.ii~,4.~l~.~/~'t ~/(/: ° /z ....... ~,? ................ ilouse Number Street v~Imnlet 6/ County Tax Map No. 1000 Section ...... .~D... Block ....~'e).~.,.O.O. ..... Lot..l~..O./,. .............. .... LotS .,. /.,. (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... F..,...~'7: .... ; .~0 ~ ~tS'~ ~,~~.' .... i..~ . -. .... ~ ..... . .................... b' Intended use and occupancy .... Z . . .~_~.~.6~../~, .j4;,/.~,, ?t;~ ' ~. ~,~ ................. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling units . .,,~ .q. ......... 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 nsc .... '. ................ 7. Dimensions of existing structures, if any: Front ...... .'w:-:.. ...... Rear ..... ~ ....... Depth ...-~-; .......... Height ....... ~ ...... Number of Stories .... .77. .................................................. Dimensions of same structure with alterations or additions: Front ...... ~ ........ Rear . .-':n.. .............. Depth ........ ~ ............ Height ......... .":w.., .......... Number of Stories....---~--. .................. 8. Dm~ens~ons of entire new construction: Front . . .'~ ,555.0 ..... Rear . . .~ ~.~-.- o . . Depth . ,.;7, ~5'-- O . . Height ............... Nu!n_._ber of Stories.../..~.~. ...... /_ .... /.~ ...................... >: '~'~ '/'r) * .... 10. Date of Purchase ...... /.~..I./. ],0 ........... ...,N~ame of Former Owner . ~z~--~.-. ~.,O '-¢da_D~2~ .......... I 1. Zone or use district in which premises are situated...~/'./.2. ................. ~....." . ...................... 12. Does proposed construction viol.ate a9~ zoning law, ordinance or regulation: ~. ...................... 13. Will lot be regraded . ,,./.~/, ~/g~.?,~.~ ~,, ..,...::. ;... Will execs F~fl_l_be~remov. ed from premises: Yes f No 14. Name of Owner of premi.se~-0-gd~. ~-24~,{iget/.. Address ~0~,7..4Zaf, A ;(7..~]ff.g~..~. Phone No. 24c'./2 ~-.7(./ .'..":-~.. 15.Is this property located within 300 feet of a tidal {~etland? *¥E$ .... NO.~'.}. · If yes, $outhold Town Trustees Permit may be required. PLOT DIAGR~ 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 STATF~.OF NEW YORK .... S COU,~Ty OF ....~.c,'.+'.~.ol.~.. a. n / · ;;~-jp'T?'4'~. -~ff~M/- ·/' ~ ~" ~ ~~~7~ .......... being duly sworn, deposes ~d 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 this application: that all statements contained ~ this application are true to the best of his knowledge and belief; and that ~he work will be perfo~ed in the m~ner set forth in the application filed therewith. Sworn to before me this · ' ~ Public .... ~~..~ .... County . , ~ ~ ~ ~ o~ ~ Vm ................................... K~ 47~ ~fl~ h ~ (Signature of applic~t) AREA . 2~,~ m~ ft. gGEHIG . .. ~Uf:FER .O0' ~.o'r ~) SURVEY OF LOT SUBDIVISION OF CEDARFIELDS FILED JUNE 27, I~BO FILE NO. 8986 A T GREENPOR T TOWN OF SOUTHOLD SUFFOLK COUNTY, N. OY~ ~00 40 - 05 -. P/O Sc. de 1" = 30' J~u~ ~, 1~0 25, 1990(found. loc.) 'Z. Lo*r ~ W .% SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES -- SINGLE FAMILY DWELLING ONLY DAT~-I~R 3 0 199~.s. RE~. NO. ~~ The sewage disposal and water supply facilities for this location have been inspected by this Department and/or other ~~ l.~nd tp, ~satis~actory. ChiefJof Bmeau of Wastewat~r Management AREA = 20,398 sq. ft. H. S. REF. NO. 90 - SO - 84 SURVEY OF LOTo 39 SUBDI VISION CEDA RFIEL DS FILED JUNE 27, 1990 FILE NO. 8986 A T GREENPOR T TOWN OF SO,UTHOLD Scale 1" = 30' J~u~ 11, 1990 25, 1990(found. loc,) Nov. ~, t990(u, c. ) CERTJgED TO, VfC, TOR F~ i/c~'l~ ._ ~ _ '~ \ 0 ~ ' ~ ~ ~ M M Y.S. LIC. NO. 49618 C. P, O. BOX MAIN ROAD SOU}HOLD, N Y. 11971 86- 521 (39)