HomeMy WebLinkAbout26871-Z FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 26871 Z Date OCTOBER 25, 2000
Permission is hereby granted to :
CUTCHOGUE PRESBYTERIAN CHURCH
PO BOX 964 ,
CUTCHOGUEAY 11935
for
NEW CONSTRUCTION OF AN ADDIT ON AND ALTERATION OF A NEW HANDICAP
ENTRANCE RAMP AS APPLIED F R.
at premises /application
27245 MAIN RD CUTCHOGUE
County Tax MSection 109 Block 0002 Lot No. 017 . 001
pursuant to ted JUNE 21, 2000 and approved by the
Building Ins
Fee $ t 75 . 00
Authorized Signature
ORIGINAL
Rev. 2/19/98
.D INSPECTION 2R
REPT `
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111 I
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MATION (2ND)
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,H FRAME & 11 11
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PLUMBING
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FLATION PER N. Y. H
;TATE ENERGY a ii
CODE 1if---��
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t
IulA11n Or III:Ar.•rn
FORM NO. I J SETS OF PLANS
TOWN OP SOII-flIO1.1) . . . . . . . . . . . . . .
SIIIIVRY . . . . . . . . . . . . . . . . . . . . .
BUILDING DRPAR'1?II?NT CIIRCR
TOWN IIALL SI;P'I'I C FORM -
SOII'TIIOLD, N.Y. 1 19 7 1
TRIL: 765- 11102 NOTIFY: 7D///
CAI.I. L�_ (Q�p�
.
MA 11, TO:
AlgrrrNed...���G?..,...... . I'errnil No. ....................................., L (
Disal>Trroved n/c ..................... ...
................................. ......
--� ............
(Mli Idirll; loslx-ctor)
' -._- APPLICATION I.OIt 111111.DING YIiR11l'1'
�� 2 1 2000 0?000
JUN Dn t P. .l�ul1/ . . . . 1�.
�.-- !
; ! )
a. itis nRlrkaraC (?!l rt>Lr' �p- elrly Fillcrd in try tylx�c.n-il:er or in illi( nrxl sulroi1_1e [o lire lltrildinl; lnsllector wills
1 sell of nccural.e plot: plan to scale. lice according to schedule.
h. Plot: plml slx><aing Iocaticxl of lot nrxl of Ixrildirlgs cx1 prerniSeS, reln[irn►ship to rxljoininl; prPrnirer, or 1>trblir
11 iS nl) or areas, nrxl g;ivinl, n del.nilecl Ilescriptim of laycxrC of prolxvrl.y nest: lm rh:xall 0" rile ding;r:m which is l►nrt of
.Mira alg>I icaCial,
C. the work ccNered by [Ilia alrlr)icaC icxl rrty rxlC Lie ctalrrnrx:P<I Imfore irstalrxP of lAri Idin� t'ermiC,
d. Illxxl algrrcrval. of this nlgrlicnlion, life IAlildinr; Inspector rail) issl►e a IArildint;
x!rrniIPermiC to the nli�rlicant. Srich
l: slmll re kepr t: oilt.ile prt�nises availahle for insperl:ioll I:hrotOIxlt life raclrk.
e. 1Jcr Ixrilding Shall be occupied or used in whole or in part: for Orly rxrrpose whatever until a ( -rtificate of
k'rulxllxy Miall have Ix?en g;raolecl Iry 11►e 1%lildiol; Inslrector,
AI'19.1(J1'1'L(>rl IS IH;It1i11Y N1AI1. to tlwP IArildion I)rlrarinrnt: for the isstulrx;e of a Klilding; Perrnit lxrratl:nll to the
krilding, 7cxxt Otdirvnx'e of the 'Iix.nl of Stxltholclgula , I;trffolk t:cxnlly, Nara Yo11c, aril other npplicahle laws, OrYlio:nlcen or
lescribitxrs, for [Ire ctxrstrtrcticxr of Ixrildiogs, :xklititxrs or alteratitxrs, or for r1rt11INa1 or dermlition, an herein
Ic_srrilled. Nle aplilirmrt ag;rPes t:o ""filly will1 all nlgilicnl)le laws, ordinalrces, Ix!iildinR rcxle, Ixxasing; ccxle, arxl
el,Ulnticxls, nlxl to ,xinil: :n1Cl►orizPd inspeclora txi premises alxl in Ixriltlir for 1leressary ioslrPcticxla.
(Sigplature of nlg)licant, or nnrrr, if. a corlxrrnticxl)
.I
tfox ..C!�Z C�fv5''....
...........
(MriIiwlg; rrcklress of alglli(,anl:)
Male Aietber appl icant: is crlarler les:>Pe a;
g eld.:, arrllitect, P,11101leel , APfx-
,(���' �•,�� %�� rrrl contractor, electririronir
l, plter or Ixlil<ler.
-•"���l.V.T.�...Ott!/!�. .. !LGfcL1S'...... ..... ....... .... ......... ...
GMP of (narx?r of premises ..........................��5���..�1, .
(a5 Oo I.Ile lax rcr)I or latest deed) ..• •• '
f nlrplicant is a corlxrra[icxl, nigrr:lture of duly aul.lxrrizecl officer.
KIM Orxl title of c:orlx�rnCe officer)
IkliIders License No. ............... ..... ..... RMOW `"</�L� ��f�/(J� �//�i.
,Z •
I'lud►ers License No. �, '
Electricians License Nu. ........... .. ... . ....
Other Tr:xle's License No. ................ ....
fcxaticx� of lnrxl owl wllidl prolxrsed work will be. (knle.........
I"Jse Ntrrber Strect .....................
j//�� lbuleett:
(:cxrnt.y Tax K-11) No. 101X) Sect:ial ....,l.4...... Mock ..... ....... .�!
Sulxlivisicxl ....... ......................... F i Ied M•Ill No. ............... 1
State existing; use arxl cxxxgkmxy of premises aril ioterxled use arxl ocruparx;y of pl-olxrsetl ccxlstruc[ion:
n. Rxislilrg; use arxl tx'ct I):nxy .............. . .......... .a1 U!PdtT........ ............................ ...
h. illi elxlerl use aril occtrlxrrx y ............................V,& .... ....................................
A
I. Nuure^.)I' ►x)IIc Wreck ►dric:h al l)licvllrle): We,4 IklildIn ~ '
14auiiI. .. .. . .1, ll Aiklition , .. . . . . ... Aller/1Ciun
I(talryval . ......... ... Dom IiIll orl .... ... ..... Other IJolk
A. `O 0-00 fDellcrlpt:iar)
�1 I:r;l:lslill ctrl (;osC ...../........ .. . ... . fere .. . ... ...... . . .. . .
((o be paid on I i I ing drill application)
'i. I f 'AAA I doll, INAII)er of ekxel l Jill; tinil:s . . .
/46.4.. .. ""')er of thOel I ioil ' 'll s oil each flexr .. .,
II' l;arage, I■nlxer of cal it ...... . . .
6. !f Ixlailress, (xnulercial or mixe(I occupancy, slx:cify nature alit extent of each tylx: of tise... ..�V/W/
/. 111111'11,"o"S of exiSIA118 atm(Atires, if airy: FI(xrt.. .. .JJ. . . �—�-
ik:il;I1l: ... ..�,�.. . ... .... . R216er of Slot ieti . . ..Q
1)inrvlrsl(xrs of snle W rtx:ttne ui th III fel at i(xls or ixkli L ions: FI out . . • cS Q�27r • • , ,• Itear
lksplh i
SB7YIF. . .... Ik: JjiL . . . ... .Yl�_
.. .. .. .. ... . . . . - fA„1lx:r of Slur I(!s . . .40
S
11, Uiur:nr;i(x19 0l` entlle lm--w c(xrslrrxa i(xr: lil(xll. � 12101% AI&POO
Real Ik l)I II . .. .. . . .......
Ikil;Irl .... . . .... ... ..... .. . ... . Iil,I)er of Stories . . . .. ..
9. / ; . .
;;Ize f lot: I�Icx1C .. . .l.°'?.-
oO. �,� •• ... 14:ar .. .,. . . o �/ ,•. .. Ik.irllr
10. 'Erle of hirchase ...../74T.i�l ._... iJ,,ne of Foiller WIWI. ..... .4(*khOWh
I I. 7.()"x: Or title 'listrict in vAii(JI prclniseS are "iLtlated .. .... . . .. ...
........ . . . ... .. . .. ... .. ....... .... ... .. . ..... ...
12. prolx)t;ed ccxlat nx:l loo violate ally uxling lam, ordilkirlce or regcllal.icxl. . .. .... .. A/Q•
,rte .. ... ....
I ).
Will 1of be regrixle(i ......,lY v,•••,,., , Willexcess fill lu: relKwed frau prc:mi lies: YN. tXj
14. tliYlle?s of Omer of prf3uisies CUTcyO(OOZ- -(�- CIC . Atli lreasIt- 40
0g IF jiloi
Nin1l: of nr<:Iritecl: .4J: � 4)•, 7�rFlf/T1.Y. .... Aiklre"s if!l ,utt�6¢aE' _6.t�
. .. Mom..x: tJo. 0�
PAN! of (Axil:racfor ..... ... .. ..... ... ........... .. ... . Aiklress .. .
. ... . . . . . . .. . . . . . .
is this plolx:rty within NX) feet: of a tidal me-Harxl? * YES ... ... . .
*IF YES, SIX11ll(li)) 'It'll" -110g;11%1 l7:1ir11'!' !NY I11? Ia Alll(11).
PLOT 1►IAGRAN
lix:ale clearly S(xl dislinctly iIII IAlildings, vAiether exisl:ing or prolx)se(l, al)() ifxlicSte all set--back diaensioils
fluu prol)erty lines. (live slreeL alld block imber or ilescripLiou accotrling fo (lee(Ir alr(I fJlcA4 sLreeL lames Soil itYlicale
tAlelller interior or corf►er lot,
0,0/V5 MUCT 041
s�{w/v, 7a
SI'n'IE (W 11-.14 YWK,
UAJill IY (A. . .. .. . . .. . . . . . . . .. . ...
• • •• • • • ..•. . . . ..lWin'l duly mmull, delxrset; alxl says that lie is the appl icasll.
(Minn. of ilxlivi(lual signing contract)
illx)ve luNI A, ,per
Ik! h. tilt: . ..... ...... .....��lG�I
(CcnU rar.tur, alleiiL, corl,orate officer, et.c:.)
if said (uoer or lxJlxtf$, Iloil In ('illy irolllori7..e'd to Ix!ri'U1111 or have lx!rfonlled the "aid 4)orlt flild to llikke illki flit- Illifl
illll)l lcaLlolq that: III 8Latow.1101 colll(lllx'.11 111 till" i1ppl lcal.ioll ale Lllx' to the IK!fi(: of hit; 1(Ix)ule(Ige III KI Ix:l lt-f, alNl
(hilt Lhe mnk N(II Ix+ perfo(1111:(I t11 (lie IIFIIIIx?r liet: 1711th in like appl.I(lfll:loo tiled thereMltl.
,XA)II1 to helole Ilr! Ihi"
. . .. .iii of .J19'
tJnlary Nlhl i(•
,o
... ..... .... . . ...... .. . ... .......
JOHANNA 0. MILLER Wilpiattlre of Appl i(:iilrt)
Notary Public, State of New York
No.01M15061225
Qualified in Suffolk Coqnty i
Commission Expires June 3-44
BUILDING PERMIT REVIEW CHECK LIST
t
DATE REVIEWED: 9
APPLICANT NAME: L,4, �h h DATE SUBMITTED: / /!
PROJECT LOCATION
STREET: CITY:'.-/,k, SUBDIV. NAME:
ARCHITECT/ENGINEER: �•f �� �» S-t����� FAST TRACK: YES ox
SCTM# --- DISTRICT: 1.000 SECTION: 61 _ BLOCK: LOT: /7. /
ZONING:
ZONING DISTRICT(R4 _R80 AC CONFORMING: YES oR NO REQUIRED LOT SIZE: 4',' SQFT.
WHERE ACTUAL LOT SIZE FROM? 77; A C Dov ACTUAL LOT SIZE: *6746 SQFT:
FRONT:S&'PROPOSED:^r ' SIDE YD:�'/ &; ' PROPOS p -,CbREQ.,/ REAR: PROPOSED: ham''LOT COVERAGE: ALLOWED:,.O_% EXISTING:310+ sfNEW:gZd sf/% TOTAL:-t0,( sf 9°�a
CORNER? YES R NO WAT ER FRONT? YESOR O DESCRIPTION:
SINGLE& SEPARATE CERTIFICATION-REQUIRED: YES o O OTES:
LOTS 40,000SF --100-24. Lot recognition. (CREATED before June 30, 1983), UNDERSIZED LOTS FROM
JAN.1997 100-25. Merger. (A nonconforming at any time after July 1, 1983.)
PROJECT DESCRIPTION ADD ALT ACC OR N/D: e irccasso�
AGENCY PERMITS REQUIRED FOR REVIEW
NEED
TOWN SPETIC PERMIT: wo
SUFFOLK COUNTY HEALTH DEPT: YEBED #): DTE:—/—/ PERMIT #:R10-
NEW YORK STATE DEC: YESo
SOUTHOLD TOWN TRUSTEES: YES o
TOWN ZONING BOARD APPROVAL: YES o
TOWN PLAN. BOARD APPROVAL: YES or
FLOOD COMPLIANCE ZONE: PANEL #: FLOOD ZONE: ,
NYS ENERGY: YES OR NO : EGRESS: VENT: LIGHT:
NOTES: j6c v .,.r,- «guitze
6TC,N ?"� Ca• t/!c y d/TN e�i3c ��
FEE STRUCTURE: FOUNDATION: SF
FIRST FLOOR 1 j d SF
SECOND FLR SF INIT OTHER TOTAL
TOTAL: SF FEE FEE FEE
OT( SF)- ( SF)= SF X $ =$ +$ +$ _ $ <00