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Home My WebLink About17557-Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 19 eermit No...4 ..... Disapproved a/c / ................................... · ............................. .... APPLICATION FOR BUILDING PERMIT BOARD OF HEALTH ............ 3 SETS OF PLANS ............ SURVEY ..................... CHECK ...................... SEPTIC FORM ................ CALL 3 ~ MAIL TO: Date OCTOBER 19 1988 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and Submitted to !he-Bi~it~ffig Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buddings on premlse$,.relatm,s~lp,to :,4ttf&r~n~ ,~,,~es or public streets or areas and giving a detailed description of layout of property must be drawn on thb diag~rd ~hi ~]3'!s part of this appli- c. The work covered by this application may not be commenced before issuance:of ttuHdih~ Permit. d. Upon approval of thru application, the Budding Inspector will ~ssmed a Buildn'eg'~6M11]~t~Se~P~f~cant. Such permit shah be kept on the premises avai/ab]e for inspection throughout the won~ic No building shall be occupied or used in whole or in part for an~'l~tOsd ig'ff~u~'L'nc~'~cate~ ~ '~ "--~'~ of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department ,flora' t~lla~t~ding Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, l~wl ~!~ ~ ~l:h~ 1~l)l~lol4~ws, Ordinances or Regulations, for the construction of buildings, additions or alteratioq~,~Ol~fo~lqt~81~ ~ herein described. The applicant agrees to comply with all app ical~'e laws, ordinances,~"~3l~ co-"--d~'h'~tl~hg code, and r-' ~ egulaUons, and to admit authorized inspectors on ~remises and in building for necessary (Si~"F'ff~me, if a corporanon) POB ~50, ORIENT, NY. 11957 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor; electrician, plumber or builder. OWNER Name of owner of premises ..... CHARLES E.BAKER and L'AURA H. BAKER (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder s Lmense No .......................... Plumber's License No ......................... Electrician's License No ....................... ~ ~7 ~ ¢~ ~ 13213-BI (EXCAVATOR-DEMOLITION)~ ~~ Other Trade's License No ...................... SOUTH SIDE, OF RT 25, ORIENT, NY. Location of]and on which proposed work will be done .................................................. ACROSS FROM THE OLD CHARLES ROSE AIRFIELD House Number Street Hamlet 019 1 P/O~J-4~.4-~ /'/ ~ County Tax Map No. lO00 Section .................. Block .................. Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use a.d occupancy of proposed construction: RESIDENCE a. Existing use and occupancy ..................................................................... DEMOLITION b. Intended use and occupancy .................................................................... 3.Nature of work (check which applicable): New Building ..... ' ..... Addition .......... Alteration ......... Repair .............. Removal .............. Demolition ~... Other Work (Description) so9 ' t~d C ' 4. Emma ost ..................................... Fee ..................................... SINGLE (to be paid on filing this application) 5. If dwelling, number of dwelling units ................ 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 ......... 18.~ ........ 7. Dimensions of cxistin~ structures, if any: Front . . . .3.4.' ......... Rear . . .3..4: ........ Depth .............. Height . · .1.2, '. Numbcr o f Stories ONE Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth ...................... IIeight ...................... Number of Stories ..................... 8. Dilnensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............. ,.. Nmnber of Stories ........................ ~2~.; .............. 9. Size of lot: Front .150 .................. Rear ..... 'zi~; ......... Depth ... I0. Date of Purchase ....... 7../.6/.8.7. ............... Name of Former Owner HOWARD HOEY RESIDENTIAL 1 I. Zone or use district in which premises are situated ....................... Iii0 ............................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ YES .~AK,..Will excess fill be removed from premises: Yes No 13. Will lot be regraded ...... ~i4~,LggT'C,~.OR.A' 9~d~ POB 350, ORIENT Phone No 323-2573 14. Name of Owner of premises ..... Name of Architect .................... .' ......Address ................... Phone No ................ Name of Contractor CAMPBELL EXCAVATING Address CUTCBOGUE:NY , Phone No 734-7476 ................................. : ......... , . ........... iT" 15.Is this property located .ithln 300 feet of a txdal wetland. YES .... NO... · If 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 interior or corner lot. t SEE SURVEY FOLt.OW~NG 1. FOUNDATION . FO~ 2. ROUGH - ~ 3. INSULATION 4. FINAL CONSTRUCllON MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCllON & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. STATE OF NEW YORK, S.S COUNTY OF ................. ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ......................................................................................... (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 application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work w/Il be pert'onned in the manner set forth in thc application filed therewith. Sworn to before me this ............. /3 ........ d yof .... .v...¢LU. ............ /9 / .......HEI.EW I~ DE ¥0E : ................ ~ ............ ~''' NOTN~Y PUfLIC,. State of New Ymk (Signature of applicant) ~o. 4707871{, Suffolk Term £xpi~ Ms,ch 30, 19.~ October 1~, 88 Southold Town Building Dep't. Town Hall Main Road, Southold, NY. 11971 Ched Baker POB 350, Orient, NY. 11957 Dear Folks in the Building Dep't, I am including this letter of intent with our permit application to clarify this construction. We own this 2 acre lot and my wife, myself, and two young children are living in the small cottage located on the northeast corner of the lot, noted on the survey. It is our intention to demolish the cottage as soon as the newly constructed modular home is in place. We intend to apply for the demolition permit in the near future, and have already acquired an estimate for the work. If you have any further questions concerning the permit, please give us a call at 323-2573. Thank you. Sincerely, THE Date ' THIS CERTIFIES THAT NEW YORK BOARD FIRE UNDERWRITERS BUREAU OF .~ITY B5 JOHN STREET, )RK, NEW YORK 10038 ottly the electrical equipment as described below end introduced by the applicant ~mmed on the above application number in the premises of in the following locatlon; ~ B~sement ~ Ist FI. Lot FIXTURE L- FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS DRYERS TIME CLOCKS SYSTEMS NO, OF FEET OTHER APPARATUS: E R V I NO. OF CC COND. PER ~ C E This certificate must not be altered m any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.