HomeMy WebLinkAbout27831-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 NO3 27831Z Date OCTOBER 25, 2001
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I
Permission is hereby granted to :
MARK E & LOUISE D GAUMOND
3 EAST MEADOW RD
WESTPORT, CT 06880
for
NEW CONSTRUCTION OF A FOUR BEDROOM SINGLE FAMILY DWELLING WITH AN
ACCESSORY ONE CAR GARAGE AS APPLIED FOR.TWO C/O ' S WILL BE RQUIRED
at premises located at CHOCOMOUNT DR FISHERS ISLAND
County Tax Map No. 473889 Section 003 Block 0004 Lot No. 005 . 002
pursuant to application dated AUGUST 2, 2001 and approved by the
Building Inspector.
j Fee $ 2 , 151 . 60
"hor ignature
ORIGINAL
Rev. 2/19/98
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A• OABB YAx 4.2001
- PROPOM 4 BEDROOM FIESMENICE
a f1IEFr 1 BE+
BUILDING PERMIT EXAMINER CHECK LIST
DATE REVIEWED: a/�O1
.DATE SUBMITTED:15/b1 /01
APPLICANT NAME: !was
SCTM# DISTRICT: 1.000 SECTION:QoR BLOCK:__� _ LOT: ,5'a
STREET: 91UAI7-r 600 OrF LRsr 9 a. CITY:+-. - SUBDIV.NAME: AJA
PROJECT DESCRIPTION:
` cos
ARCHITECT/ENGINEER: ` Acee FAST TRACK? ljo
SINGLE&SEPARATE CERTIFICATION-REQUIRED? d O NOTES: O-. 05q c d -
LOTS 40,000SF-100-24.Lot recognition. .ATED fore June 30,1983),UNDERSIZED LOTS FROM JAN.199 00-25.Merger.(A nonconfmTriuot any time after 7/1/83)
ZONING DISTRICT: R-I&o CONFORMING?*r5 `
REQ.LOT SIZE:�ZO ACT. LOT SIZE: 15RREQ. LOT CO 6 ACT. LOT COV. 2
REQ. FRONT 460 PROP. FRONT 1-2-o REO SIDE o ACT. SIDE. /G
REQ.REAR PROP. REAR f
WATER FRONT? A4 DESCRIPTION:
PANEL #: FL OD ZONE:
AGENCY PERMITS REQUIRED FOR REVIEW
PROVALS RE UIRED:
SUFFOLK COUNTY HEALTH DEPYES NO, (BED#): DTE:e kg/ V/ PERMIT
NEW YORK STATE DEC: PRE-DEC 9/1/75 YES o lob' r-P.Dm
R tNp��
SOUTHOLD TOWN TRUSTEES: YES o O �' r
TOWN ZONING BOARD APPROVAL:YES o
TOWN PLAN. BOARD APPROVAL: YES
TOWN HISTORICAL PRE (SPLIA): YES
NYS ENERGY: YES O
EGRESS (18 H min.?4 s otal) VENT(SQ. FT.x 4%) LIGHT(SQ. FT. x 8%)
BUILDING PERMITS OPE XPIRED: BP -Z/C/0 Z- -
HAVE PRE CO'S : Y OW BP Z/C/0 Z- ,
NOTES•
c"S
FEE STRUCTURE: FOUNDATION: c216 I SF
FIRST FLOOR : 3�13 SFS
SECOND FLR : I b 9 A SF INIT OTHER TOTAL
TOTAL: SF FEE FEE FEE
OT Z SF)- S(-60 SF)=4WZ SFX$ .30 =$Iq O +$ l�0' +$ _$'2ow'6O
Ate.
TO F SOUTHOLD BUILDING PERM APPLUCATION CHECKLIST
B — -DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of caf
SOUTHOLD,NY 11971 3 set8 of Building Pleas~
TEL: 765.-1802 SMWY y
PERMIT NO. 2 833/ Checky I ._.—
septic Farm mor i✓ ��L��J
Trustees
Examined /d/2S _20_ Contact: --
Appro200E Mail to:
Disapproved a/c
. Phone: -960-
L S I 1�1, Building Inspector
''QiO�. nF^ fir, i J CATION FOR 13UR DING PERWM.
T� F S H L t
Date 20CV
INSTRUCTIONS
a.This application MUST be oompletely filled in by typewriter or in ink and submitted to the Building Inspector with 3
sets of plana,accurate plot plan to scala 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 waterways.
c.The work covered by this application may not be iced before issuance of Building Permit.
d.Upon approval of this application,the Building luspeotor wM issue a Building Permit to the applicant. Such a permit
shall bwkept 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 whawo-ever until a Certificate of Occupancy
is issued 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 Southold,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 oode,and regulations,and to admit
authorized inspectors on premises and in building for necessary'inspections.
H P BROOM HOUSEWRIGHT INC.
(Signatm of appHowd or nen e,if a corporation)
P 0 BOX 70, HADLYME,, CT 06439
(Mailing address of applicant)
State whether applicant is owner,lessee, agent, architect, engineer,general contractor,electrician,plumber or builder
GENERAL CONTRACTOR
Name of owner of premises MARK E & LOUISE D GAUMOND
(as on the tax roll or latest deed)
If applicant ik ao my auth rized officer+
(Name sa t1e of corporate o )
Builders License No. 13061 HI
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
PRIVATE ROAD OFF EAST END ROAD FISHERS I,SI,AND, SOUTHOLD
House Number Street Hamlet
County Tax Map No. 1000 Section 003 Block 4 Lot .5 - 0,
Subdivision
5 - a-
Subdivision Filed Map No.
(Name)
t. state existing use and occupancy of.premises and intended use and occupancy of proposed construction:
a. Existing Use and occupancy UNDEVELOPED .BUILDING LOT
SINGLE .FAMILY RESIDENCE -WITH GARAGE
b. .Intended use and occupancy
3. Nature of work(check which applicable):New Building X Addition Alteration
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost 900,000 Fee
. (to be paid on filing this application)
5. If dwelling,number of dwelling units 1 Number of dwelling units on each floor
if garage, number of cars
6. Nbusiness, commercial.or mixed occupancy, specify nature and extent of each type of use. N.A.
7. Dimensions of existing structures,if any:Front Rear Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories. j
8. Dimensions of entire new construction:Front--!I FT Rear 9 i. FT Depth 58FT
Height 341-1n6 Number of Stories 2
9. Size of lot:Front APPROX 3 5 0 FT Rear APPROX 2 2 0 FTDepth APPROX 450- FT 3.4 6 + ACRES
10.Date of Pm-chase' OCT 14, 1999 Name of Former Owner ROBERT & JANE GENIESSE
11.Zone or use district in which premises are situated R-120
NO
12.Does proposed construction violate any zoning law,ordinance or regulation:
13.Will lot be re-graded MINIMAL will excess fill be removed from premises: YES NO
MW &iotas
14.Names of Owner of �es c� Address . Cr�,-- 'hone No. -221-02_o
Name of Architect S RM �Ams GREENWICH Phone No 203-869-7250
Name of Contractoz�
BROCM 202SEWIRHGr Address HADLYME, Cr Phone No. 860-526-9836
X
IF YES, SOUTHOLD TOWN
15.Is this property within 100 feet of a tidal w1'R�TEE5 PERMITS MAY E REQUIRED
16. Provide survey,to scale,with accurate foundation plan and distances to property lines.
17. if elevation at any point on property is at 10 feet or below,must provide topographical data on survey.
Cid
STATE OF )
SS:
COUNTY OF�Q,13
being duly sworn;deposes and says that(s)he is the applicant
(Name of individual signing contact)above named,
(S)He is the Coy,
(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 belied and that the work will be
performed in the manner set forth in the application-filed therewith.
swornrefore me
day of �� 200 1
Notary Public S9111=
of Applicant
ti-3�-0S