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Home My WebLink About31664-Z ". , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 -, '.. Examined n!-r I ~ r . 20Q( Permit No. -:l;/ H 'Iv Disapproved ~j _ ~ 1-tJ 7 . 2<X6' Approved /r;~ I (Building Inspector) .,"..,."......,..,;;~0L1CATION FOR BUILDING PERMIT ~,C'"", e," ~ j,J\,,"< \ \ \\\ \\ ~'"'\ I, " .".~.- \\\\\ 1'<;\,,':-'-"'- ~,\ l~\ .\",.' - ~ \\.-1\ \'<, ~\J'l"'; .' .J a. This \~~~~~a"-~ ' in by typewriter or in ink and submitted to tbe Building Jnspector, witb 3 sets of plans, ac te ~Rl' e, Fee according to schedule. b, Plot pi . location oflot 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 tbe diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, tbe Building Inspector will issue a Building Permit to tbe applicant. Such permit shall be kept on tbe premises available for inspection throughout tbe work. e. No building shall be occupied or nsed in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by tbe Building Inspector. Date INSTRUCTIONS APPLICATION IS HEREBY MADE to tbe Building Dep ent for tbe issuance of a Building Permit pursuant to tbe Building Zone Ordinance oftbe Town of Soutbold, Suffolk County, ew York, and other applicable Laws, Ordinances or Regulations, for tbe construction of buildings, additions or alterati s, or for removal or demolition, as herein described, The applicant agrees to comply witb all applicable laws, ordinan s, building code, housing code, and regulations, and to admit autborized inspectors on premises and in building for ne ssary inspectiJl' _ J AJA 1( 1/f/'l'A,uk , (Signature of ap1>ficant, or name; if a corporation) Suffolk Environmental Consulting, Inc. P.O. Box 2003: Bridl!ehamDton. NY 11932 ( i .. (M.'I""_=of",,II_J State whether applicant is owneJ;, see, agent, arc tect, engineer, general contractor, electrician, plumber or builder GENT Name of owner of premises JOHN ~ERSON (as on tbe tax roll or latest deed) 1. Builder's License No. Plumber's License No. Electrician's License No. Otber Trade's License "* If applicant is a corporation, signature of du N/A (Name and title of corpo House Number osed work will be done sls North Parish Drive Street Ba 'ew Hamlet County Tax Map No. I 0 Section 071 Block 0 I Lot 033 Subdivision Filed Map No. N/A Lot N/A (Name) 2. State existing use d occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and cupancy VacantlUn-imoroved land Private sirnzle fumilv dwelling witb rel~ed 'reside1ti:il aoburt;rnances .' . . '". 3. Nature of work check which applicable): New Building X Repair Removal Demolition A?!litlOn A1th~~on OtberWork . 4. Estimate<! !:ost $ 250. 000 Fee f ~- ,-- ,.,. -:;0-- (to be paid on filing this application) Number of dwelling units on each floor N/A 5. If dwelling, number of dwelling units One (I) If garage, number of cars N/ A 6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dimensions ofexisting structures, ifany: Front N/A Rear N/A Height N/ A Number of Stories N/ A Dimt,mSions of same structure with alterations or additions: Front Depth N/A Height N/A 8. Dimensions of eutire new construction: Front 72' 10 \1," Height 28' I" Number of Stories 2 9. Size oflot: Front 140.0' Rear O. Date of Purchase N/A I. Zone or use district in which premises are situated R - 40 2. Does proposed COnstruction violate any zoning law, ordinance or regulation: No. 3. Will lot be re-graded No. Will excess fill be removed from premises: 4. Name of Owner of premises Jon Anderson Phone (516) 480 _ 0978 Name of Architect ASHLEYlMcGRAW Address 508 Main Road. Aauebogue. NY 1l931Phone No. (631) 722 _ 3511 Name of Contractor N/A Address Phone N6. 5. Is this property within 300 feet of a tidal wetland? *Yes No X *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM N/At Depth N/A N/A Number of Stories Rear 71' 9" Rear N/A N/A 45' II Y, " Depth 140.53' Depth 178.85' (max.) Name of Former Owner N/A Yes No , Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from .roperty lines. Give street and block number or description according to deed, and show street names and indicate whether :!terior or corner lot. Please refer to attached Plans. iTATE OF NEW YORK, :OUNTY OF SUFFOLK S.S D;oAA... J( W4<;(ltAC being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) hove named. Ie/she is the Al!ent - Suffolk Environmental Consultinl!. Inc. (Contractor, agent, corporate officer, etc.) ,f 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 this knowledge and belief; and bat the work will be performed in the manner set forth in the application filed therewith. :worn to before me this ;;i~ /. Matthew D. Ivans Notary Public of New York No. 011V6053859 Qualified in Suffolk County Commission Expires January 22, 2ll'37 r 2005 ~otary Public ---------- )U~. I{ ..1r~ . '-'"(Signature of Applicant)