HomeMy WebLinkAbout28583-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. 28583 Z Date JULY 23, 2002
Permission is hereby granted to:
SARAH WICKHAM GICALE
22 DELLCASTLE COURT
MONTGOMERY VILLAGE MD, 20886
for
VOID NOT BUILT
at premises located at 160 EAST RD CUTCHOGUE
County Tax Map No. 473889 Section 110 Block 0007 Lot No. 017
pursuant to application dated JULY 17, 2002 and approved by the
Building Inspector to expire on JANUARY 23 , 2004 .
Fee $ 75 . 00
C
Authori ed i ure
ORIGINAL
Rev. 5/8/02
1
FIELD INSPECTION REPORT DATE
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BUILDING DEPARTMENT Do you have or need the following,before applym
TOWN HALL Board of Health
SOUTHOLD,NY 11971 3 sets of Building Plans
TEL: 765-1802 Survey
PERMIT NO.AdZ-%)� Check
Septic Form
N.Y.S.D.E.C.
Trustees
Examined i ,20 Contact:
Approved 0 ,20 c5t Mail to:
Disapproved a/c �r�q 42—
Phone: 713
Building Inspector Y - CyA' N
APPLICATION FOR BUILDING PERMIT
Date 20_
INSTRUCTIONS
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with
sets 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 waterways.
c. 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 issue a Building Permit to the applicant. Such a permit
shall 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 what-so-ever until a Certificate of Occupan
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 code, and regulations, and to admit
authorized inspectors.on premises and in building for necessary inspections.
(Si of applicant or e,if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, gent, archite , engineer, general contractor, electrician,plumber or.builder
Name of owner of premises L pV l S AhyG 5ftAtE 61 CELE
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
/ O e-45, 9-0040 Cum Elv 6 C)E
House Number Street Hamlet
County Tax Map No. 1000 Section 110 Block
Subdivision Filed Map No. Lot
(Name)
e
>.. State existing use arid,occupancy of premises and intended useed occupancy of proposed construction:
a. Existing use and occupancy ,
b. Intended use and occupancy N1
Addition Alteration
3. Nature of work (check which applicable): New BuildingoX Other Work
Repair Removal____�Z Demo (Description)
t. Estimated Cost J 0D Fee
(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.
S �� �
7. Dimensions of existing structure , y: ront Rear Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
Height Numberof Stories
9. Size of lot: Front Rear Depth
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation: &V
13. Will lot be re-graded /V D Will excess fill be removed from remises: YES NO
Z2 El.t_G�STI-e Gr
LO!/ S, n 5�42�YH M oar d o'4r" 0i c.4o}a E, M n
14. Names of Owner of ' es . .G!c.A(.� Address Z o 7P6 Phone No.
Z a$ - �0 39
Name of Architect C G�M Address A0 6," 9 33 Phone No -734414EC
Name of Contractor Address CcMAa 4&K Phone No.
15. Is this property within 100 feet of a tidal wetland? *YESNO
MI
• IF YES, SOUTHOLD TOWN TRUSTEES PERTS MAY BE 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.
STATE OF NEW YORK)
SS:
COUNTY OF )
PC,1f-VJ4rZ'TZ being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the
(Contractor,6genorporate 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 will be
performed in the manner set forth in the application filed therewith.
Sworn before me this
day of SIN /' 20 0
Notarybhc Signature of Applic t
ELIZABETH A STATHIS
NOTARY PUBLIC,State of New York
No.01 ST6008113,Suffolk Co�
Term Expires June 8,20cL
SURVEY OF PROPERTY
SITUATE:FLEET'S NECK NEAR CUTCHOCGUE
TOWN: SOUTHOLD N
SUFFOLK COUNTY, NY w E
SURVEYED 10-05-01
SUFFOLK GOUNTY TAX # 30 g
1000-110-7-17 \
GERTIFIED TO: — \
LOUIS GIGALE
SARAH GIGALE A � Zs_ of \ \
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NOTES: �F NF�Y L V avd arized alteradan-addltl-to o.-.y
�P� �• /O oPlomair oaSGcensed lads veyo
o seal is a
t on f tion 1209, l5ln 2,of the
New York Stateto"E Education Law.'
■ MONUMENT Cq only copies from he o lglnal of this wrvey
marked with em orlghal of me larq wrveyor's
stamped seal shall be considered to-valid We
1 copies'
O PIPE * ` -certlf c L;ors a dlllten her—slgmfy mat ws
'
.—y",
prepared m accordance with the ez-
ting code of Practice for Land S.irveys adop.6
AREA = 43,447 SF OR 1.00 AGRES ¢ by the New Yark State Assoclatlon of Professional
�^ O Land Surveyors. Sold certflcatlo-shall run only
1, ^ to meperson for whom the wrvey Is p-pored,
�w� oI10Y (` and on his o if to the tltle compmy,gov -
-Y L �J tol agency andn
d Idmmg V-1-listed her on,o-
ELEVATI ONS REF. NGVD '29 v to me aseigne,of me lending InetiWtlan. Gertlf ca-
ND5 [lone are not—foloole to additional in=titutons
FEMA FLOOD ZONE LINE ANNOTATED FROM JOHN C. EHL AND SURVEYOR
FIRM PANEL 164 OF 1026 MAY 4, 19x8
6 EAST MAIN STREET N.Y.S.LIC.NO. 50202
GRAPHIG SGALE 1"=30' RIVERHEAD,N.Y. 11901
369-8288 Fax 369-8287 REF.\\Hp server\d\PROS\01-278A.pro
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