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Home My WebLink About40867-Z T�'�WI�,OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD, NY 11971 �� , _ ,, , 4 sets of Building Plans ' TEL: (631) '765-1802 � � ' Planning Board approval FA : (631) 765-9502 �� Survey �, � � � . Sout�oldTown.NorthFork.net PERMIT NO. Check Septic Form N.Y.S.D.E.C. • Trustees � C.O.Application Flood Permit Examined ,20 ; Single&Separate n . Storm-Water Assessment Form . %� � Contact: A roved � 20 / , Mail to: �'In1� I I pp � f- D�sapproved a/c g S N-��hwoo� i�o� S�"`°r�l p�3 a i g� i Phone: q�7— — 0 0 � Expiration L� ` �- -', 1 � Building Inspec or JUL 2 2 2416 � APPLICATION FOR BUILDING PERMIT H�IlliG D�. TQWN 4F SOUT'HOLD Date �.�1 v ��/ d2 I , 20 /� INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 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 the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date.•If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize, in writing,the extension of the permit for an addition six months. Thereafter, a new permit shall be required. 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 fo��n�e�C��s�'sat.,'y�- i ' ns. � � e��i� �° � "� �/� ' �� s�e'�� , � �,'C (Si ture of applicant or name,if a corporation) � � � �' ✓�� \�\ �r� . - . o�� \�� ;;,-,�;;�, Fo� � 7�.� yo�K �ye �a�+� . rvy.►�� a� ► �� , � �,0 �` .�� ` �S•, `l ��U (Mailing address of app icant) , 4 U 0 �� n? a��,�S�'��n1��•t�.. `��G State whether applicant is owner, l�s� ��a�e��;archit�c`v��r�gi��;�general contractor, electrician, plumber or builder �Q�'�-0 i�ph�� p `�,�ta�� ' _ /�UJ/� L� �e.F `�� p�' �FRP�� ,.�.�� ,� � �}\1�`�\.��QNr,��n-,UC�;`��c'; ��1C'.E� ��`1 . Name of owner of prerriises f'4' �}�'-, ` ��`L_L%��',cS�F �OR �• � � r �;J�� n� �.F�� .��:,oha't erta�,uql��caC,�a;�'s�'deed) If applicant is a corporation, signature of dul��a�t�-�tSrizec�r-o�i,c�r�� p�� /l/ P�-�' ,��e�"h�`a C,°'-��vG�� (Name and title of corporat officer) R� �S' �� G�'` �l�p` ��0 pC� Builders License No. „�s\ Plumbers License No. � Electricians License No. ` - Other Trade's License No. 1. Location of land on which proposed work will be done: • �'.� �i c �woa� (�o�+o- svu��fv�c,c�;N�� rl�' � � � � House Number Street � � tl�` ��,,., � ''+ Hamlet ' ' � , "•.=�{�� ' . :�.;�; t;_�>„�- . ,,.� � � � , County Tax Map No. 1000 Section ��/ S Block' ' �"' � '� """ Lot Sr� 1 Subdivision y 73 8'$q ��P`�' — S� Filed Map No. SS`�� Lot � � 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupanc�lm�j�C� � ' 3•�� y� �$.g �S.P� �,��Ch�c� Su��/@ �/'� b. Intended use and occupancy G�-�� 3. Nature of work(check which applicable): New Building Addition Alteration �Repair Removal�_Demolition Other Work (Description) 4. Estimated Cost 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, co'mmercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of�existing structures, if any: Front Rear Depth Height Number of Stories Y'�`� u�'�qr�'1"E�"``� �'`4,'__"a , :�I ' �� '� ��.:��,�`° ;:a,� ,. '• � l Dimensions of same structure with alterations or additions: Front � Rear�' ;; ; Depth Height Numbe Sta�;ies ;.: :�; ��, ' � � e . �T. 8. Dimensions of entire new construction: Front Rear De�pth Height Number of Stories a��"��"��'`�'�~�-�:�`, { �,�,�'�aa�.'�a`•�v��5 G�a'9��J,,`�" 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? YES NO 13. Will lot be re-graded? YES NO Will excess fill be removed from premises? YES NO 14. Names of Owner of premises Address Phone No. Name of Architect Address Phone No Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO * IF YES, D.E.C. PERMITS 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. L + , � , , 18. Are there any covenants and restrictions with respect to this property? * YES NO * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: , � COUNTY OF ) � being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)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 will be performed in the manner set forth in the application filed therewith. Sworn to before me th's ' a,`��(o �- day of �NNIE D.�UIdCH - � • � � �+ota�Public,State of fVew York l^f �' � �^t�� t�o.01 BU6185050 �.....�:�:,..,:.,u.��County � �- Notary Public ��,�mt:sior► Fxpires April 14,2 0�,� � nature of Applicant � . � . , . :� , . .� ..:; . . . x� � � � /� , i��0 �' ��— 9—�",3 T� �� S�UTH�LD� - ��OPE��'Y .��C��D CA�D � O NE � � �� STREET � VILLAGE DIST. SUB. LOT ,�, ss��'��t�i�.�;°�'-�� .1�` �'�tu.��'`�'.�: �'`r 1` �-f?�d t�� d�CY � (d ��d � �C}� � l�r�G �tu 8 c�c� �� /��tt��p Cw.� , � FORMER OWNER N E A�CR.�,,� �fYf/�,!��DU� �Dl��`,,�` � 't�'�"' '-� �l�� . �'jp , � ��-'� ��j S W TYPE OF BUILDING -yf�� c� � `�.. .,�.'-��--� '� �"'� RES��p1 SEAS. VL. FARM COM�M. CB. MICS. Mkt. Value . LAND IMR. TOTAL DATE REMARKS ,;''� o �� ,� /,f�� I ir> s i�� -�� . f�o--c^�. b-�--J . /,/�.� 7/d7�— .5 H��.E �/� �'/�� / o rs t� c"� ' / o o � �" � z� �" c� a�� 3/ � iYl��' - � � S� � ��a-�i / f5d ��' �3t3 �o /�/� �7 ,Sl��.� /a7�./�,:�� rt 1 avo u d,��s a �r,�c�;�.�s ��`'�'.�'a;�"P�3"`�"� a /l o o �-��-r-� ��-v � s �� 9 `��/ �- ��'� -� ns�' r� � e.. ,�-� ��rrv � F �� -=_� ��'�Crz� . `�� o.� � �. � =...... � � �- � 9� " �P ��Ic� � . -� � -�� , ' . '� la o5 3Iz�,5 �e. �. �� ►��Fsc�� o �� -� AGE BUILDING CONDITION �� _'7�t i�05 (.�� I Z(�(ed�d�cc.es �3�`� �333`� 0 3 J a-�I NEW NORMAL BELOW ABOVE /Z �s�d��`�- + �i°'��1`Q��•7,, ` , I.O .C�l ��,�� 1.�'��tJ�-l� FARM - Acre Volue Per Value • ` � Acre � ��' � � 5 � .2G '-�'1'0 — tl 1'u). � � Tillabie FRONTAGE ON WATER � � � � Woodfand FRONTAGE ON ROAD Meadowl•and DEPTH House Plot . BULKHEAD � � Total ``� �"'`1 DOCK � .� � � � y��.:�� , . � �, r _�. ��..- - : ..._ _.�. .� �._.=.,.�--.. . - � ' COLOR �(�� "f"�1 t��,�"�"`' TRIM � t-1 ��"'� , (�C� �' � "��1 - (�r�e�l�.c��.- `�- -��;��,� � �. x - - �;�'� oL�(�-- �=� �I�.c�a — ��... � . � � � �-�� s� i � , . � � � � M. Bldg. � �--�r.2 = /' v U � �z S� ��2 c�'� a � . Externsi�n Exfension - Extension � J 4 c� � _: - Foundation �� Bath Dinette� �v��.r.:--� - -.�Y-�-�:,�- -_ _..__.-----�— — K. Porch V � � Basement ��- J � �, Floors G, �.� ��CF=. Ext. Walls � I terior Finish LR. �Z /0 X(Z =- I� .,/ �v L sF►�rv tn�° �.J� �.C.- t'.E� Br e e z e w a y Fire Piace Heat F.-� DR. �c� g ` Type�Roof - r Rooms 1 st Floor BR• Ga ra e � Z � G�.� .�"` � ,�c� � �-�-�S`r� �a � ' Recreaicion Room Rooms 2nd Floor FIN. B Patio ' �-p � �� -�''��'� Driveway t=�-�--f`-'�J(�`�`"- (�.� n.�. �� Dormer l:��' . 1 �_D� 7 �,*-,..._.,.._n-e.,.../� x=c-_.'._. a.� � � TOtOI ` ' f '�� , ,�" .�� r„ „P �, , ,� � � , ,' �._�,L� 735 ,-�'� _J r �� , I�-�3�n :t��.v' �.. � , . , � . , JOB No. 05-3'I �� TAX I.D. No. 1000-78-09-53 � � . NpRTy $ A y��w R � -- � ��D �49,5► � . � - � � `�olh�rr � � � 75°lg4p„E 132 osl `� _ _ - , _` � w��aFFN�� `\ �� ` �m � UJ .� �o� �D4 . � � - �QT O O` � c N�FNr ?43 • �. N Zo • , • Q � ?� � . � ' �Sx�? m o , � TO� � '03, F?ST � �35 � eRl�pqn �N � ��MF ��k �!� o 17 o�`b O � • S,> �/hG ro ( h- �ji �. � � � g o so � � �U� D� � Qp� 4p, S� rv �ST � �" .� c'�r-(, �� p � -\ Y � (J �3.3 � pq°�c �s' ry Q ' � � t `� G� �NXs, � � 2 CF� �•�,, ��''�lZa q�T . \ �'q{-- J� -, -- - - - - - --- -- - --- - \ Sp�, � � , \\ ..\asu�n 1 sso',� \ �� / O��r'w- �2 i � �'V 124 85� m _ tor4 r � r.rs 1?,y. 04�S SURVEY PURPOSE:CONVEYANCE OF PROPERTY � FILE MAP No.5547 NOV 30, 1970 Unauthorized aHeration or adddton to this document is a violetion of Se�tion 7209 or tne N�Yor�srete Ed��«on�w. SURVEY OF: LOT 2 Cert"dicatfons indi�ated hereon shell run only to the person Torwhom ft is prepared andonhisbehalftotheTdleCampany,GovemmentalAgencyendLending MAP OF HIGHWO�D AT BAYVIEW . Inslftutions Iisted hereon. Certifications are not transferable to addfional institutions or subsequent owners. Copiea ot this document not bearing the proTessioners inked seet or embossed gAYViEW TOWN OF SOUTHOLD seal shall not be conatdered a valid true wpy. , The oftsets[ or dimensiona]shovm hereon from structures to the property lines ere for a specific purpose and use and therefore are not intended to guide the erection of SUFFOLK COUNTY NEW YORK fences,retaining walls,pools,patlos,plentinp areas,edditlon to bufldinps,or any Wher , wnstruction. The e�Astence of rl�ht of ways and/or easemeMs oT recoM,It any,not shown are not euaranteed. SURVEY DATE: 12/05/06 SCALE:�"=80' CERTIFIED ONLY TO: MARY E.CANTWELL DESTIN G. GRAF � JPMORGAN CHASE BANK,N.a. LAND SURVEYOR COMMENWEALTH LAND TITLE INSURANCE COMPANY P.O.BOX 704 Rxky Point,Newr York,11778 , , 631-821-3442 By DESTIN G.GRAF N.Y.S. LIC NO.50067