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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. 28592 Z Date JULY 23 , 2002 Permission is hereby granted to: LINDA BELANGER PO BOX 34 GREENPORT,NY 11944 for DEMOLITION OF AN ACCESSORY GARAGE AS APPLIED FOR at premises located at 75 EIGHTH ST GREENPORT County Tax Map No. 473889 Section 0.48 Block 0001 Lot No. 008 pursuant to application dated JULY 23 , 2002 and approved by the Building Inspector to 'expire on JANUARY 23 , 2004 . Fee $ 35 . 00 r uthor' zed nature J ' ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DKPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 3 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 � Survey www. northfork.net/Southold/ PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees Examined 20 Contact: Approved 20 �'L" Mail to: Disapproved a/c Phone: — ©� Expiration 20 (MM In �i �i Building I "s . 2 3 2QOZ 1� APPLICATION FOR BUILDING PERMIT RL-OG. DIE,"T �''•E o o¢ sx4���t �� Date z , 20 0 INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 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 adnut authorized inspectors on premises and in building for necessary inspections. J, (Signature of applicant or name, if-a corporation) d 3 4 (�> �_(�, e K O a _- , A) V (Mai ing address of appl cant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder o-wycn.t Name of owner of premises )—6n I zz ��� ,,�G V (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: 77/ 7 ra-� � e etipe�-�"' House Number Street Hamlet County Tax Map No. 1000 Section—0 4�.--,O 0 Block O k P o Lot . 00,q-, 06 y Subdivision Filed Map No.�?�' �j Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constriction:. a. Existing use and occupancy 5-,,e_ 4,,( S o cr,-moria tAC b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition X Other Work (Description) 4. Estimated Cost 46c) , 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 I — t „�< <, c� - d S�.�1 l e &A 6. If business, commercial 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 Dimensions of same structure with alterations or additions: FrontRear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase Sr t Name of Former Owner Ck y sA eKc P n 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 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. STATE OF NEW YORK) SS: COUNTY OF � )-i Vd-� q e-( a vtc e ►' being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)He is the d w t'_� r (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. Swo to before me thi day of 20 U�-- No ry Public Signature of Ap icant JOYCE M.WILKINS Notary Public,State of New York No.4952246,Suffolk County Term Expires June 32, '-?-O 0 3 r = r OCCUPANCY O CERTIFICATE �P :R _ l OF OCCO P ,NCYgm - _. ;r•.r._ �. v "'`,} - - .r a t..•..1}-�:.... P { s» � '{,gyp 4`..r s. .., tlnauthanzed alteratton:or addttion "" N®TI ®1l1I.D1NG DEP RT�1 t tnahts aurveyvie a vl, ation of r t" Section 7203:of the N®or York Stat® ' ?65-1602 :S AM'10 16 o a��att¢n tats FOu,OWING INSPECTIO* F'6P_ j copies of ibis survey msp ttot bearing _ LL t FOUNDATION • TWO REQV1 �'r the'tanrisurveyorsinkadasai,aP' . Y r ornbossed seal shall not be con lld8md . FOR POURED CONCR to be a valid true copy. r 9 guarantees indicated teereari YhYP9 ntn. { . Z. ROUGH - FRA1111N PLliin , l INSULATION only m thap®rson for wham the eurvep 1 ; f rxr , is prepared and on htebehaff to ttN �`� - 4 FINAL a CONSTROC?10K m1l�i' govor h*rrtefep®nayra'(d: lPndmy institution listed hereon H1d EE CbMPLETE FOR�� � 't �5 , to the as5tgneas of the lerp9 fnsd- i AL1. CONSTRUCTION S ,� � canon Guaranteas ar®not�tra�r>sferebtn ��� �� to acdmonal;instttuUons Of au dent t THE OQUIREMENT,S (W, E ! STATE CONST RU 10th E } t CODES. NOT RES ONSI®tE AOR x ! # OESi ' OR_CONS UCi1�1 #J a T c�-�:• c ,c F� " ' k..» 't >,.. °: :+r. r ,r, ;�p�'} {{,�..,, -.+ ��••±+ .��-,�.+ �.., 4 itK. t�'�g r: txti .[� ,''x�, ✓� 4i it Q.r;}- ,t (�'� - - �.r�"*�y k 4 a•.T ; } ..,. a ...,,y ,.ia-�+ _ `8+. »0- 12— 1'0.0 f I Co U14"t r i `^' ... «t { r; k F Sys '0f +IS«, '} S _ p spy (" �•- ,Yp �"' h[^ $ $ yj �e?L�i' -�}�,i�„..,'>Y Vlrw..F v.^te u....;.,.. , "•xi` tif,. •F y w r4*. t L f > Z MW 'f t ! 4 r T "i , . w R TOWN OF ,SOUTHOLD PROPERTY RECORD CARD OWNER STREET' VILLAGE DISTRICT SUB. LOT FORMER OWNER-,, N ,�� �: E ACREAGE ea i' `p S'c�i�fS f'` e . , ire= '-� C,' c), 1 ' S € Wj E' TYPE OF BUILDING D � g RES. a 1`� SEAS. VL. FARM COMM. PND. CB. MISC. LAND IMP. TOTAL DATE REMARKS � ' r , ; Y„ s _5 1" ;•.. � ! � DIG. .�ryLjj / t E ra �, � .h. ,W•. .tom dt 0 a ,T s L e s % i, � sd_nr QiUl- 70U, 1 .1a -s,v 1�,#" �6 ,4 ix d s ' C 14 R P S' F! d 7 Llu AGE BUILDING CONDITION r�1df, � e� �-� ed,� ►� � � 4e, d NEW NORMAL BELOW ABOVE 'FuB � a�"lf r MCA Farm Acre Value Per Acre Value Tillable . 1 Q �Q Tillable 2 Tillable 3 - Woodland Swampland Brushland HSxu�,es Plot Tata I Al 4 � I 9, —di 7 a ♦ti P IR L+ �--+--�—^ JM- NO MN e , — — Foundation C �,,C BathC', �^ Exp ;. , 5� Basement r- Floors Ext F Ext. Wails �� Interior Finish n7 O, Ext e'n rl �� as Fire Place /YO Heat Z Z 'r Porch Attic �� 7,�;.� Porch Rooms 1st Floor S o % �3 i e Rooms 2nd Floor Patio Garage .. Driveway i,- C�,t mitts ' 9p � BUILDING PERMIT EXAMINER CHECK LIST DATE REVIEWED: /B/02 APPLICANT: T Nh DATE SUBMITTED: /02 SCTM#DISTRICT: 1,000, SECTION: AIA , BLOCK: _�, LOT: 21-5 STREET ADDRESS: �p/ CITY: <f7iy b SUBDIVISION: PROJECT DESCRIPTION: Mc� ESTIMATED PROJECT COST: ARCHITECT/ENGINEER: FAST TRACK? SINGLE& SEPARATE CERTIFICATION-REQUIRED? NOTES: LOTS 40,000SF-100-24.Lot recognition.(CREATED before June 30,1983),UNDERSIZED LOTS FROM JAN.1997 100-25.Merger.(A nonconforming at anytime after 7/1/, ZONING DISTRICT: CONFORMING? REQ. LOT SIZE: ACT. LOT SIZE: REQ. LOT COV. ACT. LOT COV. REQ. FRONT PROP. FRONT REQ SIDE ACT. SIDE REQ. REAR PROP. REAR REQ. HEIGHT PROP. HEIGHT WATER FRONT? DESCRIPTION: PANEL #: FLOOD ZONE: , APPROVALS REQUIRED SUFFOLK COUNTY HEALTH DEPT: YES or NO, (BED#): DTE:—/—/ PERMIT MR10- TOWN SEPTIC RECEIPT: Y or N NEW YORK STATE DEC: PRE-DEC 9/1/75 YES or NO SOUTHOLD TOWN TRUSTEES: YES or NO TOWN ZONING BOARD APPROVAL: YES or NO TOWN PLAN. BOARD APPROVAL: YES or NO TOWN HISTORICAL PRE (SPLIA): YES or NO NYS ENERGY: YES OR NO : EGRESS (18 H min.? 4 sq total) VENT(SQ. FT.x 4%) LIGHT (SQ. FT. x 8%) BUILDING PERMITS OPEN/EXPIRED: BP -Z/C/0 Z- , HAVE PRE CO'S : Y OR N BP -Z/C/0 Z- , NOTES: FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR: SF SECOND FLOOR: SF OTHER: SF INIT OTHER TOTAL TOTAL: —2 SF FEE FEE FEE 1. ( SF)- ( _SF)-- SFX$ =$ +$ +$ _ $ 2. ( SF)-(_ SF)— SFX$ =$ +$ +$ _$