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HomeMy WebLinkAbout29174-ZFORM 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. 29174 Z Date FEBRUARY 28, 2003 Permission is hereby granted to: JUAN ANTONIA SECAIDA 803 WIGGINS ST GREENPORT,NY 11944 for : EMERGENCY FIRE DEMOLITION WORK TO SINGLE FAMILY DWELLING ONLY ANY OTHER RE-CONSTRUCTION REQUIRES PERMIT AMENDMENT OR NEW BUILDING PERMIT at premises located at County Taxx Map No. 473889 Section 048 pursuant to application dated FEBRUARY Building Inspector to expire on AUGUST 630 WIGGINS ST GREENPORT Block 0001 Lot No. 029.001 28, 2003 and approved by the 28, 2004. Fee $ 150.00 Authorized Signature ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.net/Southold/ Examined~2~ ,ff __, 20 0 ~ Approved ,2X~,--- _, 20 OB Disapproved a/c Expiration FElt PERMIT NO. BUILDiNG PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 3 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Phone:~,a.e- d~O[-~_ ~{~t7 "Building Ins~'ector .... 2 20 APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to thc 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 Ce~ificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of is'suance or has not been completed within 18 months from such date. lfno 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 ~s herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and rqqgulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Si~ature 6f applicant or nabte, if a corporation) ***'~ b--IQ ! ~ 5 ~ ~ ~.t ',~ E I~ / (Mailing address of applicant) -- State whether apl~./~{i~Ja~r,~e~/]h4:gtect, engineer, general contractor, electrician, plumber or builder 0cCUP), APPROVED AS.firED Nameofownerofpremises ,~{_/~ ~7)~'g~/~ ,~.C .... ~iOTiFf ~UiLbihiG UF-pAfl~MI:NT AT (As on the tax roll or la[esi oeeo~65.1802 B AM TO 4 PM FOR THE If applicant is a corporation, signature of duly authorized officer FOLLOWING INSPECTIONS: (Nan~e and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License ~.O~1. Location of land on which pronosed work will be done: House Number Street County Tax Map No. 1000 Section Subdivision Block 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE ROUGH - FRAMING & PLUMBING 3. INSULATION 4, FINAL - CONS?RUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS Hamlet ~ Lot '~ 7 Filed Map No. Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 4. Estimated Cost /~ - ~'~ 5. If dwelling, number of dwelling units If garage, number of cars Addition Alteration Other Work ~[~ ~-r,'C~ ~c~.- ~,4~-'/ (Description) Nature of work (check which applicable): New Building Repair /.,/ Removal Demolition Fee (To be paid on filing this application) Number of dwelling units on each floor ~ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Depth Height. Number of Stories Rear 8. Dimensions of entire new construction: Front Height Number of Stories Rear Depth 9. Size of lot: Front Rear .Depth 10. Date of Purchase 7~r~- ~ ~ Name of Former Owner 11. Zone or use district in which premises are situated ]~ q © 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO kJO 13. Will lot be re-graded? YES NO Itx]C)Will excess fill be re,moved from premises? YES NO V~79 · 14. Names of Owner of premises -..TuO,~ <oO-Cctig[:6ddress ~ (k~r-J~5 Xl~,ehone No. Name of Architect vTx9 ~ L~_t>~'(, 4 · Address Phone No Name of Contractor ¢x~ ' $.~ L~.~Ctt 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 KEQUIRED. b. Is this property within 300 feet ora 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 ) 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 tree 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 tlYw,~ ~:~ day of ~/'~o/~¢/~ ~/ 20/~ NotaW PuBlic ELIZABETH A STATHI~ NOTARY PUBLIC, State of New York No. 01 ST6008173,. Suffolk Co~ rib/ Term Expires June 8.20~aL-)~