HomeMy WebLinkAbout29529-ZFORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES LrNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PEP34IT NO. 29529 Z Date JUNE 30, 2003
Permission is hereby granted to:
THOMAS J MCCARTHY
PO BOX 1266
SOUTHOLD,NY 11971
for
DEMOLITION OF TWO STORAGE BUILDINGS, WITH NO UTILITIES, AS APPLIED
FOR
at premises located at 885 WICKHAM AVE MATTITUCK
County Tax Map No. 473889 Section 140 Block 0002 Lot No. 009
pursuant to application dated JUNE 25, 2003 and approved by the
Building Inspector to expire on DECEMBER 30, 2004.
ORIGINAL
Rev. 5/8/02
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL '· '
SOUTHOLD, NY 11971 ,_ _
TEL: (631) 765-1802:
FAX: (631) 765-9502
www. aorthfork.neffSouthold/ PERMIT NO. &ti ~ ~ ~--
Examined E/gL ., 20 ~
Approved ~ ~ ,20 3
Disapproved a/c [
Expiration
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:.
Building Inspector
APPLICATION FOR BUILDING PERMIT
~*[~ ~ ~0'~[~ Date
B.P. INSTRUCTIONS
a. This applll~l~l~.cSl~l~y typewriter or in ink and submitted to the Building Inspector with 3
sets of plans, accurallOlfl~p~ld}~n~lo schedule.
b. Plot plan ~ l$o~io~f4o~ln~[~ln,nl~l~lings on premises, relationship to adjoining premises or public streets or
areas, and waterwa)~LLO~[~
c. The work~(~[~'l~[ ~[}_a~l~l)not be commenced before issuance of Building Permit.
d. Upon appro~~~ Building Inspector will issue a Building Permit to the applicant. Such a perm/t
shall be kept on the 8r4l~,[av~lln~[~l~nroughout the work.
e. No builditlg II~l~upied or used in whole or in part for any purpose what so ever until the Building Inspector
issues a Certificate
f. Every buildi~ttl~tl~[~! ~_.~.~lhe__w_0.rk. guthorized has not commenced within 12 months after the date of
issuance or has not l~l~ ~~~_fi~such date. If no zoning amendments or other regulations affecting the
property have been ~,~j~,, ~,.,,~t~, ~~pector may authorize, in writing, the extension of the permit for an
addition six months.~l~lie~ra~t~']~ired.
APPLICAT 'tl~l~'fl~ng 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.
~e o~f applicant or name, if a corporation)
(Mailing/address of applicant)'
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Nameofown~ofpremises K'F~Ov-~L a% ~ ]~/~? O0/t%W ~' 5l ,~',O.--v%l/~· )OQO (Q~L4. ~'~
1/] -- /// (As on the tax reft or latest deed)
i,
(l~an~e and tffl~officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
Location of lanqt on whi9tl proposed wo.r.k will be done:
House Number Street
County Tax Map No. 1000
Subdivision
Section
(Name)
Hamlet
Block
Filed Map No.
State existing use and occupancy of premises and inten~iled ¢s~} a~nd occepancy of proposed construction:
a. Existing use and occupancy /--' [~)~'(- ~0~ lJo ~'~'~(~
b. Intended use and occupancy ~6 ~ ~-~ ~O~;
Fee
Addition Alteration
Other Work
(Description)
(To be paid on filing this/application)
Number of dwelling units on each floor W/~
3. Nature of work (check which applicable): New Building
Repair Re~)val. Demolition
4. Estimated Cost
5. If dwelling, number of dwelling u/nits ~//~
If garage, number of cars N/lq
6. Ifbus~ness, commercial or mixed occupancy, specify nature and. extent of each tyjpe of use.
7. Dimensions of existing structureg, if any: Front Rear _Depth .
Height Number of Stories
Dimensions of same structure with alterations or additions: Front
Depth. Height Number of Stories
Dimensions of entire new construction: Front
Height
Rear
Number of Stories
9. Size oflot: Front ~ I,~ /
I0. Date of Purchase ~ O [ Name ofFo~er Owne
l 1. Zone or use district in which prmises ~c si~ated~
12. Does proposed construction violate ~y zomng law, or&n~ce
13. Will lot be re-~aded? YES NO~ Will excess fill be r~/rom are~eg ~ ~
14. Nines of Own~ ofpr~ses tern /~ ~Addres
Nme of ~chitect (Address
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,It'EQUIRED.
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 )
k~O,'Y3. Q.~ ~. ]~/~0~ ~ Otkk'~U being duly sworn, deposesand
(Name of md~wdual s~gnlng contract) above named,
(S)He is the 0 (~ gx,) ~.
(Contractor, Agent, Corporate Officer, etc.)
says that (s)he is the applicant
of said owner or owners, and is duly authorized to perfo~xn 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.
;-l-~om to before me this~
~ ~ ~_~ day of ~z~cc4~-~ 200~
Notary Public
Ruth ~
NoM~/Public State of New Yo~
No. 01 L06054063
Qualified In Suffolk County
Commission Expires Mar~h 5, 20