HomeMy WebLinkAbout29530-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. 29530 Z Date JUNE 30, 2003
Permission is hereby granted to:
MOLLY G GAFFGA
125 REEVE AVE
MATTITUCK,NY 11952
for
DEMOLITION OF EXISTING SHED AS APPLIED FOR
at premises located at 9135 MAIN BAYVIEW RD SOUTHOLD
County Tax Map No. 473889 Section 078 Block 0009 Lot No. 065
pursuant to application dated JUNE 27, 2003 and approved by the
Building Inspector to expire on DECEMBER 30, 2004 .
Fee $ 35 . 00
��AN
Authorized Signature
ORIGINAL
Rev. 5/8/02
sx----3
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FI .ACE � FIIMNEY
REMARKS: � -
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DATE / INSPECTO
TOWN 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 3 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Survey_
www. northfork.net/Southold/ PERMIT NO. e9-9S 30F,— Check
Septic Form
N.Y.S.D.E.C.
/// Trustees
Examined,20 0_3 Contact:
Approved b' 3c),20 OMail to:
Disapproved a/c
Phone:—
Expiration 14t),
hone:Expiration13t1, 200
110"Ll I
Building Inspector
L 7 T APPLICATION FOR BUILDING PERMIT
Date 20Q
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 demo 'tion as herein described. The
applicant agrees to comply with all applicable laws, ordinances, building code, housing co , and regulatio s, and to admit
authorized inspectors on premises and in building for necessary inspections.
(Sign e cant or name, a corporation)
Bela dL
(Mailing address applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
ATTiGiZve- �
Name of owner of premises ��I Z �Z} r F�Clq z
(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 ¢one'. Q u �� f
9135 ►t A6,1 ��VI � w
House Number Street Hamlet
County Tax Map No. 1000 Section 8 Block 9 Lot
Subdivision —Filed Map No. Lot
(Name)
2. State existing use and occupancy of premises",and intended use and o ancy of prop sed construction:
a. Existing use and occupancy �fYP 0 1 79� 7 � UBC
b. Intended use and occupancy 70 '6�r
3. Nature of work (check which applicable): New BuildingAddition Alteration
-
Repair Repair Removal Demolition /\ _Other Work
Ls,�T�/��✓ 3 oo sl (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, 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: Front Rear
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 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.
STATE OF NEW YORK)
(( SS:
COUNTY OF 5�, +of�
P,41L A , (.PH wH t u I To being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the a,4, ,/PS/ I �"Q^
(Contractor, A ent, 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 this
day of 200'=-�
Z
N6tao6 P blitgnature of Applicant
CAMILLE LUCARINI
Notary No.
Siete of New York
No.4910722
Qualified in Suffolk County
Commission Expires lkjlU1)5