HomeMy WebLinkAbout29565-ZFORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
(THIS
BUILDING PERMIT
PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 29565 Z Date JULY 14, 2003
Permission is hereby granted to:
ELIZABETH D HILDRETH
310 HUNTINGTON BLVD
PECONIC,NY 11958
for :
DEMOLITION OF AN EXISTING CONCRETE FOUNDATION AS APPLIED FOR
at premises located at 310 HUNTINGTON BLVD SOUTH/PEC
County Tax Map No. 473889 Section 067 Block 0004 Lot No, 008
pursuant to application dated JULY 9, 2003 and approved by the
BuildingFee $ Inspector35.00to expire on JANUARY 14~uyr~i/~~~///A ' '
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 ~1 Iq 20 o~
Approved ~t[iq 20 5
Disapproved a/c
Expiration I ,20_6'-
PERMIT NO. 3q~'-6~--~x-
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:
'¢~PPLICATION FOR BUILDING PERMIT
',' - i
\ Date_~//~/ ,20
INSTRUCTIONS
a.kTtrl~s a¢¢iication MUST be completely filled in by t~ewhter or in i~ and submitted to the Building ~spector with 3
s~s of plans, acetate plot pl~ to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on pre~ses, relationship to adjoining pre~ses or public streets or
areas, and wate~ays.
c. The work covered by this application may not be co~enced before issuance of Building Pe~t.
d. Upon approval of this application, the Building ~spector will issue a Building Pe~t to the applicant. Such a pc~it
shall be kept on the premses available for inspection t~ou~out the work.
e. No building shall be occupied or vsed in whole or in pa~ for any p~ose what so ever ~til the Building ~spector
issues a Ceaificate of Occupancy.
f. Eve~ building pemfit shall expire if the work authorized has not co~enced within 12 months a~er the date of
issu~ce or has not been completed within 18 months from such date. If no zoning amen&cuts or other regulations affecting the
propeay have been enacted in the intehm, the Building ~spector may authorize, in wdting, the extension of the pemt for an
addition six months. Therea~er, a new pemt shall be required.
~PLICAT1ON IS HEREBY M~E to the Building Depanment for the issuance of a Building Pe~it pursuant to the
Building Zone Ordin~ce of the Town of Southold, Suffolk Co~ty, New York, ~d other applicable Laws, Ordinances or
Re~lations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The
applicant a~ees to comply with all applicable laws, ordin~ces, building code, housing code, ~d re~lations, and to ad~t
authorized inspectors on presses ~d in building for necessa~ inspections.
(Signature of applicant or name, if a corporation)
(Mailing address of applicaflt) /! ~ ~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises /'x} O./q CA~ C
(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.
Location of land on which proposed work will be done:
151o ', t,""qLo Pec,o tc
House Number Street '
County Tax Map No, 1000 Section
Subdivision
(Name)
~kJ ~amlet
Filed Map No.',
LOt -
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
3. Nature of work (check which applicable): New Building
Repair Removal ~ Demolition ~'''''
4. Estimated Cost '~ ~ O O O ct0
Fee
5. If dwelling, number of dwelling units
If garage, number of cars
Addition Alteration
Other Work
(Description)
(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
8. Dimensions of entire new construction: Front
Height Number of Stories
Rear Depth
9. Size of lot: Front Rear .Depth
Rear
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 __ N(~
13. Will lot be re-graded? YES ~"~O Will excess fill be removed from premises? YES NO
14. Names of Owner of premises I,J ~,-,o1 Co~l,~, Address
Name of Architect Address
Name of Contractor Address
Phone No.
Phone No
Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES * 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.
NO J
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.
Swo~ to before me this ir;
[ day of ~ ~..0, 20
- 'lq~tary Public
LYNDA M. BOHN
NOTARY PUBLIC, State of New York
No. 01 BO6020932
Qualified In Suffolk County
Term Expires March 8, 20
~i~ature of Applicant
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