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HomeMy WebLinkAbout28646-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 AUTU'ORIZED) 1 PERMIT NO. 28646 Z to AUGUST 12 , 2002 Permission is hereby granted to: WILLIAM L HOP E 76 CHANDLER TREET BOSTON,MA 0/116 for CONSTRUCTION OF A SINGLE FAMILYDWELLING AND ACCESSORY GARAGE AS APPLIED FOR. TWO COS REQUIRE at premises located at 580 UHL LA ORIENT County Tax Map No. 473 89 Section 015 Block 0005 Lot No. 024 . 014 pursuant to applica on dated JULY 22 , 2002 and approved by the Building Inspecto to expire on FEBRUARY 12 , 2004 . Fee $ 1 94 . 00 ` 1 t uth rized Signature COPY Rev. 5/8/02 FIELD INSPECTION REPORT DATE CO ]T3 �d FOUNDATION(1ST) S _ 3 FOUNDATION(2ND) z o S r ROUGH FRAMING& a PLUMBING � x INSULATION PER N.Y. y STATE ENERGY CODE ' Y FINAL ADDITIONAL CODEWI NTS o Z ' rn t� 5t 0 z x x O ?. State existing use and occupancy°f=PTs4and inter ed a and occupancy of proposed construction: a. Existin g use and occupancy f p b. Intended use and occupancy Addition Alteration_______ 3. Nature of work(check which applicable):New Building Other Work Repair Removal Demolition (Description) Fee 4. Estimated Cost (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 Rear Dimensions of same structure with alterations or additions: Front of Stories Depth Height Number 8. Dimensions of, fire new construction: Front .S� Rear -r/ Depth Height a Number of Stories 9. Size of lot: FrontL_ 8'0 3a 9f Rearals (o S- / DeP��'`�'`� �� 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated on violate an S NO �/ 12. Does proposed construction Y zoning law, ordinance or regulation? YE 13. Will lot be re-graded?YES NO i Will excess fill be removed from premises? YES,NO pd//6 14. Names of owner of premises Address Z6 G�fo,e,. Phone No..t//" Name of Architect Address Phone No Address Phone No. Name of Contractor / 15 a. Is flus property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO ✓ * IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BFB 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 mof being duly sworn, deposes and says that(s)he is the applicant (Nam individual signing contract)above named, (S)He is the e_-V, 711 (Co metor, 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. Sworn to before me this day of��—20 b)– otary Pifbhc gnature of Applicant LINDA J.COOPER Notary Public,State of New York No.4822563,Suffolk Ceu X6'1-- Terr.;ExP�< TOIXN 0I?4SOUTHOLD BUILDING PERMIT APPLICATION CHECKL: BUILDING DEPARTmEN r Do you have or need the following,before apply. TOWN HALL Board of Health SOUTHOLD,NY 11971 3 sets of Building Plans TEL: (631) 765-1802 Planning Boyd approval FAX: (631) 765-9502 Survey 4/ PERMIT NO. Check. Septic Form N.Y.S.D.E.C. Trustees Examined ,20 Contact: - 1 Approved f l Z ,20_,:F,� Disapproved a/c `L Phone: 'T 7 7—51Z Expiration ,20 Building kspector APPLICATION FOR BUILDING PERMIT Date�./Gc � 200 INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 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 of 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 permii 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 th property have been enacted in the interim,the Building Inspector may authorize, in writing,the extension of the permit for an addition sit: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 admit authorized inspectors on premises and in building for necessary inspections. (Signa f applicant or name,if a corporation) (Mailing f app t) State whether appl' ant is owner, less , agent azchitect, engineer, general contractor, electrician,plumber or builder Name of o ner of premises_4QJ l )11114-vv) 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 roposed work will be done: IS 90 okl e� House Number Street Hamlet County Tax Map No. 1000 Section [ Block �©0® S Lot ' . Subdivision r.Iain-t u � Fileda No. b Lot (Name) � ;� �