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Home My WebLink About28535-ZFORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMBNT Town Hall Southold, N.Y. (THIS BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED} PERMIT NO. 28535 Z Date JULY 8, 2002 Permission is hereby granted to: for : DEMOLITION OF A 224 KENNETH H DUNASKE 27 EDGEWATER AVENUE MASSAPEQUA,NY 11758 SQUARE FOOT ACCESSORY GARAGE AS APPLIED FOR at premises located at County Tax Map No. 473889 Section 087 pursuant to application dated JULY Building Inspector to expire on jANUARY Fee $ 35.00 1350 MINNEHAHA BLVD SOUTHOLD Block 0002 Lot No. 012 5, 2002 and approved by the 8, 2004. ORIGINAL Rev. 5/8/02 SURVEYED FOR:- I/---~ik.iN./~----~J--/--~ H' ,~ ,~,,~:"2:~,(.--~l'~N..~ ~. LOCATEDAT ~~ , ~¢~, ~. , ~ ~ '~,~'~.~P/~l'~ , . usE~suN~w~u~ ~, a~,~ ~ ~ ~.~r ~WITHOUT CERTIFICATE OF OCCUPM ~ FILE NO. V~LLIAM R. SIMMONS Ill, LS.P.C. 11 MEROKE LANE EAST rSLIP. L.I.. N.Y~ 11730 Fax: (631) 581-1691 GRI, D TOWN OP SOUTHOLD BUIDDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 Examined Approved 0/~ __, 20_ Disapproved Expiration BUILDiNG PERMIT APPLICATION CHECKLIST PERMIT NO. d~'~w'5-~ 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: Building Inspector Mail to: Phone: ' ~PPLICATION FOR BUILDING PERMIT , } Date ~///''¢ L- .~;-;; ]--~]~J INSTRUCTIONS a. This application MUST be completely ~lled ia by t~ewriter or in i~ ~d sub~Eed to the Building Inspector with 3 sets ofpl~s, accurate plot p]~ to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on presses, relations~p to adjoi~g presses or public streets or areas, and wate~ays. c. The work covered by this application may not be cm~e~ced before issu~c¢ of Building Pe~t, d. Upon approval ofth~s application, the Building ~spector w~ll issue a Building ~e~t to the applicant. Such a pe~t shah be k~t on t~a p~e~ses available for inspection t~ou¢out the work. e. No building shall be occupied or used ~n whole or in pa~ for ~y pu~ose what so ever ~ti] the Buildin~ ~spector issues a Ce~ificate of Occupancy. f. Eve~ building p6~t shall expire if the work authorized has not co~enced witin 12 momhs a~er the date of issu~c¢ or has not been compIeted w~t~in 18 mom,s ~om such date. If no zo~ng amen~ents or other re~lations affecting the prope~y have been eaacted in the interim, the Building ~pector may authorize, ~n writing, the 8xtens~on of t~e pe~t for an add,lion six months. Therea~er, a new p6R~t shah be requ~ed. ~PL1CATION IS HE,BY M~E to the Building Depa~ment for the issuance of a B~ldi~g ~e~t pursuant to the BuiMi~g Zo~¢ Ordin~ce of the Town of Southold, Suffolk Co~ty, New Yor~, ~d other applicable Laws, OMinances or Re~lafions, for the constmctio~ of buildings, additions, or alterations or for removal or demolition as herein desc~bad. The appI~cant a~e6s to comply w~th all applicable laws, ordin~ces, building code, houMng c~de, and re~lations, and to a~it authorized inspectors on presses and in building for necess~ ~spections. / / __ ,/(~igna~d;f applic~; 0r n;me, if a co~orafion) · f - (M~ng ad~ss of applier) State whether applic~t is owner, lessee, agent, architect, en~neer, general contractor, electfici~, plumber or builder ,20~9 -z-'" Name of owner of premises / ~ (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 qq which proposed ,work will be done: House Number Street Hamlet County Tax Map No. 1000 Section E:2~"] Block d:~r'x2 oQ. ~" '; ~'_' 'Lot Subdivision Filed Map No. ~/7..~ ~ (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_ 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition ~ Other Work Estimated Cost Fee If dwelling, number of dwelling traits If garage, number of cars (Description) (To be paid on filing this application) Number of dwelling units on each floor 7. Dimensions of existing structures, if any: Front Rear Heigh[ Number of Stories Dimensions of same structure with alterations or additions: Front Depth Height 8. Dimensiohs of entire new construction: Front Rear If business, commercial or mixed occupancy, specify nature and extent of each type of use. Height 9. Size of lot: Front 10. Date of Purchase Number of Stories Rear Name of Former Owner 11. Zone or use district in which premises are situated _Depth Number of Stories Rear Depth Depth 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 Nmne of Architect Name of Contractor Address Phone No. Address Phone No 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. l 7. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. STATE OF NEW YORK) ~~.~O,C)~l(~____. being duly sworn, deposes and says that (s)he is the applicant (NSar~e of individual signing contract) above named, (S)He is the ~//.JtL)~.,/rd~ (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work m~d to make and file this application; that all statements contained in this application are true to the best of his lmowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this f~ a _ ~.~ ~day of ~/J~ 20(J/-~-- / O -- ~I~otary Public LYNDA M. BOHN ~IOTAR¥ PUBLIC, State of New York NO. 01SO6020932 (~ualified in Suffolk Counlv Term Expires March 8, 20 ~ ~S~gnature of Applicant