HomeMy WebLinkAbout29732-ZFORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PEP~4IT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 29732 Z
Date SEPTEMBER 15, 2003
Permission is hereby granted to:
EDITH M FULLER
1460 BP~AY AVE
LAUREL,NY 11948
for :
DEMOLITION OF AN EXISTING SINGLE FAMILY DWELLING AS APPLIED
FOR
at premises located at 1460 BP=AY AVE
County Tax Map No. 473889 Section 126 Block
pursuant to application dated SEPTEMBER 11, 2003
LAUREL
0007 Lot No. 028.001
and approved by the
Building Inspector to expire on M_~RCH
Fee $ 205.20
15, 2005.
ut orized Signature
ORIGINAL
Rev. 5/8/02
KeySpanEnergy
117 Doctor's Path
Riverhead, NY 11901
September 10, 2003
Ms. Tammie Hildesheim
361 June Ave
Flanders NY 11901
RE Service Address: 1400 Bray Avenue, Mattimck
LIPA Ref #. T 100320046
Dear Ms. Hildesheim:
Please be advised that LIPA has removed all of its electrical facilities at the above
address.
Thank you for this opportunity to be of service to you.
Very truly yours,
Robert Parkinson
Scheduling Supervisor
Eastern Suffolk
RP/mad
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www. northfork.net/Southold/
Examined
Approved
Disapproved a/c
Expiration
,20
PERMIT NO.
3
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
3 sets of Building Plans
Plannmg Board approval
Survey
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Mail to:
Phone:~C~
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Date !! ~0 94T~ ,20D?:~
a. This application MUST be completely filled in by typewriter or in ink and subnfitted 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 pemfit
sh~ll 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
isgues 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 author/ze, 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 Departmeut for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk Cotmty, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of building3, additions, or alterations or for removal or demolition as herein described. The
applicant a~-ees to comply with all applicable laws, ordinances, building cod~,~housing code, and regulations, and to admit
authorized inspectors on premises and in building for necessary inspections/ /
Q~.~......~- ] (Signature of app ~iT6ant or name, if a corporation)
0,~. ~ 1.~ B.p. # ~"~" ~-~..~ \ ~ili~ng a~d.d~-, ~s~app lic ant,
State whq~l~l~Ol~a~ q~lt~,l~gent, architect, engineer, general contractor, electrician, plumber or builder
755-180~ aAM TO 4PM FOR THE
FOLLOWeiO INSPECTIONS:
1. FOUNDATION - TWO REQUIRrd)
2. ROUGH FRAMtN~ & ~u~ ~n~ .......
(As on the tax ~:oll or latest deed)
ir applic4,duly auto=ed of ccr
REQUIREMENTS OFTHE CC)DF. SOl:NEW
Builders I~:~l~s~T~ll~. NOT RESPON$1BLE FOR
pl~unbersQ~i~l~o~}NSTRUOTlON ~JIl:lO~$.
Electricians License No.
Other Trade's License No.
Location of 2~d on which proposed work will be done:
House Number ~ gtreet
County Tax Map No. 1000 Section
Subdivision
Hamlet
Block
Filed Map No.~0_ ~
(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 _~- -~-v(~ [,4 r'[~ ¢
3. Nature of work (check which applicable): New Building Addition
Repair Removal Demolition X~' Other Work C~
4. Estimated Cost
5. If dwelling, number of dwelling units
If garage, number of cars
Alteration
Fcc
(Description)
(To be paid on filing th!s 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 Rear
Height. Number of Stories ~_
_Depth
Dimensions of same structure with alterations or additions: Front Rear
Depth. Height. Number df Stories
8. Dimensions of entire new '~onstruction: Front
Height Number of Stories
Rear _Depth
9. Size of lot: Front Rear Depth
10. Date of Purchase Name of Former Owner~'~ I',
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? YE.S~. NO Will excess fill be removed from premises? YES NO
14. Names of Owner ofprer~i~esk"~v',c~ C ~\'t\~C<i~.ddress?lo\ 7J~kvx~ 3oe. Phone No. ~B (-~(o~-~c~
Name of Architect Address ri-'tan~rs '"'Jq uqOIPhone 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 d~stances to
17. If elevation at any point on property is at 10 feet or below, must prowde topographical data on ~urvey.
STATE OF NEW YORK)
SS:
C~]UNTY OF , ) ,.~::."',,,~ ......~ -', '
~ ~ ~ i~U ~ ~ being duly sworn, deposes ~,~aY~ t~t (s)he is t~e~p~t
~J (Name 6f ~divid~al si~ing contract) above nmed,
(S)He is the ~q
- ~ (Contractor, Agent, Co,orate Officer, etc.)
of said owner or owners, ~d is duly authorized to peffom or have perfo~ed th~ sa~.~o[k ~d;to ~e ~d file ~ application
that all statements contained in this application are tree to the best of his ~owl~d b~ief; ~d [ha~.~e ~ ~1~ be
perfo~ed in the ma~er set fo~h in the application filed therewith.
~ i~ature of Applicant