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Home My WebLink About29789-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. 29789 Z Date OCTOBER 8, 2003 Permission is hereby granted to: KEVIN C COLEMAN 201 E 69TH STREET- APT#50 NEW YORK,NY 10021 for : DEMOLITION OF A PORTION OF AN EXISTING BUILDING AS APPLIED FOR at premises located at MONTAUK AVE County Tax Map No. 473889 Section 009 pursuant to application dated OCTOBER Building Inspector to expire on APRIL Fee $ 89.00 FISHERS ISLAND Block 0005 Lot No. 005 7, 2003 and approved by the 8, 2005. ORIGINAL Rev. 5/8/02 T, OWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.net/Southold/ BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 3 sets of Building Plans Planning Board approval Septic Form Examined ~ -- /, ,20 Contact: [ , INSTRUCTIONS a. ~is application MUST be completely filled in by ~ypewriter or in ink an~ submitted to the Buildin~ Inspector with 3 f~ Eve~ ~uildin~ pe~it shall e~pire i~he work authorized has not commenced within 12 momhs a~er ~he date of ~uildin~ ~one Ordinance of the Town o~ Sou~hold, Suffolk Count~, New York, and other applicable Laws, Ordinances or authorized inspectors on premises and in building for necessary inspections. APPROVED AS NOTED DAI'E~o IY/7 B.P. #~ -.~o~ (S~gnature of apphcant or name ifa corporation) (Mailing address of applicant) State whether.~0pli.~a_nt j&owner, lessee,.ag.~t,TK.Cotect, engineer, general contractor, electrician, plumber or builder -et:, '~1~'- ~y:~ '65-1802 8AM TL, q~L.FOR . Name C_ 1. FOUNDATION . "~/- -- (As on the tax roll or latest deed) I f applicant is ~P~gE~r~ized o fficer Builders Lt~IliI-.- CON~TgUeTD~ ~ Plumbe~ Lic~MPl gT~ ~mm ~ ~ Electricia~c~.~t ~o.~a, .......... Other Tra~~ '~2~ ~ Mg~ ~ ~ 1. Locat ~~i~o~~b~e: ~ ~ T House Number Street Hamlet County Tax Map No. 1000 Section k..~ Block '~', '~ Lot Subdivision Filed Map No. Lot (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 v' Other Work 4. Estimated Cost ~qo~O Fee ~/yO (Description) (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. ~¢f1~7~ 7. Dimensions of existing structures, if any: Front ~ Rear '~/~O _Depth L/~ Height / ~ Number of Stories [ Dimensions of same structure with alterations or additions: Front Rear Depth. .Height. 8. Dimensions of entire new construction: Front Height Number of Stories 9. Size oflot: Front Rear 10. Date of Purchase ~/"~ /00 Name ofFormerOwner Number of Stories Rear _Depth Depth 11. Zone or use district in which premises are sitaated yVl 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 froln premises* YES 14. NamesofOwnerofpremises /~O'r'.'- ~;{,t,n.t..~ Actdtessot?' Name of Architect Address Phone Name of Contractor 5D,cl~ &,- L ~,~ 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. KATHLEEN M. 'FREUT/E STATE OF NEW YORK) Notary Public. State of New York SS: No 41~.752644 Qualified in Queens County COUNTY OF ) Commission Expires July ,~'~. 200 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 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. ' ' Notary Pubfic/ Signature of Applicant ~/F BERNADETTE WALSH 1,) COORDINATE DISTANCES ARE MEASURED FROM U.S. COAST & GEODETIC SURVEY TRIANGULATION STATION 'PROS' 2.) TAX REFERENCE; DISTRICT 1000, SECTION 009, BLOCK 5, LOTS 5 AND 8 ~NIEL$ PLAN OF PROPERTY TO BE CONVEYED TO KEVIN C. COLEMAN LESLIE R. COLEMAN MONTAU K AVENUE FISHERS ISLAND, NEW YORK SCALE~ 1" = 20' ~HEET 1 OF 1 po