HomeMy WebLinkAbout26044-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 AUTHORIZED)
PERMIT NO. 26044 Z Date OCTOBER 20 99
Permission is hereby granted to:
CONRAD VEROSTEK & WF.
415 MILL CREEK DR.
SOUTHOLD,NY 11971
for
CONSTRUCT FOUNDATION UNDER EXISTING DWELLING AS APPLIED FOR.
at premises located at 415 MILL CREEK DR SOUTHOLD
County Tax Map No. 473889 Section 135 Block 0003 Lot No. 030.001
pursuant to application dated AUGUST 11 99 and approved by the
Building Inspector.
Fee $ 75 .00
Auth ri ed Signature
ORIGINAL
Rev. 2/19/98
�. '.
Board Of Southold Town Trustees ,
' . SOUTHOLD, NEW YORK �` r
PERMIT NO. 50 ')a DATE: .O.ct. 28, 19...99
b
@ ISSUED TO .._CONRAD & J.E.SSIE VEROSTEK
Pursuant to the provisions of Chapter 615 of the Laws of
the State of New York, 1893; and Chapter 404 of the Laws of the '
State of New York 1952; and the Southold Town Ordinance en-
R, , titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS xy r
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;". and in accordance with the
Oct.27,
Resolution of The Board adopted at a meeting held on ...... ....... ..........
19, .9.9..., and in consideration of the sum of $ 150.00 paid by f
Nicholas Vero for Conrad & Jessie Verostek
,p
I of ... . ....Southold N. Y. and subject to the
Terms and Conditions listed on the reverse side hereof,
ofSc thole! Town Trustees authorizes and permits the following: t.
Wetland hermit to remove exist.structurefrom exist.foundation,
X and remove exist.locust post/concrete foundation,excavate for ne "
poured concrete foundation within exist.building footprint, & reloc +�
exist.structure on new foundation with the condition that staked
haybales be�ianc diW5heucTe lec�'specificstlionsaes�rr��ie�i �dlt�i
all,m ace once wi
the originating application.
installed; two - 4'indepth X 8' in diameter pre-cast drainage rin `
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes its Corporate Seal to be affixed, and these Presents to a
be subscribed by a majority of the said Board as of this date.
., 05aq:ni g-
c BSTAIN +
r Trustees 'a
s
I� �xa.� `'!ab�� �' aYpY •N� '+:F.EOA'•C QQ
BOARD OF HEALTH . . . . . . . . . . . . .
FORM NO. 1 3 SETS OF PLANS . . . . . . . . . . . . . . .
; ,,'1 •. TOWN OF SOUTHOLD SURVEY . . . . . .
BUILDING DEPARTMENT CHECK Jf: . . . KK . . . . . . .. . . . . . .
` TOWN HALL SEPTIC FORM
. . . . . . . . . . . . . . . . . . .
SOUTHOLD, N.Y. 11971
ODEPT. TEL: 765-1802 NOTIFY: / l/" ftc4Yt.
TOWN F F SOUTHOLD i
CALL aZ
Examined.................. 19.... MAIL TO: . . . . . . . . . . .. . .. . . .
Approved..iJ�yb......... 199A Permit No. 0.1..7� ................................
Disapproved a/c .................................. I ................................
....................................... ............
(Building I Or)
APPLICATION FOR BUILDING PERMIT
Date. . . . . . . . .. 19. . .
INSTRUCTIONS
a. This application most be completely filled in by typewriter or in ink and submitted to the Building Inspector
3 sets of plans, accurate plot plan to scale. Fee according to schedule,
h. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public
streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of
this application.
c. The cork 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. Suer
permit 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 whatever until a Certificate of
Occupancy shall have been granted by the Building Inspector.
APPLICATION IS HEREW 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, ordinancesor
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 lays, ordinances, building code, housing code, and
regulations, and to admit authorized inspectors on premises and in building for necessary inspections.
,....-r-...................
(Signature of applicant, or name, if a corporation)
[4q.... ...........� .......... .1.........
(Maili address of applicant) v, //9 7 `
State w1wther applicant is owner, lessee, agent, iter engineer, general contractor, electrician, plurber or build
�R_c, �t� T...
.......................... .. . ........................................................................
Name of amen of premises
..c.o ynAt?.. . ..JAS/ ... tle�lLc?s ....................................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
.....:...................................................
(Nae and title of corporate officer)
Builders License No. .........................
Plumber's License No. .........................
ElectriciansLicense No. .....................
Other Trade's License No. ....................
1. Location of lard on which proposed work will be done.............................................................,
Th�e.f
......................................3 .....................
House Number Street Hamlet
County Tax Map No. 1000 Section ..../.$.S...... Block ...3.......... Int .3.a.'.[........
Subdivision ...................................... Filed Map No. ............... Lot ...............
(Name) J
2. State existing use and occupancy of premises and intended use and occupancy of
proposed construction:
a. Existing use and occupancy / STi9f2jS/AlG,;C; ., /Ql!Y1,lL,7-.1:-1 .5.,!� .Nc�c............
.......................
b. Intended use and xcupancy / roA ......
...... . ... .
Nature of work (check whidh applicable): New Building .......... Addition .......... Alteration .....
liepair ............ Remaval ............. Demolition ............ Other Work Nfw.,FI?LiVflA.7AQ!✓........
(Description)
Estimated Cost ...gi.C2vJ: JO
......... fee ..............................................
(to be paid on filing this application)
If ckmlling, nurber of dwelling units .....l...... lknber of dwelling units on each floor .....r.......:..
If garage, number of cars ......JS)1.1.9 .........................
If business, commrcial or mixed occupancy, specify nature and extent of each type of use......................
Dimensions of existing structures, if any: Front...!�?:.?..... Rear .Z��.:.J...... Depth AO.'.o
height !.. ............. tkuber of Stories .../.......
Dimensif same structure with alterations or additions: Front .. ...' .... Rear ... �.`.`.?.....
Depth ......ons omoi.:J......... Deigtht ...../..f?............ Nmnber of Stories .../.....
Dimensions of entire new construction: Front .30!.3!, Rear ,3�, $ 3 Depth28. nth
Ileight ...../.(.9................ NLuber of�Stories ...�................
Size of lot: Front yi$IC/kS�Y/uu._ Depth ...�.:3 7.L
.............. Rear ....... .......
.1. Date of Purchase ..................... Name of Former Ower
........................................
1. 7.one or use district in which premises are situated ...../'- ..
......................`...................................
2. Does proposed construction violate any zoning law, ordinance or regulation: ..N'P................
3. Will lot be regraded .................... Will excess fill be removed from premises: YES
i. Names of Owner of premises Phone No. ...........
Name of Architect v!!!� tAS...4!Aygp............ Address /!D N7/LL ,KoAOplane No. Z 88 / yd!
Dv�eSjNNin%I7
Nam of Contractor ................................... Address Phone No. ..'.......
............................... ...
5. Is this property within 300 feet of a tidal wetland? * YES .......... NO ... ...
*lF YES, SOLMM 1txd1 MOMS PE[AIIT MAY BE REQOIRM.
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions
ram property lines. Give street and block n xber or description according to deed, and show street names and indicate
Ihether interior or corner lot.
s A 77ACVko
ririr or Nov Y(NT,
ISS
........(!!.lC ... ./1l: r+I�/ ..being duly sworn, deposes and says that he is the applicant
Name of inlividual signing contract)
Love named,
e is Uhe .............!`El^ N� ...6AP-C1jz
(Contractor, agent, corporate officer, etc.)
r. said weer or owners, and is duly authorized to perform or have performed the said work and to make and file this
pplication; that all statements contained in this application are true to the best of his knaaledge and belief; and
hat the work will be performed in the manlier set forth in the application filed therewith.
worn to before me this nn
......./� L .....day of Z2'" ' 19-12?.
Notary Public ..... .-L:B_L tY. ..`.:41... ..... �"--
(Signature of Applicant)
I
LINDA J.COOPER_
NNo 48225u63 Suffolk York
County
Term Expires December 31,19L--? G
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LD=INSPECTION_REPORT--_=DATE --_----_ COMMENTS
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765-1802 9 AM TO 4 PM FOR THE
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LL0104ING INSPECTIONS:
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c: � �iafftlJ("TION SI-I�I,I., t EET �_�.
� EQUIREMENTS OF THE I � N."',� i�tti-t�l c,
E CONSTRUCTION & ENER� �,r,( `F .d.� 0N & ENERGY
Y
O ES., NOT RESPONSIBLE FOR -� � R ; 3� NSIII 1: FR
k Mho i4rf� 1E. .sir Iii ,o rit; wiNi 1t own
DESIGN OR CONSTRUCTION ERRORS � . �:'R5N 0r. CONS AUCTION ERRORS
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