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Home My WebLink About27011-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. 27011 Z Date JANUARY 10, 2001 Permission is hereby granted to : EDGAR & ARLENE MARVIN PO BOX 28 NEW SUFFOLK,NY 11956 for DEMOLITION OF EXISTING ACCESSORY GARAGE DESTROYED BY FIRE. at premises located at 1635 ACKERLY PD LA SOUTH/PEC County Tax Map No. 473889 Section 069 Block 0005 Lot No. 008 pursuant to application dated JANUARY 2 , 2001 and approved by the Building Inspector. Fee $ 15 . 00 Aut o z d Sig ature ORIGINAL Rev. 2/19/98 TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST B,UI�LDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD, NY 11971 3 sets of Building Plans TEL: 765-1802 Survey PERMIT NO. �0/1 -Z Check 7; Septic Form N.Y.S.D.E.C. Trustees tiExamined 0I1101 of ,20 n -�4 N� ^�� Contact: tApproved_ 01 J 10 J 01 ,20 I'<,,� -��; Mail to: Disapproved a/c Phone:2 3 g r 5 3 L/L [SLOG. P=FST.n B in spec or APPLICATION FOR BUILDING PERMIT Date , 20 INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted 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 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 what-so-ever until a Certificate of Occupancy is issued by the Building Inspector. 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. (Signature of applicant or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder a)/� Name of owner of premises CP6Ae d A 2 L Oy r IN A Vl A (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 proposed work will be done: /�3�' A0K:cRLI b. LA. -So U,P-u )i House Number Street _;. County Tax Map No. 1000 Section Block ,`Subdivision Filed Map No. Lot 1 (Name) l r�l 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 11 (Description) z 4. Estimated Cost ��lU Fee (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 Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation: 13. Will lot be re-graded Will excess fill be removed from premises: YES NO 14. Names of Owner of premises - Address-- Phone No. Name of Architect Address Phone No Name of Contractor Address Phone No. 15. Is this property within 100 feet of a tidal wetland? *YES NO yZ • IF YES, SOUTHOLD TOWN TRUSTEES 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) CC SS: COUNTY Ol� E 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. Swo t ore me th's day of 20� 01 ft 0 Notary Pu lic Signature of Applicant LYNDA M.BOHN NOTARY PUBLIC, State f ewYOrk No.01 Glualified in Suffolk Cou Term Expires March 8,20 1• 5 i p 1 14 _�� F:l.,4.• . UUP.. �� U-+i � - I s Z LY i xi CD _ �,a`,�a`;.,r. �JT S.� 03�40vV• i� i-VJ "AI D'� - . MROPERT NOW or4MEILY AP OF P DAVIS /, .._ 4 a < ; SURVEYED POR. 92 -C�S;--- :� ►LL F 11 ' TOWN.OF SOUTN03. 'NY GUARATti' Tib THE 7 T i T -EED E: _r�f: �.. �►1ICAG0 TITCE, iN5U,fi?A E. :0r'!PAN.-) :1,Nn ?tiE irt02'{i� FGrZh HAr tK AND �kU r CO3t';:.;t•:, VMI`i L10E4VSEt7 �Atrn ctvGY'1rYO;t.�, s TOWN OF SOUTH®LD PROPERTY RECORD CARD OWNER STREET a VILLAGE DIST. SUB. LOT FORM R OWNER N E ACR. s � S W TYPE OF BUILDING ES.9'�`O SEAS. VL. FARM COMM. CB. MISC. Mkt.: Value LAND IMP. TOTAL DATE REMARKS w d:-v o a 3 6 v 1:r-/"/ AG 6 -,dc�-�'�� / .:'11! f :yam c2 9 v-v _ f—,-7/6 a � ,55(- L�rc s�f-r . 0 I c i-t AGE BUILDING CONDITION '7.3(iC_ 5-3Y�P JEW NORMAL BELOW ABOVE -ARM Acre Value Per Value Acre !liable I liable 2 liable 3 oodland ✓amplond FRONTAGE ON WATER ushland FRONTAGE ON ROAD )use Plot DEPTH BULKHEAD tol DOCK E COLOR i / N rl�uw TRIM ,g l M." a N. Bldg. a�S—r� Foundation E., S 8R Bath Dinette .xtension Y i 8 7 D 3 U 00 p Basement Pp, Floors �� K. xtension Ext. Walls Interior Finish qL u M wry !3 D LR. xtension i Fire Place iv O Heat �� DR. Type Roof Rooms 1st Floor BR. 'orch Recreation Room Rooms 2nd Floor FIN. B. 'orcli Dormer 3reezeway Driveway �oroge G Ratio J. B.. Total I 0 -- i � L-'7