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27563-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. 27563 Z Date AUGUST 20, 2001 Permission is hereby granted to: JOSEPH -CHERNUSHKA 130 DEVONSHIRE DRIVE NEW HYDE PARK,NY 11040 for DEMOLITION OF AN EXISTING ACCESSORY STRUCTURE AS APPLIED FOR at premises located at 845 BAY AVE EAST MARION County Tax Map No. 473889 Section 031 Block 0010 Lot No. 015 pursuant to application dated APRIL 19, 2001 and approved by the Building Inspector. Fee $ 77 . 00 Authorized Signature ORIGINAL Rev. 2/19/98 i��7 TOWN OF SOUTHOLDf r' - BUILDING PERMIT APPLICATION CHECKLIST: BUILDING DEPARTMENT - '�, Do you have-or need the following,before applying TOWN HALL Board of Health SOUTHOLD; NY 11971 3 sets of Building Plans Survey Check Septic Form N.Y.S.D.E.C. Trustees Examined 9120 20 D Approved 80-0. ----,200 / PERMIT NO. Z�S63 Disapproved a/c Building Inspector APPLICATION FOR BUILDING PERMIT Date . 320 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 sale.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 giving a detailed description of layout of property must be drawn on the diagram which is part of this application. 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 whatever until a Certificate of Occupancy shall have been granted 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 a licant 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. V(Si tore 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 l 4a 0Cq Name of owner of premises - t k N Us H(<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: y 84.!5 IJ�yve�..uCa (—aso�1-co f� House Number Street Hamlet County Tax Map No. 1000 Section 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 occu anc P Y 3. Nature of work(check which applicable): New Building Addition Alteration Repair Removal Demolition X Other Work (Description) 4. Estimated Cost a 700,1010 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 l 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front 30. .Rear Q �l� Depth 3 7 0 Height -(o Number of Stories I 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 �92- Name of Former Owner Crow 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 300 feet of a tidal wetland? *YES NO . . • IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY.BE REQUIRED 16. Provide survey, indicate scope of project, to scale,with 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) SS: COUNTY OFrr_� l) e � V CLP_ ��S CL Q being duly sworn deposes and sa s that she is the applicant P L g Y P Y ( ) PP (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. Sworn before me this of 20 y oPublic Signature of Applicant Ty JOYCE M.WILKINS Notary Public,State of New York No.4952246,Suffolk County Term Expires June 12, ��U BUILDING PERMIT EXAMINER CHECK LIST DATE REVIEWED: a /2a /01 6� DATE SUBMITTED: /%9 /O1 APPLICANT NAME: IWC SCTM# DISTRICT: 1,000 SECTION: BLOCK:b LOT: STREET: CITY: SUBDIV. NAME: PROJECT DESCRIPTION: f 1 1 c ARCHITECT/ENGINEER: FAST TRACK? SINGLE &SEPARATE CERTIFICATION-REQUIRED? NOTES: LOTS 40,000SF-100-24.Lot recognition.(CREATED before June 30,1983),UNDERSIZED LOTS FROM JAN.1997 100-25.Merger.(A nonconforming at any time after 7/1/83) ZONING DISTRICT: CONFORMING? .REQ. LOT SIZE: ACT. LOT SIZE: REQ. LOT COV. ACT. LOT COV. REQ. FRONT PROP.FRONT REQ SIDE ACT. SIDE REQ. REAR PROP. REAR WATER FRONT. DESCRIPTION: PANEL #: FLOOD ZONE:, , AGENCY PERMITS REQUIRED FOR REVIEW APPROVALS REQUIRED: SUFFOLK COUNTY HEALTH DEPT: YES or NO, (BED #): DTE: / / PERMIT#:R10- NEW YORK STATE DEC: PRE-DEC 9/1/75 YES o SOUTHOLD.TOWN TRUSTEES: YES o TOWN ZONING BOARD APPROVAL: YES or TOWN PLAN. BOARD APPROVAL: YES or TOWN HISTORICAL PRE (SPLIA): YES or NYS ENERGY: YES OR NO EGRESS (18 H min.? 4 sq total) VENT(SQ. FT. x 4%) LIGHT (SQ. FT. x 8%) BUILDING PERMITS OPEN/EXPIRED: BP -Z/C/0 Z- , HAVE PRE CO'S : Y OR N BP -Z/C/o Z- , NOTES-:-AA, , . sec-. s Aue FEE STRUCTURE: FOUNDATION: SF FIRST FLOOR : SF SECOND FLR : SF INIT OTHER TOTAL G TOTAL: SF FEE FEE FEE OT / °� SF)_ �G° SF) SF X$ A)=$ +$ �� +$ _$ �� - - , , _: : rI..,...:-.,_.,-,..-....,�.-',. ... . '. _.. ",". . . -:.-�:�:,,:.,- . . .. . . .. . . . - :_,':- . , _;- ..., _...-:... 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