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HomeMy WebLinkAbout27838-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. 27838 Z Date OCTOBER 26, 2001 Permission is hereby granted to: JOHN. H & LYNN A FOSTER BOX 634 FISHERS ISLAND,NY 06390 for DEMOLITION OF AN EXISTING GUEST COTTAGE AS APPLIED FOR at premises located at MANSION HOUSE DR FISHERS ISLAND County Tax Map No. 473889 Section 008 Block 0002 Lot No. 001 pursuant to application dated, OCTOBER 15, 2001 and approved by the Building Inspector. Fee $ 171 . 20 Authorized Signature ORIGINAL Rev. 2/19/98 Y TOWN OF SOUTHO ABUIL.DING PERMIT APPLICATION CHECKLIST BUILDING DEPART T C l� Do you have or need the following,before applying'. TOWN HALL � 2�0� Board of Health SOUTHOLD, NY 1.19,11. 3 sets of Building Plans ssly TEL: 765-1802 BLDG.DEPT.' D Survey 6 7 90 r-- Check ✓ Septic Form N.Y.S.D.E.C. Trustees Examined_ `!v�j ,20,o l Contact: Approved 10 20p I Mail to: e Y sKa Disapproved a/c ?Dx -20d /yslxi5 .Ts� i1✓y Phone: Building 1,&VWeerf PW, E;4 APPLICATION FOR BUILDING PERMIT Date �ci 5 , 20 0/` 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.iThe: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 Occupanc 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. Pa-.d- 608 0 -h Coa_� (Signature of applic t of name, if a corporation) (Mailing address of applicant) e�j yv State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder si Name of owner of premises �/Ohr� 4� ,1 hn F�-� APPROVED AS NOTED (as on the tax roll or latest ' If applicant,*',s' a corp at= of duly authorized officer �'1 � �' NOTIFY BUILDING DEPARTMENT AT • *7 765-1002 9 AM TO 4 PM FOR THE (Name an tle of corporate officer) FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE Builders License No. �.��v�y� A ROUGH - FRAMING & PLUMBING Plumbers License No. mss"/ & INSULATION4, FINAL - CONSTRUCTION MUST Electricians License No. =I- BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET Other Trade's License No. THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR 1. Location of land on which pro osed work will be done: / DESIGN 0R CONSTRUCTION ERRORS 6457- House Number Street p Hamlet County Tax Map No. 1000 Section -- -0cC,201Lot Subdivision Filed Map No. Lot (Name) 2. State existing use and occupancy ofpremises and intende use and occupanc o proposed construction:. a. Existing use and occupancy_., � v, Jr b. Intended use and occupancy_ 14aA . 3. Nature of work (check which applicable): New Building Addition__ Alteration Repair Removal Demolition Z _Other Work -PIC 1; X 3 C(D'escript=ion)',. r•t��.��at-},> 4. Estimated Cost �"V,ino Fee_ '��d�)Er?r P��aiy' 8 c:,'?b to be ai On 'lI k tffis' i 'lr^atibri 5. If dwelling, number of dwelling units _Number of dwelling units on If garage, number of cars &�° yC�61!41 a(C�.U:11.. (;", d{;? a Ye LS VI AV CS - e9•a�Yt��.1.Li 1i.•. jf_ .+i 5. If business, commercial or mixed occupancy, specify nature and extent of each t eldfyrut,(sz..0 VI 7. Dimensions of existing structures, if any: Front Rear Height Number of Stories `,�`?;�,;r �,;; •r Dimensions of same structure with alterations or additions: Front011 U.+.ti"A 1. ° Rea . - 'i�? �'� °'°° 0 Depth _Height Number of t�+1iI'D 3. Dimensions of entire new construction: FrontRear_ epth _ Height Number of Stories �. Size of lot: Front Rear Depth _ 10. Date of Purchase Name'of Former Owner !1. Zone or use district in which premises are situated_ :2. Does proposed construction violate any zoning law, ordinance or regulation: 3. Will lot be re-graded Will excess fill be removed from premises: YES NO 4. Flames of Owner of premises 'Address Phone No. Name of Architect Address Phone No Name of Contractor _Address Phone No. 5. Is this property within. 100 feet of a tidal wetland? *YES NO • IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED 6. Provide survey, to scale, with accurate foundation plan and distances to property lines. 7. If elevation at any point on property is at'10 feet or below, must provide topographical data on survey. TATE OF NEW YORK) SS: 'OUNTY OF ) 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.) f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; iat all statements contained in this application are true to the best of his knowledge and belief; and that the work will be erformed in the manner set forth in the application filed therewith. wo o be.o me da 6 200 Notary Public Signat of Applicant M&A@ V. Notary public$lata of New yor , P!tyt." DE) !• ' No.4808559 ` f Quallflea In Suffolk Count,,' Term Expires 12/31 TOWN ,OF SOUTHOLD_ :PROPERTY RECORD CARD INER STREET 'VILLAGE DIST. SUB. LOT , ACR. IRMER OWNER CT41 fle - E z A c ,01W TYPE OF BUILDING r . SEAS. VL. FARM COMM. CB. MISC. Mkt. Value :AND IMP: TOTAL DATE REMARKS Fry �.' '� A- 9 , F e1 12 /1'� Odd . / A t/vtvr� ?"0 6 A 7 O 71 %vz . AGE BUILDING CONDITION o Q - Cg► os W NORMAL BELOW. ABOVE SRM .Acre Value Per Value c� r! C l7. j " ,0 Acre �L �� l lable 1 lable 2 able 3 iodland . FRONTAGE ON WATER :3mpl.and FRONTAGE ON ROAD Ashland use Plot l/ '4� DEPTH BULKHEAD. tal+ DOCK srJ ; �. NOON■■■ ■■■■■■■■■■■■■■■■■■■ � • •° NOON■■■ ■■■■■■■■MM■M■■■■■■■■ NOON■■ ■■■■NOMMEN■■■■N■■■■ ,. 4 ■■■MO■ ONO ENONE■■■■■�■■MEN No mom 0 NOMMEMN mom FM MEMO 91 WIT'l Amiga xz SiNNEUMM MEMO =21EMWE 4 ��OOMNMf�M■■IRSNEWME ■■■■■■■■M�1Ml��■MM }-,, � . Y. ;Y.: : �. ■aM■�'�;,1■■■1�1M■■■E■M■ESI■■f1ME■ M■■■■M■■■■1■■■■■■■■■■�IMuAWNNo MCM EM■MMEMMMMMMMMMMMMMMMMMMMMN MEMO ■■M■EM■■■■■M■M■MME .. Foundation - Fire Place Rooms I st Floor 1 d C0 D CARD OWNER STREET VILLAGE DISTRICT SUB. LOT FORME WNER N E ACREAGE S W TYPE OF BUILDING RES. SEAS. VL. FARM COMM. I . IND. I CB. I MISC. LAND IMP. TOTAL DATE . : REMARKS AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE Farm. Acre- Value .Per Acre Value Tillable 1 . Tillable 2 Tillable, 3 Waodland Swampland Brushland House Plot Tota ... rrW ,,� ,yam , ,_, . . .. ■■4■■■■■■■,�■S■■■■■■� Interior ■�r� - Place - Applicant/ Date Go �� 0 Owners Name: _ r •� Reviewed: Architect/ Date Engineer: Submitted: •IO0/ SCTM fl: Dis(rict: 1,000 SectJon: _ Block: _ Lot: I Project Subdivision Location: M�,( s"f csvt. F .� I� = _ Name: Single & separate Required certifications: Yesf/No r Req. Req. T---- %aning.t)islric. Lo(size: _ Actual: I (Lot coverage Proposed Req. / Req. Req. (front Yard Pro• sed: I (Side Yard T Proposed: J (Rear Yard Proposed- I Project Descrip ion: Q AGENC)VERMITS Permit . REQUIRED FOR RE'VIEWFOR REVIEW N.A. NO YES Number Suffolk County Health Dept. ✓ New York State D. E. C. Town Trustees • Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation??? Flood Zone: ote : n��. � S- e�--1 71 , Z & S CONTRACTING, INC. BOX 202•FISHERS ISLAND, NEW YORK 06390 Tel: (631) 788-7857• Fax: (631) 788-5600 IVY /i97/ 17,1S �u all uD`i`I 'ele tA 7 172/e,o D`� �JfC Giu�l� Gr>iD`4sC of )ae h; /� Gc/�jiGf7 /j v 11?10 , v r- !vim � (���_,I-) I - l 0 0o 1 ; U ' O be y / oJo o ` l l0 —F—fZ-'J,L..L�G-a. L.�--T'1C�L, �' 'T�.1...1 •CJ-iCY_"-C�>�.(__Cx.>�Z� O� \ l ,� ?�` I / `\ �ll)� g .C4 I I 1 I I �\. '•.: :aN����� "_ "'/ •---T— wuy�' I I / \� �`s N� � CD WLj I I I I I / f I r,"� ,� •\ `\`1 ; ! 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