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Home My WebLink About29846-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. 29846 Z Date OCTOBER 28, 2003 Permission is hereby granted to: J~24ES & NETTIE BONDARCHUK 741 JANSEN AVE ESSINGTON, PA 19029 for : DEMOLITION OF AN EXISTING RESIDENCE AS APPLIED FOR at premises located at 1100 ISLAND VIEW LA County Tax Map No. 473889 Section 057 pursuant to application dated OCTOBER Building Inspector to expire on APRIL Fee $ 141.20 GREENPORT Block 0002 Lot No. 042.004 24, 2003 and approved by the 28, 2005. ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.~et/Southold/ PERMIT NO. / Disapproved aJc Expiration__ 20 __ BUILDiNG PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 3 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to:~2Z9 APPLICATION FOR BUILDING PERMIT i ¢ Date ~ 9__% .,20t~3 ~ 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 o£ lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by tiffs 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 the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work author/zed has not commenced within 12 months after the date o£ issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. '['hereafter, a new permit shall be required. 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. APPROYED AS NOTED State whether ~[~l~/~l~,s~ ~"Str~hitect ~1~ BULDtNG D,(TqRT~E~T AT 76~1802 8AM TO 4 PM FOR THE ifa corporation) (Mailing address of applicant) engineer, general contractor, electrician, plumber or builder -~N ame of owner 2. ROUGH - FRAMING & PLdMBING (As on the tax roll or latest deed) If applicant is ;~ dlfltjblla~fflt~, signature of duly authorized officer 4. FINAL - CON~"rRUCTiON MUST (Name. N..L CONSTRUCTION SHALt. MEET THE . REQ~REMENTS OF THE CODES OF NEW Builders ~iceg~:t~q3~-~.,. ....... = ........... Plumbers L]c~o Electricians License No. ~-Other Trade's License No. 1. Location of land on which proposed work will be done: House Number Street Ham]et County Tax Map No. 1000 Section ~'~ Block ~ Subdivision Filed Map No. (Name) Lot ' q~,4O[ Lot State existing use and occupancy of premises and intended use an~d occupancy of proposed construction: a. Existing useandoccupancy '~, ~-~r~vt.t[,_y b. Intended use and occupancy. 3. Nature of work (check which applicable): New Building Repair Removal Demolition ~. Estimated Cost /~t~~- Fee 5. If dwelling, number of dwelling units If garage, number of cars Addition Alteration Other Work (Description) (To be paid on filing this application) Number of dwelling units on each floor If business, commercial or mixed occupancy, specify nature and extent of each type of use. Dimensions of existing structures, if any: Front vS~, ~,~ Rear Height. Number of Stories ~, ~ ,q~,_ Dimensions of same structure with alterations or additions: Front Depth. Height Depth Number of Stories Rear 8. Dimensions of entire new construction: Front He}ght Number of Stories Rear .Depth 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? YES NO J i~Names of Owner of premises Name of Architect Name of Contractor ~,,-o~, 13. Will lot be re-graded? YES__ NO Will excess fill be removed from premises? YES Address _.~---'3kl~{~ ~/,o) L~~o. Address Phone No Address ~~(.~Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO x-/r * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY Bp REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO * IF YES, D.E.C. PERMITS MAY BE REQUIRED. NO 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) SS: COUNTY OF ) ~( C~t~.J~ [~) ~ ~ 3~ct~'~- being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the (..~'fl-~rr~ [ (Contractor, AgeOt, 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 tree 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 to before me this ~ __ o,~ ~ 4dyer__ (-JC~ 20 0~ - iklotary Public LYNDA M, BOHN NOTARY PUBLIC, State of New York No. 01BO6020932 Oualified in Suffolk County Term Expires March 8, 20 ~ S ig~u[e of Applicant