HomeMy WebLinkAbout29964-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. 29964 Z
Date DECEMBER 22, 2003
Permission is hereby granted to:
for :
DEMOLITION OF
PATRICIA D MILONE
3500 NASSAU POINT RD
CUTCHOGUE,NY 11935
EXISTING NON-CONFORMING COTTAGE AS APPLIED FOR
at premises located at
County Tax Map No. 473889 Section 111
pursuant to application dated DECEMBER
Building Inspector to exq~ire on JUNE
Fee $ 46.25
3500 NASSAU POINT RD
CUTCHOGUE
Block 0004 Lot No. 033
22, 2003 and approved by the
22~ 20~5~- ~
~ ~rlz~l~gnature
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.net/Southold/
Examined ,20
Approved ,20
Disapproved adc /
/
Expiration ,20___
PERMIT NO.
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:
BailPhone:
APPLICATION FOR BUILDING PERMIT
Date ,20
INSTRUCTIONS
a. This application MUS e 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 par?or any purpose what so ever until the Building Inspector
issues a Certificate of Occupancy. -~--....
f. Every buildhag permit shall expire if the work authorized has n&' commenced within 12 months after the date of
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 interml, the Building Inspector may authorize, in writing, the extension of the pem~it for an
addition six months. Thereafter, 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.
(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
/Nan~e of owner of premises -4~)~/L~{-)~tr I',~ ~ 1~ ;] 0 ~
~ ' ~ ~ -' " (~As off th~ 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. /Lof~ion~of land on ~vhich proposed. C_%ork w.~ll,be done:
',/ _ c
/ House Number Street Hamleg/
~/County Tax Map No. 1000 Section / \ ~ Block
/ x Subdivision Filed Map No.
(Name)
existing use and occupancy of prem~se~ and intended u~ ~,nd occup, angy of proposed cfins.tmction:
tat:. Existing use and occupancy //~Ot'x]~ ~??~ _~.r~/15 ~ x6>_~( ~ ,~'7 t4 ~
/ b. Intended use and occupancy ~ ~'-/~ ~- ~t~5~/~t~~' ~)
x3/~ature of work (check which applicable): New Building f~/ Addition/~'~j Alteration~
?, Repair Removal Demolition Other Work
5. If dwelling, number of dwelling units
If garage, number of cars
Fee
(Description)
(To be paid on filing this application)
Number of dwelling units on each floor
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front
Height_ Number of Stories
Rear _Depth
Dimensions of same structure with alterations or additions: Front Rear
Depth Height. Number of Stories
8. Dimensions of entire new construction: Front
Height 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__
. Will lot be re-graded? YES NO ~(. Will excess fill be removed from premises? YES__ NO~(/
. Names ofOw~ner ~fpremises~3~tTr4-~l D ¢0;~q~ddress ~O r/d,~9 /~ Phone No. 7,~/- ~,~O,-N~
Name of Architect Address Phone No
Name of Contractor Address Phone No.
,a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO
IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY I~E?EQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES NO
· IF YES, D.E.C. PERMITS MAY BE REQUIRED. ~]
P ovide to
,17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
STATE OF NEW YORK)
~~_.~.. )~. (~ //~ ~_~~.~'3~.in~swom, deposes and says that (s)he is the applicant
(Nar~e of individual si~fil~ c~n~'act) above name. lt~h~%,, ',_.
(S)He is the ~~gent, Corporate Officer, etc.)
of said owner or owners, and is d lu y 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.
before me this}, L
'~' dayof
Not~,~ Public
BONNIE I.
Not~ Public, S~
No. 01006095328,
Te~ Expires Ju~ 7, 20~
2o )3
Signature o f Appl/c~a~nt (~~