HomeMy WebLinkAbout30163-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)
30163 Z Date MARCH 15, 2004
Permission is
hereby granted 5o:
JON C & JANIS E KERBS
440 RILEY AVE
MATTITUCK,NY 11952
for
DEMOLITION OF AN EXISTING GARAGE AND TRAILER AS APPLIED FOR
NOTE: TRAILER WAS TOWED AWAY ~OT BEMOLISHED.
at premises located at 60105 MAIN RD SOUTHOLD
County Tax Map No. 473889 Section 056 Block 0003 Lot No. 011
pursuant to application dated MARCH 15, 2004 and approved by the
Building Inspector to expire on SEPTEMBER 15, 2005.
Fee $ 35.00
"Authorized Szgna~ure
Revi 5/8/02
ORIGINAL
R. ANNABEL INC.
"ELECTRICAL CONTRACTOR"
STILLWATER AVENUE, CUTCHOGUE, NEW YORK 11935
Phone 73~6790
DATE
YOUR ORDER No.
i QUANTITY DESCRIPTION UNIT PRICE TOTAL
I
I
I
I
I
I
Examined
B~DING,~ERMfT AlCPLti~ITON CI-1EL'I~tST
Do yiXt have or need the fallowing, before appkying?
Board of Health
3 sets of Building Plafis
Planning Board approval
Smwey.
Check
Sbpdc Form__
N.¥.S.D.EiC.
Trustees
Contact:
Approved
Mail to:
Disapproved a/c
~xpiration
APPLICATLON FOR BUILDING PERMIT
Date
INSTRUCTIONS
¢3 lo
~200?
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 m schedule.
b. Plot plan showing location of lot agd 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 tike work.
~ e. No building shall be occupied or used in whole or in part Fo'~%n_y, purpose what so ever until the Building Inspector
issues a Certificate of Occupancy.
f. Every building permit shall expire kf the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within 18 months from saeh date. If no zoning amendi~aents 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. T4,,erea~er. a new pe~-~dt shall be required.
APPLICATION IS HEREBY MADE to the Building Department for the issuanc~of~ Building Permit pursuant to t~e
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 removat 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 prem/ses and in building for necessary inspections.
e of Glica~t or n~e, if a corporation)
(Mailkng address of avplicant) \ [.0~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bolder
Name of owner of premises
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 oftand on which proposed work w~ill be done:
7'-,._H0use Number Street
/
County Tax Map No. 1000 Section
Subdivision
O'ame)
on the tax roll or latest deed)
NOTIFY BU L&,qG
765-1802 8 AM TO 4 P~'¢ -OR THE
~OLLOWING INSPECqON$:
1, FOUNDATION - 3 ~EQUtRSD
FOR POURED CONCRETE
2. ROUGH f FRaMiNG & PLUM~iNG
RUC MUST
PLETE ~ ~ ~"
fOR ~.v.
ALL CONSTRUCTION SHriLL ME¢ THE
Block ¢~ ~EQUiREMENTSCF,THEIC~DESOFNEW
a~ ~vtap ~No ~N gm ~u~T~TlON PE~ORS.
State existing use ana occupancy olr premise~ and inte.'ndi~d use and occupancy of proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy__¢v,,t~.~-X~
3. Nature of work (check which applicable): New Bnii~ting
Repair Removal Demolition /~:
4. Estimated Cost _%--~-~ <.D Fee
5. If dwelling, number of dwelling units
If garage, number of cars
Addition
Other Work
~_~_~
Alteration
(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.
-< ?'t/~ Front Rear .Depth ,~o~
(.~,)Dimensionsofexistingsa*uctures, ifany: //jc/X' =- /q¢' f.,~'-/~' 9'.~¢/~ 3(,,~.,~.
Height /o ', Number of Stodes /
vimensions 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 regtdation? YES NO
13. Will lot be re-graded? YES_ NO Will excess fill be removed from premises? YES NO
14. Names of Owner of premises
Name of Architect
Name of Contractor
Address Phone No.
Address Phone No
Address Phone No.
15 a. Is this property within 100 feet ora tidal wetland or a freshwater wetland? *YES
*IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE 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.~/~, )~// /__
~ c~,._ ~ ~¢_,~ ~ ~--b~ing duly sworn, deposes and says that (s)he is the applicant
(Na~.~?idual sig2i~g co~-rajct)ab ojr~, named, ~
(Cimfi'actor, Agen, C rporat fcer, etc.) 6 ~o-;c._~%
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 sot forth in the application filed therewith.
Swoni to before me this~ _
/O (", dayof /,./6¢,t~ 200'C~
/
~ ~ignature of Applicant NJ