HomeMy WebLinkAbout30167-ZFORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PERMIT
(T~IS PERMIT MUST BE KEPT ON THE PREMISES LINTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
30167 Z Date NLARCH 17, 2004
Permission is
hereby granted Eo:
EDWARD III MOCKLER
4220 SOUND AVE
MATTITUCK, NY 11952
for :
DEMOLITION OF AN ACCESSORY GARJAGE AS APPLIED
FOR
at premises located at 4220 SOUND AVE MATTITUCK
County Tax Map No. 473889 Section 121 Block 0003 Lot No. 005.003
pursuant to application dated MARCH 16, 2004 and approved by the
Building Inspector to expire on SEPTEMBER 17, 2005.
Fee $ 85.0(
Autho~i~e~_cnature
ORIGINAL
Rev. 5/8/02
NY 11971
TEL: (631) 765-1802
F~s~X: (631)~765-9502
www. nor~hf~£k.net/Southold~
Examined ~ [~ q
. , t ,20
Approved ~l~q ,20 Xt~
Disapproved a/c
~Expirafion
PERMIT NO.
BUILDFNG PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?.
~oard of Health
3 sets of Building Plans
Plamfing Board approval
Survey_
Check
Septic Form
N.Y.S.D.E:C~
Trustees
Contact:
Mail to:
Phone:
Build/ns Ins~
Date .20
INSTRUCTIONS
a. This application MUST be completely filled in by wpewriter or in ~ and submitted to the Building Inspector with 3
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showh~g 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 w/Il issue a Building Permit to the applicant. Such a perrm~
;hall be kept on the prem/ses available for inspection throughout the work.
e. No building shall be occupied or used ~ whole or i~ part ~or any purpose what so ever until the Building Inspector
ssues a Ce~ificate of Occupancy.
f. Every building perrmt stroll expire if the work authorized has not 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 inter/m, the Building Inspector may authorize, in writing, the extension of the permit for an
addition six months..Thereafter, a new permit shalLbe required.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursumat to the
Bhilding Zone Ordinance of the T0wn of Southold, Su~olk 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, ordi!~, rices, building code, houshi$ code, and regulatipns, and to admit
autholEzed inspectors on premises and kl binldihg for ne6essary inspegtions./~.f,/~ ~
-- (Signature o f app~cant or name, if a corporation)
(Mailing address of applicant) - I '
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Tmde's License No.
Location of land on which proposed work will be _done:
-._qoa
House Number
Street
1. FOUNDATION - zWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3, INSULATION
4, FINAL - CON?r~UCTION MUST
BE COMPLETE :OR ; .O i
ALL CONSTRUCTION SHfiL,~ MEET THE
REQUIREMENTS OF THE CODESOFNEW
YORK STATE. NOT RESPONSIBEE FOR
Han,~,tSiGN OH OON~sl~OOTlObl ERRORS.
County Tax Map No. 1000 Section JCfi - Block ,'~
Subdivision Filed Map No.
(Name)
2. s~at¢~exl~Eng use and oceupancy~bfprermses and intended use and occupancy o_~roposed construction. a. Existing use and occupancy ~ g,~ 6 ~
b. Intended use and occupancy
3. Nature ofwork (check which applicable): New Building Addition Alteration
Repair Removal Demolition ~ Other Work
Estimated Cost Fee
If dwelling, number of dwelling units
If garage, number of cars 2 C~_%
(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: From ~ t ' Rear 3-0 ' Depth_
Height Number of Stories
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: From Rear Depth
10. Date of Purchase ~/~0f,~t L }5~ iZ009'~ Name of Former Owner ~__~Ebl~
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning !~a~w, ordinance or regulation? YES NO
13. Will lot be re-graded? YES__ NO__Wttl excess 15:1 be removed from premises? YES
14. Names of Owner of premises
Name of Architect
Name of Contractor
Address
Address
Address
NO
PhoneNo. ~ g-qqq I
Phone No
Phone No.
15 a. Is this property within 100 feet of a 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
I6. Provide survey, to scale, with accura? 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)
COUNTY OF, LY,4~-TO/5'~)
~ffO~' d ~0-~ ]~--f be~gd~yswom, d~oses~dsaysthat(s)heis~eapplic~t
~me of ~di~dual si~g,con~act)igbove nme&
(S)Heis the : ~X3 ~ ~/
[Con~acfo~, Agent, Co.orate Office. etc.)
of said owner or owners, and is duty af~orized to perform or have performed the said work and to make and file this apphcation:
that all statements contained in'this hpplicatinn are tree to the best of his knowledge and belief; and that the work will be
performed in the manner se[ forth ii~ the application filed therewith.
Claim k. Gtew
NOtary Public, State of New York
No, 01GL4879505
Qualified iR Suffolk Coun~
Commission Expires Dee.
~cant
/