HomeMy WebLinkAbout30161-ZFORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PERMIT
THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL PULL
COMPLETION OF THE WORK AUTHORIZED
~EI~M~ ~O. 30161 Z Date MARCH 22, 2004
Permission
zs hereby granted ~o:
DOROTHY K AUSTIN
PO BOX 423
ORIENT,NY 11957
for :
2ND STORY DEMO (SHEETROCK,
FLOORING & INSULATION REMOVAL ONLY)
iADDITIONAL & AS BUILT WORK REQUIRES NYS COMPLIANT PLANS FROM ARCHITECT/ENGINEER
at premises located at 830 GREENWAY EAST ORIENT
County Tax Map No. 473889 Section 015 Block 0002 Lot No. 012
pursuant to application dated MARCH 16, 2004 and approved by the
iBuilding Inspector to expire on SEPTEMBER 22, 2005.
Fees 148.10
Rev. 5/8/02
ORIGINAL
A Single Source Provider~ of
Fire & Water Damage Restoration & Reconstruction
A Division of CMS
TOWN.OF SOUTHOLD
PUROFtRST OF LONG
ISLAND, INC.
-3/15/2004
call.
AUSTIN RESIDENCE~,~
830 GREENWAY EAST.~
VERITY:
The following
emergency services are to be performed
residence as a result of a fire loss.
a) removal of sheetrock
b) removal of insulation
c) removal of flooring
If any questions need to be answered,p~ease do not
Frank Colaiacomo /
Three Elms Lane · Wading River. NY 11792'
(6311 929-3333 . Fax (631) 929-1592
Independently Owned and Operated
at
hesitate
TOWN OF SOUTHOLD~
B¥ILDING DEPART~MENT
T ~.~WN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
ww~v. northfork.net/Southold/
PERMIT NO.
Approved ~/~L/ , 20 ~
Disapproved aJc t ~~
Expiration , 20 ,~
Building Inspector
BUILDING PERMIT APPLICATION CHECKL~
Do yon have or need the following, before al~r
Board of Health
3 sets of Btfilding Plans
Plarming Board approval
Survey
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Mail to:
Phone:
~g?
/.
- ,,~ ~ Date 3 /~/,J'- 20 O
it t.~ ~.,.~ ~ ~.~_~.~ INSTRUCTIONS
t . ~,,,.. ' ~' . ........
a. ~ap~catioa M~ST be compl~ely filled m by t~ewnter or m ~ ~d sub~tted to the BuH~g ~pector w~th 3
sets of plus. acc~am pko; pl~ to sc~e. Fee accor&g to sched~e.
b. Plot pl~ s~w~g location of lot ~d of b~dings on pre~s~, relations~p to adjoi~ pr~ses or public stre~s or
~eas, ~d wate~ays.
c. The work'c~ere~tDVt~s application my not be co~enced before issu~ce ofB~l~ng Pemt.
d. Upon ap~o~ of~s appHcafi~, the B~lding ~spector will issu~ a Buil&g Pemt to the applic~t. Such a pe~t
sMll be kept on the pr~s~;a~abte for ~pecfion tkou~o~ the work.
e. No b~l~ng's~e ~ccupi~ or used ~ whole or in p~ for ~y p~ose wha so ev~ ~fil ~e B~lding hspector
~ssues a Cea~ficate o20Ccu~cy.
f. Eve~ h. I,Imu ' ' ' ' ,'x',~re if~e work au~ofiz~ has not co~enced witch 12 months a~er ~e ~te of
i ss~ce or has n,,~ ~,,',., ,:,,~ l'k' ,', I ,.'d' ir 18; monks ~om ~ch date. ~,no zo~g men&ems or o~er relations affea~g the
property have be~ enact~ ~ ~e ~te~ ~e BOlding ~spector my au~o~ze, in ~t~g, ~e e~ension of the p~t for ~
addition s~ mont~. ~; a daw p~ ~ be req~ed.
~PLICATION. I8 ~Y~E to the B~l~ng Dep~mem for ~e issu~ce ora B~l~ng Pe~t p~suant to the
Buil&g Zone Ordi~ee o~,~e To~ of Sou~old, S~fo~ Co~ty, New York ~d o~er apphcable Laws, Or&~s .or
Re~atio~u, for the conm~ ofb~ldin~,;ad~tions, or ~teratio~ ~ for removal or dmolifion as h~ein de~fibed. The
applic~t a~ees to comfy ~h aH apphcable laWS, ordi~ces, buil&g code, housing cMe, and re~lations, ~d to a~t
authorized inspectors on pre~ses ~d in b~&g for necess~ inspection.
~T
( S~-~aur e of epplicanFor ham'e~'if a corporation)
(Mailing address of~pplicant) ' l ! Z~.
State whether ~ architect, engineer, general contractor, electrician, plumber or builder
2) BO~JGH
;4. ~]:lh¢\['; CONS[~?~ uu~ h '(As on the tax roll or latest deed)
...... BE COMPLET.~ FOR G:O. ...... : :zed officer
DESIGN OR CONSTRUCTION ERRORS.
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
Location of tand on which proposed work will be done:
House Number ~ Street
County Tax Map No. 100O Section
Subdivision
(Name)
Hamlet
Filed Map No.
%~exisfing use and occupancy of premises and intended use and occupancy of proposed co~sh-uction:
X%!} Existing use and occupancy
b. Intended use and occwpancy_
3. Nature ofwork.(check which applicable): New Building Addition Alteration
Repair ~../ Removal Demolition ~J Other Work
4. Estimated Cost
5.
l~welling, 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. Ifbusiness, commercial or m/xed 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 Stori6~:::--
8. Dimensions of entire new construction: Front
Height Number of Stories
Rear Depth
9. Size of lot: Front
10. Date of Purchase
Rear ,~., Depth
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
13. Will lot be re-graded? YES NO ,/Will excess fill be removed from premises? YES NO
14. Names of Owner of premises ~)~fon~,,,/ aj~,sT't~t AddresS ~'X6 ~c~¢,o W~7 Ca~Phone No. 6.~'!-
Name of Architect Address Phone No
Name of Contractor ~,~c~Ifct~-i- o~c~:$1a,vdAddress ~ ~/.~%q L,~_ PhoneNo. ~$~ _qZ_q
! 5 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 BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES NO
* IF YES, D,E.C. PERlvlITS MAY BE REQUIRED.
16. Provide survey. ~o scale, with accurate foundation plan and distaii6'~-t6 p/~6p'erty
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
~ F} JL /'h/~l/~ ~/'2~~ /~f3 T'("} D being duly sworn, depose..s and says that (s)he ~sthe applicant
~Name of m&vzduaI szgmng contract) above named,
~S)He is the .
~ Contractor. Agent, Corporate Officer. etc~l
of said owner or owners, and is duly author/zed to perform or have performed the said work a~d to make and file this application:
that all statements contained/n this application are tree to the best of his knowledge and belief: and that the work will be
performed in the mariner set forth/n the application filed therewith·
Sworn to before me this j b ~ ,
'"~o~r~ l~u b/h'/c
_ No. 01BE6097127
St~gzature of Apphcant