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Home My WebLink About30302-ZFORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Tewn Hall Seutheld, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PEP~MiT NO. 30302 Z Date MAY 10, 2004 Permission is hereby granted to: JOHN L SR HURTADO PO BOX 1925 SOUTHOLD,NY 11971 for ; DEMOLITION OF ~N EXISTING BUILDING AS APPLIED FOR at premises located at 19625 SOUNDVIEW AVE County Tax Map No. 473889 Section 051 pursuant to application dated MAY Building Inspector to expire on NOVEMBER Fee $ 40.78 SOUTBOLD Block 0001 Lot No. 022.002 6, 2004 and approved by the 10, 2005. ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD~ NY 1~.97t TEL: (631[) 765-1g02 ..... : -- .... ~. no~hfork.neqSouthol~ PE~[T NO. Examined ~¢v ,20 ?/ Disapproved a/c Expiration 20__ BUILD1NG PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Plaarfing Board approval Survey Check Septic Form N.Y.S.D.E.C. Trastees Conmet: y Mail to: ~ector APPLICATION POR B~'D-[NG PERMIT E~!STRUCTI[ONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Bu/lding Inspector with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot pim~ showing location of lot and of bdld/ngs on premises, relationship to adj oining premises or public streets or areas, and waterways. c. The work covered by this application may not be commmmed before issuance of Building Permit. d. Upon approval of this application, the Burlding Inspector wili issue a Building Permit to the applicant. Such a permit shall be kept on the prerdses 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 mntil the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed witkin 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interia2, the Bufiding Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new perm/t shall be required. AP?LICATION 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 ofbtfild/ngs, 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 anthor/zed inspectors on premises and in building for necessary inspections. ~ (S~nature of applicant or name, if a corporation) l(Mai]~ng/d'ddress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electhcian, plumber or builder Nmmeofownerofpremises ZFO/4~/ ~. /¢/0 C//-/Af~-'-/;:/&ff C~ (As on ~e tax roll or latest deed) If applicant is a corpor, ation, signature of duly authorized officer (Narze and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location ofland on which proposed work vdli be done: House Number Street Hmlet Comnty Tax Map No. 1000 Section Subdivision (Name5 /-' Block / Filed Ma~n No. ~L State existing use a_ed occupancy of premises and m.~_lded us~ and occupancy of proposed cens~cfien: ~. Existing use m~d occupancy ~5 ( ~7(p ~ b. t~tended use ~d occup~cy fi~ ¢q ~ p ¢r~/~ & ~ 3. Nat~Lce of weFt: (check which applicablek Repair Removal ( 4. Estimated Cost 2. 5'-0 d 5. Ifdwehmg, n,cmber o~{ehing ~its f garage, number of csh~. 6. If business, co~zmercial or mlxe~a=cy, Fee Addition Ak~at!on Other {Description) (To be paid on fi~-~g t_is apl¢a~atmn/ Number of dwelling mits on each nacre mad extent of each type of use. 7. Dimensions of existing s~Tuct-:~ces. Number of Slot Rea- Denth Dimensions of same structure w,th a ~eratm~s oF =ddh Dimensions of entire new constx:ction: Front ~eight 9. Sizeof!ot: Front 10. Date of Puzchase 1 i. Zone or use district in -which premises are sitmated Number of Stories Real Name of Fc:,?~er Owner Front 12. Does proposed consUaction violate any zomng [aw. ordinance or regAation? YES NO 13. Wi2 lot be re-graded? YES__ NO ¢' Will excess fill be r~oved from .remises? ~S__ i4. N~_es of O-~_er cfprem=sesM~D Na~e o¢ Com~scto~ ~ A~dmss ~one No ~5 a. is chis property wL~n :00 fee. o~ a tidal w~,zemd or t Eeshwa;er wetand? *~ES ~ NO * IF YES_ SOUTHOLD b .... .¢ · ,,~ 9~ __ __ . Is ~ms property wxtbm 300 feet o, a tdal we~A. YES NO * IF YES. D.E.C. PERMITS ~Y BE / / NO ~ !6. Provide smwey, to scale, with accurate foundation plan mad distances to propexy lines. 17. If elev~t~o_ at any po:m on p:opexy ~s a~ 10 feet or ¢eIow. must orovide topo~'aTohical data o2 sua'vey, STATE OF NEW YORZ{i ~[~,¢,lb¢ ~. , ?o* ~%T~)%~ bekng duly sworn, d%9oses and says that Is>he is ee applicar_t (Nmme of h~dividual signing contract ~ above named. (SIHe is the Contractor. Agent, Corporate Officer. of said owner or owners, and is duly authorized to perform or have performed the said work ~d to mmke and fi_,e dfis application; that ail statements conta/med in this application are tree to the best olios Imowledge mhd beIiefi ~m th.,t me xverK wzA oe pe~o~ed in the maimer set fo~h in the application filed therewith. Sworn to before me this day of 20 b Slgnatui:e of Applicant L S. 38,00' ME~ N HIGH 103.00' N~ 70' SJ' 20" VENUE SURVEY OF DESCRIBED PROPERTY AT SOUTNOLD TOV/W OF $OUTHOLD, SUFFOLK COUNTY~ NEW YORK EASEb{ENTS AND/OR SUBSURFACE STRUCTURES, RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE TH~ PREMISES AT THE TIME OF SURVEY. THE OFFSETS OR DIMENSIONS SHO~YN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PUR?OSE AND USE. THEREFORE. THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECT/ON OF FENCES. ADDITIONAL STRUCTURES OR ANY OTHER IMPROVEMENT. O/STRICT SECTION BLOCK LOT I000 5t I 22,2 I 1 CHURCHILL LANE. $fdl THTO~No NE~' YORK TEL, (6811 S4J-S/J£