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Home My WebLink About29975-Z FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PE IT MUST BE KEPT ON THE PREMISES UNTIL FULL C MPLETION OF THE WORK AUTHORIZED) 1 PERMIT NO. 29975 Z Date DECEMBER 24, 2003 { Permission is hereby gr nted to: SCHEMB HOMES IN (ZOLDESSY) 5350 RGEN AVE MATT UCK,NY 1V952 for CONSTRUCTION OF A NEW SINLE FAMI DWELLING JITH ATTACHEP TWO CAR GARAGE, AND COVERED JROt� PORCH IS APPLIED F R at premises located Vat 5450 AVE TITUC County Tax Map No. 473889 Section 113 Block 0007 of No. 0 4 . 002 pursuant to application dated DECEMBER 17, 20.03 and appy ed by the Building Inspector to expire on JUNE 24, 2005 . Fee $ 1, 406 . 70 Authorized Signature ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the followmi ,before applying? TOWN HALL Board of Health_ SOUTHOLD, NY 11971 3 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey www. northfork.net/Southold/ PERMIT NO. --;I X9 75-,-,-' Chec64-- 955K Septic Form N.Y.S.D.E.C. Trustees Examined J`] 12003 Contact: Approved ,20 03 Mail to: Disapproved a/c Phone: Expiration Building Inspector I � DEG410ID APPLICATION FOR BUILDING PERMIT i BLDG. DEPT. TOWN OF SOUTHOLD Date , 20 INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 sets Cf 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 aims, 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 part for any purpose what so ever until 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 within 18 months from such date. If no zoning amendments 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. 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 / ) Name of owner of premises (As on the tax roll or laatest deed) If applicant ' a co oration, signature ofd ly authori ed officer (Name and title of co orate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on whicAproposed work will be done: ,l 1"I �Tf1G House Number Street Hamlet County Tax Map No. 1000 Section / f J Block 0-7 Lot L4 o a' Subdivision Filed Map No. Lot (Name) 1 2. State existing use and occupancy of premi d intend d use d oc upancy of proposed construction: a. Existing use and occupancy / �) Q b. Intended use and occupancy Njox,2 3. Nature of work(check which applicable): New Building X Addition Alteration Repair Removal Demolition Other Work (Description) 4. Estimated Cost -9 ) 0 0 0 GO Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Fronts Depth -- Height —' Number of Stories 8. Dimensions of entire new construction: Front 6 o Rear o Depth 32, 8 Height a..19 t Number of Stories 9. Size of lot: Front /o D Rear /G 6) Depth J,a 1 , 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 13. Will lot be re-graded? YESK NO Will excess fill be removed from premises? YES NO Som7� 14. Names of Owner of pr ises Address Whone NaQo. fName of Architect Address Pone No Name of Contractor ddress Phone No. 15 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. PERMITS MAY BE REQUIRED. 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) S: COUNTY OF d_,�Egj being duly sworn, deposes and says that (s)he is the applicant (Name of individ 1 signing contract)above named, (S)He is the a��aC47--w (Contractor, Agent, Corporate Officer, etc.) 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 set forth in the application filed therewith. Sworn to before me t day of 20�� Notaryy#lic ignature of Applicant DONNA FIRENZE NOTARY PUBLIC STATE OF NY No.4785585,COUNTY OFSUFFO K COMMISSION EXPIRES MARCH oZ � DEC 1 820 SURVEY OF PROPERTY -� SITUATED AT MATTITUCK L T9VJ;� r S`'UTHGL'J V "t - TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK • v►� ��1` �.. .-: -,T -,` ('Z S.C. TAX No. 1000-113-07-4.2 ID A 1`� • . SCALE 1•=40' Rr+ .- ; :,- • - OCTOBER 3, 2003 lam` V� DECEMBER 17, 2003 ADDED PROPOSED HOUSE Pik, 350.00 AREA = 20,000.00 sq. ft. 5�1 A+ Q gas 0.4'9 ac. N CERTIFILD TO: � FdnwAL2 SCHEMBRI HOMES ASSOCIATES, Inc. v1 COMMONWEALTH LAND TITLE INSURANCE COMPANY 0 t^. 1Kr morim 1. ELEVATIONS AHI[ INFUE NEO TO AN ASSURED DATUM ?• •: O_ p E71i1NIS 10"ATMNM AN BROWN OR*-JU L IMM SEFRC TANK CAPAOrM FOR A / TO 4 BEDROOM HOUSE Hs 1,000 vAL1OIR RC1 1 TANK: r wm V-3' Rem 0'-T' ow ~Y---• x x 3. MROMN LENCHINO SYSM FOR A I TO 4 BEDROOM HOUSE 13 300 M /Y SIDEIIALL AREA. �Y 7 FO01: 12* DEEP, 0' M. ny 60.0 p _ .—�C� �e'�1'\s� F110FOSFD 00711M1011 FOOL'Jb 7\'iC -Z�E-.� E x� � F/Kr00LD L4JICIONO FOOL ........=_ ®Fnoro�aFsnc TANK 4. M LOGROM OF MH0.1S A10 Hx3SF00LS SilOMlll MERMON ARE FROM itELD u N_ _— - _ , • ._ { t+ ORSERVATIONS AND/OR DATA ONTARO® FROM OTHERS. C-1 7 -:ter-• " - NN � TEST HOLE DATA 4 O tom"r-� i+ _ (TEST HOLE DUG 81' ON SEPTEMBER 25. 2003) tn%4 TnDARK BROWN LOAM OL to Vl to to 0.3 E. saws S<r SAND 9Lr p • i 5 F A$ MUM 0= MWI Sm LAW .v1 TO) 0.5E E NOW MNE TO 00ANSE SAND 9N O CJaw' -15 .,A!10 (�3 V A� t N.Y.S. LSC. No. 49M UNWRIOI�D ALTFJMTgN OR ADDfnON D FOR ro nO SIAMEY 5 A NaN10M OF LOT@) pvLpA0 R��ER �720 OF 721E NEW rax srAlE JO � A. �Q� oN Pl xt E cam a THIS LrIP NOT WIN" si `� ' L"°"�"m°'�``� Lid Surveyor mi OR 5UH E 1. lyDSl► ,SS m°1 WE AA vWo THREaw WE oaaoeHm ��"�r�+••� OERrv`K 7KlNS almim mmm Mall RUN lr�" mse CA� 7, 1•S ONLr10 IWE�,PERM FOR THE W 70 THESURVEY 011 MAS WnE O ANT,rGOVIONGENIAL 7M1 Ae ono Ift &rvap - Su6dvW*m - Sib Pkmw - Cww&ucUon LMW 1 nr THE J10010010101 OF INE LJOINA MOR- AiE NDr iR 0, NONE (631)727-2M Fox (631)727-1727 THE OOSTEHCE OF NOW OF MAYS OFFX S LOWED AT MUM AODIMSS AIO�OR EA�ITS OFJM. F ANr NOf sHO�MN ARE NO1 OIMRANI[ED. 322 ROANOKE AVEMW P.O. Box 1031 RMDWJID. Mm Yak 11901 HlwrtkeW. 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