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Home My WebLink About30624-ZFOP34 NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 30624 Z Date SEPTEMBER 9, 2004 Permission is hereby granEed to: SAUNDRA J PERRY PO BOX 627 NEW SUFFOLK,NY 11956 for : DEMOLITION OF AN EXISTING ACCESSORY STRUCTURE AS APPLIED FOR at premises located at County Tax Map No. 473889 Section 117 pursuant to application dated SEPTEMBER Building Inspector to exnpire on MARCH 5850 NEW SUFFOLK RD NEW SUFFOLK Block 0002 Lot No. 018.001 8, 2004 and approved by the 9, 2006. Fee $ 35.00 Authorized '~ignature ORIGINAL Rev. 5/8/02 TOXXSN' OF SOUT~OLD BUILDING DEPARTMENT TOWN l:L~LL SOUTHOLD, NY 11971 TEL: (651) 765-1802 FAX: (631) 765-9502 w~nv. north£ork.net/Southold/ Examined Approved ~/~ ,20 Disapproved a,c" Expiration ' / .20~~ PER3IIT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need ~e following, l~fore applying? Board of Health 4 sets of Bdilding Plans pJannlng Board approval Survey_ Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to:__ pO. Jr. c"~c6-~r~q~ Phone: Building Inspector APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of bu/Idings on premises, relationship to adjoining premises or publ/c streets or areas, and waterways. c. The work covmed by this application may not be commenced before issuance of Building Permit. d_ Upon approval of this applicarien, the Building Inspector will issue a Building Permit to the applicator. Such a permit shall be kept on the premises available for inspection throughout the work. e. No building stroll be occupied or used in whole or in part for any purpose what so ever until the Bdilding Inspector issuo's a Certificate of Occupancy. ; f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issue.ace or has not been completed within 18 months fi-om such date. If no zoning amendments or other regulations affecting the prop?erry have been enacted/n thc 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. )d~PLICATION 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, end regulations, and to admit authorized inspectors on premises and in building for necessary inspections, amr/,--~ (Sign name, ifa corporation) (Mu in g address o f applicant) State whether applicant is owner, lessee, agent, arch/tect, engineer, general contractor, electrician, plumber or builder APPROVED AS NOTED Name of owner of premises -~'&~'~ ~ T)~ i?~a2'4 (As on the tax roll or~~ If applicant is a corporation, signature of duly authorized officer 765d80~ 8 AU TO 4 Pk', FOR THE (Name and title of corporate officer) Builders License No. Plumbers License No. Electricim~s License No. Other Trade's License No. Location of lund on which proposed work will be done: House Number Street County Tax Map No. 1000 Section Subdivision (Name) Block Filed Map No. FOLLOW/lNG iNSPECTIONS: 1. FOUNDATION,- ~NO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR ¢.0. ALL CoNSTRUCTiON SHALL MEET THE REQUIREMENTS OF THE CODES OF NL=W YORK. STATE. NOT RESPONSISLE FOR .~u OR CONSTRUCTION ERRORS. Lot ' loc.` t 2. State existing use and occupancy of premises and intended use and occupancy o f proposed construction: a. Existing use and occupancy b. Intended use and occupancy_ 3. Nature of work (check which applicable): New Building ~ Addition Alteration Repair Removal Demolition L,,,/ Other Work Estimated Cost Fee If dwelling, number of dwelling un/ts If garage, number of cars (Description) (To be paid on filing this application) Number of dwelling un/ts on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use_ 7. Dimensions of existing structures, if any: Front t.~ :~(~ ~'Rear _Depth Height. Number of Stories Dimensions of same structure with alterations or additions: Front Depth Height Number of Stories Rear 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 zon/ng 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 O~vner 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 freshxvater xvetland? *YES NO * IF Y'ES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED_ b. Is this property witlffn 300 fee/~)fa tidal wetland? * YES __ NO__ * 1~ YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide stow'e% to scale, ~vith accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or beloxv, must provide topo~aphical data on smwey. STATE OF NE%' YORK) : ~'.~ SS: ~ , COL~V~ oF'~ - · ~,x.~".j2~_ .~..(%~ : ' being duly sworn, deposes and says that ts)he is the applicant (Name of individi~al si?ing'contract) above named, tS)He is the ~.. :' .' 't. ~s(XT'~'T~XL ; r;. :. ,...;(Contractor, Agent, Corporate Officer, etc_) of sa/d owner or owners, and is dUly,~fithoriz~l:t~.'pcrform or have performed the said work and to make mad file this application; that all statcmants~>ntahz~d'fi~ t~s~aplS]icati~n.~?~ true to the be~t of his kmow]edge and belief; mad that the work will be performed i~ the nmnner:set f~rth in the-a~l~liealJon fried therewitlx ~.' ~'~.V 2J:¥~:~ .~].,.:7;':Li~~ ';?'O~ Nota~3, Public -- ~ S ign~a~['~ f A~-~-lic ant Public, Smt~ of ,~o. 0tc050t7852 Ouaiitied in S~ffolk ~un~/ DV~!~LLIN5 i~I,-,E~LLIN6 New Suffolk Road u~ rV ~ ~ '0 C~G LU ,££'6£ .... ~-~:~ ........ ~:: ........... ,I -'~"' . / " 190.53' , N0S~,~0~ tv ~_ 0 ~- z ~ uJ r, N°