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Home My WebLink About30301-Z FORM 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) PERMIT NO. 30301 Z Date MAY 7, 2004 Permission is hereby granted to: ANDREW & NANCY LOCASTRO 107 ERNEST STREET NORTH MASSAPEQUA,NY 11758 for CONSTRUCTION OF A NEW SINGLE FAMILY DWELLING WITH ATTACHED GARAGE, COVERED FRONT ENTRY, REAR SCREENED.`PORCH & DECK AS APPLIED FOR at premises located at 250 LAUREL WAY LAUREL County Tax Map No. 473889 Section 125 Block 0004 Lot No. 024 . 020 pursuant to application dated MAY 6, 2004 and approved by the Building Inspector to e�pi.re on NOVEMBER 7, 2005 . Fee $ 2 , 383 . 20 Authorized Signature r ORIGINAL Rev.' 5/8/02 r ELD INSPECTION REPORT DATE COMMENTS FOUNDdATION(1ST) r� ----------------------------------- FOUNDATION(2ND) ROUGH FRAMING& PLUMBING _ H rQ INSULATION PER N.Y. STATE ENERGY CODE H FINAL ADDITIONAL COMMENTS n -o z m X b � O z C� r7 Gd TOWN OF SOUTHOLD "BUILbING PERMIT APPLICATION CH&KLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL `IR 18 20 Board of Health SOUTHOLD,NY 11971 ' 4 sets of Building Plans TEL: (631) 765-1802 ( Planning Board approval FAX: (631) 765-9502 =' Survey www.northfork.net/Southold/ PERMIT NO. 3D 9 0f� Check Septic Form N.Y.S.D.E.C. Trustees Examined_ '20 0 Contact: Approved 1,20 ,20 691/ Mail to: Disapproved a/c Phone: Expiration lI _�_,200 Building Inspector APPLICATION FOR BUILDING PERMIT II / W Date m q r c k ", , 20_,2_qINSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 . sets of 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 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 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 m 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 4 name,if a corporation) 2 a 6 L i rt e. o f r- S k r-eek" (Mails—g dress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder l S c^ C- r G r ' 1 6 L+ Name of owner of premises n �r'(J_t,J L o C, a�� r"o (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. '10 150— �� -f-rit n Plumbers License No. -( p, 62 Electricians License No. ( 2 Other Trade's License No. -r' 6 T,7 1. Location of land on which proposed work will be done: L c4 J rte ' House Number Street Hamlet County Tax Map No. 1000 Section 1 2 S Block Ll �„ 12flAt � 6g Z + TO�iR# ,a; ,Ei 4trtn91 Subdivision Filed Map No. �tn�^ tiict,8;vri1?rtA (Name) 4S A Out Z5114X3 -PIS[ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy_ ti Q 1 �0 1 �, b. Intended use and occupancy k 3. Nature of work(check which applicable): New Building ✓ Addition Alteration Repair Removal Demolition Other Work 4. Estimated Cost 0, d Q 0 Fee (Description) (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 t A:. `Re Dept - 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 - O ' _Rear_ 10 '- 6 " Depth Height Z I Number of Stories Z 9. Size of lot: Front 46 y . 5C) Rear Z G -3 , 93 Depth $0. 00 10. Date of Purchase /U Name of Former Owner �V 11. Zone or use district in which premises are situated 12. Does proposed constructionviolateany zoning law, ordinance or regulation? YES NO ✓ 13. Will lot be re-graded? YES v NO Will excess fill be removed from premises? YES /NO k"' � � a'•7 E r�e�,t,'c.�: 516 14. Names of Owner of premises Ah L+r�.U L (uS�roAddress N• ss g_Phone No. 4 Z O $ 6 y D Name of Architect Ch ar I Q S NI .-r horn n , Address Z06 hn c��, 5fi Fj Qg dphone No Z'7 Name of Contractor_ 'r'.�i-_Q. Address 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 MAYBE QUIRED. 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) SS: COUNTY OF ) S being\auly sworn, deposes and says that she i (Name of mdivid signing contract)above named, ( ) s the applicant ant (S)He is the_A C4,0 (Contractor Agent, orporate Officer, etc.) of said owner or owners, and is duly authorize 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�efore me thi f day of 2004 I 1 N t Public Signature of Appli t BONNIE J.DOROW Notary Public,Stato Of NewVA No.CID06095328,Suft Cquaft Term Expires J*Is 20