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Home My WebLink About30924-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. 30924 Z Date JANUARY 28 , 2005 Permission is hereby granted to : FORK BEACH NORTH 52325 CR 48 SOUTHOLD,NY 11971 for DEMOLITION AND FULL REMOVAL OF AN EXISTING SWIMMING POOL AS APPLIED FOR at premises located at 52325 CR 48 SOUTHOLD County Tax Map No. 473889 Section 135 Block 0002 Lot No. 024 pursuant to application dated NOVEMBER 5, 2005 and approved by the Building Inspector to expire on JULY 28 , 2006 . Fee $ 80 . 00 JL�'��utho n e ORIGINAL Rev. 5/8/02 �a r o. �'.\ of v °'♦°" �: W � 0 hn.ieuycw rvnra. �rw. tq .. IJo'r�v. Cow�2s..•[7 - —�T t- a+�vr - 5 fes ;' 10 Y �2Q; n VC9 o C-) wo v►ti�-P T5 C� �' �Jo } �h � � k � �a c h C ' , c) m k YV �,�. vis � o O � o h a--b � mcg Tou ,O L . v) k vn � , I� Pmo � Islas � c co v--2- r cj �cY-) TOWN OF SOUTH,LD ''' BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 O ` f Survey www.northfork.net/Southold/ PERMIT NO. 't Check Septic Form ` N.Y.S.D.E.C. Trustees Examined 1 '20 Contact: Approved 1/7 20 5 Mail to- Disapproved a/c \ a Phone: Expiration ,20-Z— tng In r APPLICATION FOR BUILDING PLS MIT Date j O , 20 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 buildings on premises,relationship to adjoining premises or public streets or areas, and'waterways. q.•T't;�-,work covered by this application may not be commenced before issuance of Building Permit. on approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept:orithe 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?gr&s to comply with all applicable laws, ordinances,building code,housing code, and regulations, and to admit authorizedhnspectors on premises and in building for necessary inspections. (Signatule of appl' ant or name,if a corporation) 13 o6tf�) Cd (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder XName of owner of premises ,-a (As on the tax roll or latest deed) If applicant is a corporatin, signature of duly authorized officer (Name andel t�f corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. Location of land on which proposed work will be done: -PCS eL,� CyyV House Number Street Hamlet T2.39 log,-" �(Subd ountyTax Map No. 1000 Section Block fty =v sIkz.;n:110,netolhot ivision ,.A)r r �� a, Filed Mi.t�puV s Lot (Name) ��QS,�d tzu teti►�x3 nai�ttimrtK,� 2` 'hate existing use and occupancy of premises and intended use and occupancy of proposed construction: xa. Existing use and occupancy Y\ iy1n, Vne b. Intended use and occupancy Y'V\ I 3. Nature of work(check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work (Description) 4. Estimated Cost 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 aiterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 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 zoning law, ordinance or regulation? YES NO 13. Will lot be re-graded? YES NO Will excess fill be removed from premises? YES NO 1 Names of Owner of premises Address Phone No. Name of Architect Address Phone No Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES Oil,, NO ;;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. 6. Provide survey, to scale,with accurate foundation plan and distances to property lines. 7. 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 OTSWR�l 1(-) aGC Y) being duly sworn, deposes and says that(s)he is the applicant (Name of indiv dual signing contract)above named, (S)He is the (4' (0� (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 before me this day of (Nft/YI 20t)4 r JL:� 91m&4 i-C2�'I)'" Not Public Sign9fure of Applicant No N*4 co in i `2W