HomeMy WebLinkAbout31089-ZFORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PEPd~IT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 31089 Z Date APRIL 27, 2005
Permission is hereby granted to:
CHRISTINE LEIMONE
505 SOUND BEACH DRIVE
MATTITUCK,NY 11952
for :
DEMOLITION OF ~N ACCESSORY SHED AS APPLIED FOR
at premises located at 505 SOUND BEACH DR MATTITUCK
Cou~nty Tax Map No. 473889 Section 099 Block 0001 Lot No. 022
pursuant to application dated APRIL 25, 2005 and approved by the
Building Inspector to expire on OCTOBER 27r 2006.
Fees 35.00 ~~/~ ,
k~,,~ut h6ri zed S~-~ ~ ~ ~
ORIGINAL
Rev. 5/8/02
TOWN OF SOUTHOLD
BUILDING DEP.~RTMENT
TOWN HALL
SOUTHOLD. NY 11971
TEL: (631) 765-1802
FAX: (631) 765~9502
~s~'. northfork.net/Southold/
Examined f/~. 1t'! ,20fi
Approved
It
Disapproved a_ c
eE 1rr
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before appl5 lng?
Board of Health
4 sets of Building Plans
Planning Board approx al
Survey
Check
Septic Form
N Y.S.D.E.C.
Trustees
Contact:
Mail to:
?'"~ ~ f'~...'. -'~\i~' APPLICATION FOR BUILDING PEI~IIT
. '2" ~ ~ .
~ a~~T be completely filled in by t.ewnter or in i~ and submitted to the Building hspector with 4
sets of ~curate plot plan to scale. Fee according to schedule.
b. Plot pl~ showing location of lot and of buildings on premises, relmionsNp to adjoining premises or public streets or
are~, and watenvays.
c. ~e work covered by this applicmion may not be eo~enced be~bre issuance of Building Pe~it.
d. Upon approval ofths application, the Building Nspector will issue a Building Pemit to the applicant. Such a pe~it
shall be kept on the premises available for inspection t~oughout the work.
e. No building shall be occupied or used in whole or N p~ for any pu~ose what so ever until the Building Nspector
issues a Certificate of Occup~cy.
f. Eveo' building pemit shall expire if tM work authorized has not commenced within 12 momhs a~er the date of
issuance or Ms not been completed withN 18 momhs ~om such date, If no zoning amendments or other regulations affectNg the
prope~y have been enacted in the Nte~, the Building Nspector may authohze, in writing, tM extension of the pe~it tbr an
addition six months. Thereafter, a new pe~it shall be requked.
.~PLICATION IS HE.BY M~E to tM Building Depanmem t~r the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold. Suffolk County, New York, and otMr applicable Laws. Ordinances or
Re~lations, tBr the construction of buildings, additions, or alterations or for removal or demolition as herein described. The
applicant agrees to comply with all applicable laws, ordin~ces, building code, housing code. and regulations, and to admit
authorized inspectors on premises and in building for necess~' inspection~
[- ~ (Signamre~l~cant or~a~o~
,Mail~g address of applicant, ~.l~ ~
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
(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.
Plumbers License No.
Electricians License No.
Other Trade's License No.
Location of land on which proposed wgrk will be done:
House Number Street
Hamlet
._County Tax Map No. 1000 Section
Subdivision
(Name)
Block [
Filed Map No.
Lot
Lot
2.'/~tate existing use and occupano: of premises and intended use and occupa~y ot~roposed construction:
/ a. Existing use and occupa~cy '",_?9~&a_r~! ~'4--t_~,-n dg'~
b. Intended use and occupancy
' ,~. Nature of work fcheck which applicable): New Building Addition
,/Repair Removal Demolition_ ~-.~7'--Otber Work
4. Estimated Cost Fee
5. If dwelling, number ofdwelliug units
If garage, number of cars
Alteration
(Description)
(To be paid on filing this application)
Number of dwelling units on each floor
6. If business, commercial or mixed occupancy, specif? nature and extent of each t5 pe of use. _. _
7. Ditnensions of existing structures, if any: Front
Height Number of Stories
Rear Depth
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
o. Size of lot: Front Rear Depth___ __
0. Date of Purchase
Name of Former Owner
1 I. 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
/iamesofOwnerofpremiseslL),c~ ~cqtnc~, ~O~ Address 'q~ STo l~,t 'l ~Phot~ ~.
amc of Architect _ Address Phone No
amc of Contractor Address Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES
* 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 tbundation plan and distances to property lines.
ssTT. [f elevation at an.,,' point on property.' is at I 0 feet or below, must provide topographical data on sur,'ey.
ATE OF NEW YORK)
SS:
COUNTY OF~V'~4 k.¢
.~lt-'_['v~ k~ ~, '~.~n,~% _ being dtfly sworn, deposes and says that Is)he is the applicant
(~,/~m-e of ~ndividual ~-i_oning contract) above named.
IS)He is the
(Contractor, Agent. Corporate Officer, etc. )
of said owner nr owners, and is dui3' authorized to pertbnn or have pertbm~ed the said work and to make and file this application:
that ail statements contained in this application are tree to the best of his knowledge and belief: and that the work will be
performed in the manner set tbrth in the application filed therewith.
Sworn to betbre me t~s
Notary Public
'- Sign~tu're ~ fXpp~chnt,..,/
8