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Home My WebLink About31129-ZFORM 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. 31129 Z Date MAY 12, 2005 Permission is hereby granted to: MARIE D JABLONSKI PO BOX 524 CUTCHOGUE,NY 11935 for : DEMOLITION OF AN ACCESSORY SHED AS APPLIED FOR at premises located at 1125 PEQUASH AVE CUTCHOGUE County Tax Map No. 473889 Section 103 Block 0007 Lot No. 020 pursuant to application dated MAY 12, 2005 and approved by the Building Inspector to expire on NOVEMBER 12, 2006. Fees 35.00 ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOV~'N HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 ,~nvw. nor thfor k.net/Southold/ Examined Approved Disapproxed ac ,20 Expiration ,20___ PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying'? Board of Health 4 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Buildin~ Inspect o r~'~"'"'-~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS / Date 5]12--- ,20L)~'~' a. This application MUST be completely filled in by t~,pewriter 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. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, tile 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. ExeD' building pemfit shall expire if the work authorized has not comntenced 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 ora Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk Count},,', 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 regulafi_.O, lm,2lL.d to admit authorized inspectors on premises and in building for necessaD' inspect~~/~ ? $\ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ~ame of owner ofpremises (~O/'~ ,.'~E~"~T'~' \~ C (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. 1. Location of land on which proposed work will be done: House Number Street Hamlet ~-~ jCounty Tax Map No. 1000 Section /'~)..~ Block 7 ~ Filed M_.gp No. (Name) Lot Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: //~a. Existing use and occupancy '5 ~3 [~ )~.') b. Intended use and occupancy /'3/-~ ¥" I C~ 1- i 'I \ & ',. ~ 3. Nature of work (check which applicable): New Building_ Repair Removal Demolition Addition Alteratiou Other Work ( Description } 4. Estimated Cost Fee 5. If dwelling, number of dwelling units If gara§e, number of cars ITc be paid on filing tiffs application} Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specie' nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height. Number of Stories Real' 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 Del)th 9. Size of lot: Front Rear Depth 10. Date of Purchase Name of Former Owner I 1. Zone or use district in which premises are situated l 2. Does proposed construction violate any zoning law, ordinance or regulation? YES NO 13. Will tot be re-graded? YES NO Will excess fill be removed from premises? YES NO 14. Names of Owner of premises Name of Architecl Name of Contractdr ~ Address Phone No. Address Phone No Address Phone No. 15 a. Is this property within 100 feet cfa tidal wetland or a freshwater wetland? *",'ES * IF YES, SOUTHOLD TO%2q TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet cfa tidal wetland? * YES NO * [F YES, D.E.C. PERMITS MAY BE REQUIRED. NO 16. Provide su~'ey, to scale, with accurate fbundation plan and distances to proper~y lines. 17. If elevation at all}.' point on property is at 10 feet or below, must provide topographical data on suP, e ,/ STATE OF NEW YORK) SS: / COUNTY OF 50 fF,, Ik ) ,/ ~ e o ,,-,5 ~ 50 c, 1~ ~J e ~ e} { -- being dui5' swom. deposes and says that (s)he is the applicant (Name offindividual signing contract) above named, (S)He is the O',-,o .',~ ¢,-- (Contractor. Agent, Corporate Officer, etc.') of said owner or owners, and is duly authorized to pertbnn or haxe 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 know[edge and belief': and tbat the work will be performed in the maimer set fbrth in the application filed therexdth. Sworu to before me this I?__+~' day o_f (h'x ,~7 200~- ~blic ~-- NOTARY PUBLIC, State of New YorR No. 01JU6059400 Qualified In Suffolk County Go mmi,~ion ~pim~ MaF 29, 20 ~ ~ ~4,' SiCnature oi~ ,'~pphcant SURVEY OF: PROF:'ERT"r' 51TUATt~.- C,,U'Td. HO~UE TOI",IN. .SOLtT'HOI_P 5URVE'r'ED OD-DI-2005 ~UFFO/~ C. OUNT¥ TAX ~ I000 - 109 - -/ - 20 N NOTE~: MONUMENT FOUND AREA = I;~,qq6 5.F. or O.D2 AC, RE ®t~.APHIC. SC. ALE I"= 90' JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S. LIC. NO. 50202 pdArERH~AD, N.Y. 11901 369-8288 Fax 369-8287 REF.\LFIp server\d~PROS\05-t53.pro '