HomeMy WebLinkAbout31170-ZFORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
(THIS
BUILDING PERMIT
PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 31170 Z
Date MAY 27, 2005
Permission is hereby granted to:
FP~ANK B ZIMMER AS TRUSTEE
PO BOX 355
ORIENT,NY 11957
for
DEMOLITION OF ~2q EXISTING BARN AS APPLIED FOR
at premises located at 29525 MAIN RD ORIENT
County Tax Map No. 473889 Section 013 Block 0002 Lot No. 007.014
pursuant to application dated MAY 20, 2005 and approved by the
Building Inspector to expire on NOVEMBER 27, 2006.
Fee $ 140.00
Authorized Signature
ORIGINAL
Rev. 5/8/02
TOWN OF SOUTHOLD-
BUILDING DEPARTSIE~f
TO~VN HALL
SOUTHOLD, NY 11971U~
TEL: (631) 765-1802
F~: (631) 765-9502
~vw. northfork.neffSouthol~
Examined
Approved
Disapproved a,.c
,20 a~
BUILDING PERMIT APPLICATION CHECKLIST
Do you have m need the following, before applying?
Board of Health
3 sets of Building Plans
Planmng Board approval
Check
Septic Form
N.Y.S.D.E.C.
Contact:
Mail to:
Phone:
Expiration I I{,~ 7 ' 20 ~
Building Inspector
APPLICATION FOR BUILDING PER3IIT
Date
,20
INSTRUCTIONS
a. Tins application MUST be completely filled in by typewriter or in ink and subnfitted 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 prenfises, 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 Pem~it to the applicant. Such a permit
shall be kept on the premises available for inspectiou throughout the work.
e. No building shall be occupied or uaed in whole or in pan for an5 purpose what so ever until the Building Inspector
issues a Certificate of Occupancy.
t~ Evers' building permit shall expire if the x~ ork authorized has not cmmnenced within 12 months after the date of
issuaxrce or has not been completed within 18 months from such date. if no zoning amendments or other regulations affecting the
property have been enacted hi the interim, the Building Inspector may authorize, in writing, the extension of the permit for an
add!'~on six monthq. Thereafter, a new permit shall be required.
.M;'PLICATION 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 County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions, or alterationa or lbr remox al 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 neceaaaO' inspections.
(Signature of applicant or name, if a corporation)
(Mailing add'ss of applicant)
State whether applicant is owner, lessee, ageut, architect, engineer, general contractor, electrician, plumber or builder
Nameofownerofpremises Fr~.¢ta/u... ~, 2.,rn~,'~iq-..~
(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 work will be done:
House N~ber S~eet
Hamlet
Lot
Lot
CourtW Tax Map No. 1000
SubdMsion
(Name)
Section
Block O ~..
Filed Map No.
2. State existing use and occupancy of premises and intended nse and occupancy of proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy~Ct/k
3. Nature of work (check which applicablel: New Building
Repair Removal Demolition
4. Estimated Cost
5.
If dxvelling, number of dwelling units
If garage, number of cars
~Xddition
Other Work
Fee ~ tqO,c'''
Alteration
Description}
i I. Zone or use district in which premises are situated
O. Size of lot: Front
10. Date of Purchase
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
Rear
Rear .Depth
12. Does proposed construction violate any zoning law. ordinance or regulation? ",'ES NO
13. Will lot be re-graded? YES NO
Will excess fill be removed fi'on, premises? 'YES . NO .__
14. Names of Owner of premises
Name of ,Architect
Name of Contractor
&ddress Phone No.
&ddress Phone No
.Address Phone No.
15 a. [s this property within 100 feet of a tidal wetland or a freshwater ,^ etland'? *YES
* 1F YES, SOUTHOLD TO\X?N TRUSTEES & D.E.C. PERMITS MAY BE REOUIRED
b. Is this property within 300 feet of a tidal wetland? * TES NC)
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
16. Provide sum'ey, to scale, with accurate foundation plan and distances to property lines.
1 ?. If elevation at any point on property is at I 0 tbet nr below, must prox ide topogaphical data on sun'ey.
STATE OF NEW YORK)
~,~at.~ ~. ~, Zl ~ ~ K ( ~ 3~ being duly sworn, deposes and says that I s~he is the applicant
(Name of individual si~ing contract) abox e named.
{Contractor, .kgcnt. Ct,~orate Officer. etc. ~
of said owner or owners, and is duly atttborized !o perform or have performed the said work and to make and file t,his application;
that all statements contained in tl6s application are true to the best of his knoxx ledge and belie£: and that the work will be
performed in the manner set fortt~ in the application filed therewith.
Swom~t9 before me thist
Z4~~'''- darer /k/k~T,,;.,4 20~
Notary Public
Claire L. Glow
Notary Public, Stats of New Yolk
No. 01GL4879505
Qualified in Suffolk Court.fy
Commission Expires De=. 8,'~
NO
Signature of Applicant
Dimensions of same structure with alterations or additions: Front
Depth Height Number of Stories
6. If business, commercial or mixed occupancy, specify nature and extent ,fie:ich t_x~>e of use.
7. Dimensions of existing structures, if any: Front_ ~_ Rear l-~- Depth
Height Number of Stories
ITo be paid on filing this application}
Number of dwelling units on each floor