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HomeMy WebLinkAbout29711-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. 29711 Z Date SEPTEMBER 8 , 2003 Permission is hereby granted to : SHORES INC BREEZY PO BOX 38 GREENPORT,NY 11944 for . REPAIRS TO COTTAGE #1 . THIS PERMIT REPLACES PERMIT #27123 AND ALL REQUIREMENTS OF ORIGINAL PERMIT REMAIN. ADDITIONAL CERTS MAY BE REQUIRED at premises located at 65490 MAIN RD GREENPORT County Tax Map No. 473889 Section 053 Block 0005 Lot No . 012 . 005 pursuant to application dated SEPTEMBER 5 , 2003 and approved by the Building Inspector to expire on MARCqu Fee $ 150 . 00 Signature ORIGINAL ev. 5/8/02 V FIfiLD INSPECTION REPORT DATE COMMENTS I r r FOUNDATION ( 1ST) ------------------ -- TrII---'----u �V I'� � �{�Il ' � ------------------ ----.. II IL_ II II FOUNDATION (2ND) IppIII ROUGH FRAME b PLUNKING Im_--- R n fn \ INSULATION PER N. Y. STATE ENERGY li n ---- ------- CODE - -n— I Iu1 ' fl IJ N- ------II---- --- - -- --------------- FINAL. I x �-------SNI — --- -------- ADDITIONAL COMMENTS: — ---- — --------------- ------- ---------- Cil 9 ----- BOARD OF HEALT11 . . . . . . . . . j FORM NO. 1 �3 SETS OF . PL.\,1S . . . . . ... . . . . • • . . a TOWN OFSOUTHOLD /SURVEY . . . . . �j .!a BUILDING DEPARTMENT /C11ECK . . . . . . • . . . . . . . . • , 7�1T _s � � I - I TOWN HALL SEPTIC FORtl _ . . . . . . . . . . . . . i SOUTHOLD, N.Y. 11971 BLDG.DEFT. TEL.: 765-1802 R OT I FY TOWN OF S UTHOLD CALL . . . . . . . . Examined . . . .. . . . . . . . . .. 19HAIL TO / Approved . . . . . . . . . . . .. 19/b Permit No. �9�„ .r �. • . . . . . . / d W Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . INV . e�04 . . . . (B ' di nr) APPLICATION FOR BUILDING PERMIT Date . . . . . . . . . . , INSTRUCTIONS 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 giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. 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 issued a Building Permit to the applicant. Such 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 whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. 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 Rggulations,, for the construction of buildings, additions or alterations, or for rem val or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, bu' in cod , housing ode and regulations, and to admit authorized inspectors on premises and in building for necessary i pect nkialicant, k?. . . . . . . . . . . . -' (Signa ur c�oor We, if a corporation) . . . . . . . . . .(Mailinaddress of applicant) g PP State whether applicant is owner, lessee, 'agent, architect, engineer, general contractor, electrician, plumber or builder. DCc)JUCt . . . . . . . . . . . . . . . . . . . . . . j. . . . . . . . . . . . . . . . . . . . . ... . . . . . . . , . . . . . . . . . . . . . . . Name of owner of premises . . I'uC . . . . . . . . . . . . . . . . . . . . � t • (as on the tax roll or latest deed) If applicant is a corporation,signature of duly authorized officer. -!e tom:(.. (Name aed title of corporate officer) Builder's License No. Plumber's License No. Electrician's License No. . . . . . . . . . . . . . . . . . . . . . . Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OWT . . . ... . . . . . . . . . . . . . . 1 ► . : . . . . . . . . .7-. ... . : . . . . . . . . . . . .. House NunYber Street Han-Aet ! County Tax Map No. 1000 Section . . . : . . .S-1?�. Block . .�. .�. . : . . . Lot . /.�: . . . . Subdivision . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... Filed Map No. . . . . . . . . . . . . . . Lot . . . . . . . . . . . . . (Name) , 2.. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ��b. Intended useand occupancy . . . . . . . . . . . . . . . . . . . . .'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3. Nature of wor . . . . . . . .(c ck which applicable): New Building . . . . . . . . . . Addition . . . . . . . . . . Alteration . .�. . . . Repair . . . . Removal . . . . . . . Demolition . . . . . . . . . . . . Other Work . . . . . . . . . . . . . . . (.Description) 4.4. 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 0 &4)f,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 alterations or additions: Front . . . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . , . . . . . . . . . . . : Number of Stories . . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . .Height . . . .. . . . . . . . . . . . Number ofStories . . ... ... . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . 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: . . . . . . . ... . . . . . . ... . . . . . . . . . . . . . . . 13. Will lot be regraded . . . . . . . : . . . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes No . 14. Name of Owner of premises . . . . . . . . . . . . . . . . ... Address . . . . . . .. . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . • Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . Name of Contractor . . . . . . . .Address . . . . . . . . . . . . . . . . . . .Phone No. . . . . . . . . . . . . . . . 15. ' Is this property within 300 feet of a tidal wetland? . *Yes. . . . . .. No. . . . . . . . . *If yes,- Southold Town Trustees Permit maybe required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and.indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW Y RK, AOL COUNTY OF . . S.S . , , . , , , , , �.�. . . . . . . being duly sworn,deposes and says that he is the applicant (Name of individual signing contract) above named. Heis the . ... . . . . . . . . . . . . . . . . . . . . . . . :. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 to before me this . . . . . . . . . . . . . .day of. . . . . . . . L:L.. . . . ., 19 Notary Public4" o . .. ounty HELENE D.HORNE , Notary Public,State of New York " " " " " " ' " " " " " " " ' No.4951354 (Signature of applicant) Qualified in Suffolk County Commission Expires May 22, 19��