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HomeMy WebLinkAbout31178-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. 31178 Z Date JUNE 2, 2005 Permission is hereby granted to: JEAN E DEAN & ORS PO BOX 224 EAST MARION,NY 11939 for : DEMOLITION OF AN ACCESSORY SHED AS APPLIED FOR. at premises located at 8555 MAIN RD County Tax Map No. 473889 Section 031 pursuant to application dated JUNE Building Inspector to expire on DECEMBER EAST MARION Block 0003 Lot No. 013 2, 2005 and approved by the 2, 2006. Fee $ 35.00 Authorized Signature ORIGINAL Rev. 5/8/02 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INfi,~ULATION [ ] FRAMING [~']'~INAL [ ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION REMARKS: ~?~} ~ DATE ~J/,~/~ -J'-'-- INSPECTOR '~ TOWN OF SOUTHOLD BUILDINGq)EPARTMENT TOXVN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 w~v. northfork.net/Southold/ Examined ___, 20 Approved ,20__ Disapproved Kc Expiration __ . 20____ PER31IT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before appl.x4ng? Board of Health 4 sets of Building Plans Planmng Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Phone: ,,~_ _ '~ ? ' .,.--= '; Building Inspector ~ ~ ~PPLICATION FOR BUILDING PE~IIT ,,, .~; -'~' INSTRUCTIONS a. This application MUST be completely filled in by t3pexvriter or in i~ and submitted to the Bulldog ~spector with 4 sets of plans, acc~ate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to a4joining premises or public streets or areas, and watenvays. c. The work covered by this application may not be commenced be~re issuance of Building Pemit. d. Upon approval of tiffs application, the Building ~spector 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 in pan tbr any pu~ose what so ever until the Building Inspector issues a Certificate of Occup~cy. f. EveD~ building pemit 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 aft~cting the prope~y have been enacted in the interim, the Building ~spector may authorize, in writing, the extension of the pem~it for an addition slx motors. Thereafter, a new pemfit shall be required. ,~PLICATION IS HE,BY M~E to the Building Depa~ment for the issuance of a Building Pe~it pursuant to the Building Zone Ordinance of the Town of Southold. Suffolk County. New York, and other applicable Laws, Ordin~ces or Re~lations, for the construction of buildings, additions, or alterations or tBr removal or demolition as herein described. The applicam agrees to comply wkh all applicable laws, ordinances, building code, housing code, and re~lations, and to admit authorized inspectors on premises ~d in building for necess~' inspections. .20 ( Signature of applicant or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name ofowner of premises (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 ?_~ 2~h~osed work will be done: House Number Street County Tax Map No. 1000 Subdivision (Name) Section Hamlet Block C)~ ~ ': 'Lot Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost 5. If dwelling, number of dwelling units If garage, number of cars Fee Addition Alteration Other Work (Description (To be paid on filing this applicationl Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specit? nature and extent of each type o f usc. 7. Ditnensions of existing structures if atw: Front Height. Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Depth. Height. Number of Stories Roar 8. Dimensions of entire new construction: Front Height Number of Stories Rear Depth 9. Size of lot: Front Rear Depth 10. Date of Purchase Name of Former Owner 1 1. Zone or use district in which premises are situated 12. Does proposed construction violate ally zoning law, ordinance or regulation'? YES NO 13. Will lot be re-graded? YES NO Will excess fill be removed from premises? YES NO 14. Names of Owner o f premises Nal-ne of Architect Name of Contractor Address Phone No. Address Phone No Address Phone No. 15 a. Is this property within I00 feet ora tidal wetland or a freshwater wetland'? *YES * IF YES. SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this properly within 300 feet of a tidal wetland? * YES NO ~' * IF YES. D.E.C. PERMITS MAY BE REQUIRED __NO __ V' 16. Provide survey, to scale, with accurate foundation plan and distances to property, lines. 1 7. If elevation at all3' point on property is at 10 feet or below. ~nust provide topographical data on sum'ex'. STATE OF NEW YORK) SS: COUNTY OF~j ,f'?B L~- t [.-- POe-, ~ ~'~ ~-N gl,-C-©f,q being dui>' sworn, deposes and says that (s)he is the applicant (Name of individual si~g contr~above named. (S)Heisthe C X~~'~ ~c-~ ~ Z- T~ 2 ~ ~ [Contractor. Agent. Co.orate Officer. etc. ~ of said owner or owners, and is duly authorized to perfom~ or have pertbmzed the said xx ork attd to make and file this applicatkm: that all statements contained in this application are tree to the best of his knowledge and belief': and that the work will be performed in the mariner set forth in the application filed therewith. 20 b _ 52 / Si~mture of~pplical~/' MELANIE DOROSKI NOTARY PUBUC, Stat,~ ~ New ~ No. 01D0463 8 0 Qualified in Suffolk County -~.~--~,L 7 5- ~9'50 T:- , '\ g I,¥2-"'