HomeMy WebLinkAbout31361-ZFORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUIL4DING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 31361 Z Date AUGUST 15, 2005
Permission is hereby granted to:
K NORM3LN
73 PRIMROSE AVENUE
FLOP=AL PARK,NY 11001
for :
DEMOLITION OF AN EXISTING GAPJ~GE AS APPLIED FOR
at premises located at 2265
County Tax Map No. 473889 Section 067
pursuant to application dated AUGUST
Building Inspector to expire on FEBRUARY
MILL RD SOUTH/PEC
Block 0007 Lot No. 005.001
8, 2005 and approved by the
15, 2007.
Fee $ 35.00
Authorized Signature
ORIGINAL
Rev. 5/8/02
TOWN OF SOUTHOLD
BUILDING~EPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
~w. no rthfork.net/Southold/
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
4 sets of Building Plans
Surve3P lanni,ng Board ~appr°val
Check ~/
Septic Form
N.Y.S.D.E.C.
PERMIT NO. .~/:~ a f ~.
Trustees
Examined ~/[ (,20 &2,~ Contact:
//
Approved ~D[d~,~0 o ~'~ Mail to:
Disapproved wc 7~ ~f~Po~
Phone: 5l~
IIool
Expiration
Building Inspector
~,L"<i~"-'~--~'-~-a--~.-~. ~A'lT,. PL ICAT ION FOR BUILDING PERMIT
i ..... ~ INSTRUCTIONS ......
a. t ms appm~~letely filled in by typewriter 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, the 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. Every building permit 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 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. Ihereafter, 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 Iown of Southold, Suffolk County, 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 regulations, and to admit
authorized inspectors on premises and in building for necessaD, inspections.
(Signanfire of applicant or name, ifa corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner 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.
Location of land on which proposed work will be done:
House Number Street
Hamlet
County Tax Map No. 1000 Section ~,-~ Block 7
Subdivision Filed Map No.
Lot
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 use and occupancy
Nature of work (check which applicable): New Building___
Repair Removal Demolition v'/
Estimated Cost Fee
If d~velling, number of dwelling units
If garage, number of cars
Addition Alteration
Other Work
.,"~ 5-, 6,: (Description }
(To be paid on filing this application}
Number of dwelling units on each floor- _.~/~
6. If business, commercial or mixed occupancy, spe~°nature m~d extent of each type of use. _ .~..[
7. Dimensions of existing structures, if any: Front Rear
Height Number of Stories tJ/a,
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
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? YES__ NO
13. Will lot be re-graded? YES __
NO ~Will excess fill be removed from premises'? YES
NO J
14. Names of Owner of premises
Name of,,~rchitect
Nmne o f
ma,~tddress
Address
Address
4,,e~_Phone No.
Phone No
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.
NO J
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
STATE OF NEW YORK)
SS:
COUNTY O~d~/ ~
f~/~, _~/{/.( ~/'~/< /~//~),'-~beingduly
(Narffe of individual signing contract) above n~{'ned,
(S)He is the ~//.~ (SC~/q~/~
sworn, deposes and says that (s)he is the applicant
(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 truc to the best of his knowledge and belief; and that the work will be
performed in the manner set forth in the application flied therewith.
S~to before me this('x
'~ ' NotaO ~ubli~ ~
20 0.'~
MELANIE DOROSKI
NOTARY PUBLIC, State of New York
No. 01D04634870
Qualified in Suffolk County.~,
Commis~n Expires September 30dA 1 }~