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HomeMy WebLinkAbout31373-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. 31373 Z Date AUGUST 17, 2005 Permission is hereby granted to: AT MATTITUCK BAYVIEW PO BOX 871 MATTITUCK,NY 11952 for : DEMOLITION OF EXISTING BUILDING AS APPLIED FOR at premises located at 100 MEADOW BEACH LA MATTITUCK County Tax Map No. 473889 Section 115 Block 0017 Lot No. 017.002 pursuant to application dated AUGUST 15, 2005 and approved by the Building Inspector to expire on FEBRUARY 17, 2007. Fee $ 119.15 Authorized Signature ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,' SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 ~nvw. northfork.net/Southold/ Examined Approved Disapproved ac PERMIT NO. Expiration ,20 ~-'--"~. This application MUST BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying'? Board of Health 4 sets of Building Plans Plalming Board approval Surve3~ Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Phone: APPLICATION FOR BUILDING PER3ilT Date INSTRUCTIONS be completely filled in by t)pewriter or in ink and submitted to the Building Inspector with 4 2005 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 a,,ailable 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. L 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 Lqspector ma3' authorize, in writing, the extension of the permit tbr an addition six months. Thereafter, a new permit shall be required. 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 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 necessary' inspections. (Signature of applicant or name, if a corporation) (Mai{ing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises ~_ A ~'tJl~0 ~-t (As on the tax roll or latest deed) If applicant is a corporation,.,~ign~tture of duly authorized officer U(I~ame and title of corpo/~te officer) -dp~4~ 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 ~qtreet Hamlet County Tax Map No. 1000 Section [, ! ~' Block [~ "/ Subdivision /-~A~O~ v'~a'<o n,-*- ~¢,..rrttn2e:r< (Name) . Lot'., Filed Map No. ~-~ 7-'/ Lot'," 2. State existing use and occupancy of premises and intended use and occupano/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 ~ 2,.~ O~ Fee 5. If dwelling, number of dwelling units If garage, number of cars Addition Alteration Other Work (Description) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front ~'1~ Rear ~ I t Depth Height [ -7 Number of Stories Dimensions of same structure with alterations or additions: Front ~/r~, Depth. Height Number of Stories 8. Dimensions of entire new construction: Front ~ fA Height Number of Stories Rear Rear Depth 9. Size of lot: Front I gb'-'. ~--t Rear ff).6j,~-I Depth 10. Date of Purchase %~I~ ,lh,~ Lq'ga NameofFormerOwnerMAwl'ue~,/4n~- A$$6c 4 11. Zone or use district in which premises ~e situated ~ k~ ~u 12. Does proposed construction violate any zoning laxv, ordinance or regulation? YES__ NO Yx l 3. Will lot be re-graded? YES__ NO X Will excess fill be removed from premises? YES NO K~ 14. NmesofOwnerofpremises~U~ Address ~,~gT( PhoneNo. ~q~-ff[gV Name of Architect Address Phone No Name of Contractor Address Phone No. 15 a. Is this property within 100 feet ufa tidal wetland or a freshwater wetland? *YES NO . _ * 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 * !F YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at' any point on property is at l 0 feet or belo~v, must provide topographical data on survey. STATE OF NEW YORK) SS: COUNTY OF _~ ~6 (~ , ~"C.J~-'~ being dui3' swum, deposes and says that (s)he is the applicant (Name of individual signing contrac't) above named, (S)He is the (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have pertbrmed the said work and to make and file this application: 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 manner set forth in the application filed therewith. Swum to before me this~ ~:~ ~"~ dayof ~ 20 ( Notary. Public BERNADI=! IE BROWN NO?ARY PUBLIC, State of No. 01BR4654087 Qualified In Suffolk Count~/ Ooffimlssion Expires June $0, ~OU~ Signature of Applicant ~Y LOT . ,,~,, ,,o,,,".'""' DRIVE tos ....