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Home My WebLink About31570-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. 31570 Z Date NOVEMBER 1, 2005 Permission is hereby granted to: STANLEY J VOLOSIK 43100 PASEO PADCE PKWY FREMONT,CA 94539 for : DEMOLITION OF AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 860 OLD NORTH RD SOUTHOLD County Tax Map No. 473889 Section 055 Block 0001 Lot No. 007 pursuant to application dated OCTOBER 28, 2005 and approved by the Building Inspector to expire on MA'~ Fee $ 149.20 ~h~Signat ure ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.net/Southold/ Examined Approved Disapproved a/c Expiration BUILDiNG PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? PERMITNO. 2']f~:~ ~-~-' //~.// , 20 Board of Health 4 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Phone: ' APPLICATION FOR BUILDING PERMIT . ? , 2 8 2005 ,./; [-' L---. ::~ ~" 'j ~ Date /~..,. ,20aJ'~' L~ ~,:= .._..._~z9 kO_g.~__J INSTRUCTIONS a. This application MUST be completely 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 p, roperty have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for 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) / (Mailing address of appliCant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises t42.,')/M~ ~ ~ (As off/fi)6 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 ' L°ca-ti°n °f land °n w~igh 'pr°p'qsed~w-grk '~i~be d°ne: ~~ II HouseNmber Street . ,, ,., :.,? Co~tyT~MapNo. 1000 Section ~df Block ~/ ~,:~ ,,;~,.,~',e~-~*,,~0 Subdivision Fil~ 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 Addition Alteration Other Work (Description) Fee Number of dwelling units on each floor (To be paid on filing this application) 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height Number of Stodes Rear 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 9. Size of lot: Front // ' Rear Rear Depth 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 14. Names of Owner of premises Name of Architect Name of Contractor Address Phone No. Address Phone No Address 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 ? 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 surves. STATE OF NEW YORK) SS: coLr Ty OF. ) ~/~~///' being duly sworn, deposes and says that (s)he is the apptic ant (Name of indSvidual signing contract) above named, (S)He is the ~ eontractor, A gent, 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 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. Sworn to before me this ¢ yof g562-- 20v r Not ai~'l~l~l~ifllCH ERT Noilly ~, ~ ~ N~ Y~k J ~. 3~7411~ S~nature of Applicant ~'~ S,D.T,M. NO, DISTRICT: ID~O S[C~ON: ~5 BLOCK: 1 LOT(S): 7 LAND N/F OR WILLIAM HAMEN FO O.~'E $t13.07,2~,,E LAND N/F OR MATHEW CAMPBELL 67,5' 4.4. MON. AND O~ DATA ~TAINED ,C~OM OTHERS. AREA: 45.563.9 S,F OR 1.0,5 ACRES £LEVA~ON OATU,U.. ......................... UNAU~IZEO AL~A~ ~ AD~ ~0 ~IS SU~Y IS A ~A~ ~ ~CTI~ 7209 ~ ~E NEW ~ STA~ g~CA~ON LA~ COPIEE OF ~IS SURLY ~AP NOr BEAR/NC ~g LAND SUR~'S EMBO~ED SEAL ~ALL NOT BE C~DERED TO BE A VALID ~UE C~ GUARAN~ES INDICATED HERE~ SHALL RUN ~LY TO ~g ~RS~ F~ ~ ~g SURLY IS ~EPAREO AND ~ HIS BEHALF TO ~g ~g C~PAN~ GO~RNMENTAL A~NCY AND LENDING INS~TU~ON LIS~D HERE~. AND TO ~g AS~EES ~ ~g LENDING INS~. ~ARAN~ES ARE NOT ~AN~ER~LE. ~g ~F~ ~ OIMEN~S ~0~ HERE~ FR~ ~E PR~ERTY LINES TO ~g S~UC~RES ARE F~ A ~EOFIC PUR~ AND USE THEREFORE ~EY ARE SURVEY OF: DESCRIBED PROPERTY MAP OF': FILED: SITUATED AT: SOUTHOLD ~owN OF: SOUTHOLD SUFFOLK COUNTY, NEW YORK FiLE ,~ 25--107 SCALE: 1"--40' OATE: AUG. 50. 2005 CERTIFIED TO: THEODORE C. MARTZ JR. FIDELITY NATIONAL TITLE iNSURANCE CO. OF N.Y.; ABSOLUTE ABSTRACT INC.; SUFFOLK COUNTY NATIONAL BANK; KENNETH M. WOYCHUK L.S, Land Surveyln~ and Design P.0, Box 3, Mattttuck, New York, 11952