HomeMy WebLinkAbout31559-ZFORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPA~RTMENT
Town Hall
Southold, N.Y.
BUII/)ING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 31559 Z
Date OCTOBER 26, 2005
Permission is hereby granted to:
FORK CHURCH NORTH
PO BOX 872
M3~TTITUCK,NY 11952
for :
DEMOLITION OF D=N EXISTING MOBILE HOME AS APPLIED FOR
at premises located at 3525 CR 48
County Tax Map No. 473889 Section 141 Block 0002
pursuant to application dated OCTOBER 26, 2005 and approved by the
Building Inspector to expire on APRIL ~,
Fee S 119.90 i~ /~e.d Sig~nature
MATTITUCK
Lot No. 021.004
ORIGINAL
Rev. 5/8/02
P.O BOX 635
MATTITUCK, NEW YORK 11952
Phone 63t-298-9602
Fax 63t-298-t970
Email: RobertPaladino~optonline.net
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD,tNY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www. northfork.net/Southold/
Examined 20__
Approved 20__
Disapproved a/c
Expiration ,20
PERMIT NO.
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
4 sets of Building Plans
Planning Board approval
~' Survey
~e~Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Mail to:
I.(~ I Building Inspector
2005 . ~,APPLICATION FOR BUILDING PERMIT
r Date . /~ ,20 ~
~2~ ~STRUCTIONS
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 paxt for any purpose what so ever until the Building Inspector
issues a Certificate of Occupancy.
f. Every building permJt 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 zordng 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. 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.
~namre o~ applicant or nam¢~ ff a ¢orpom~on)
/~. - · a (Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises
If apl?licant 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
County Tax Map No. 1000 Section
Subdivision
(Name)
(As on the tax roll or latest.tll~P~lO¥£D ~$ NOTEO
NOTIFY BUIL~~'; =; :'~,~]MENT AT
765-1802 8AM ;O ,, ,:q FOR THE
FOLLOWING INSPEGTIONS:
1, FOUNDATION - TWO REQUIRED
FOR POURED CCNC~ETE
2.ROUGH - FRAt~JNG & PLUMBING
3.INSULATION
4.FINAL- CO~ ?~UCTION MUST
A~T,~U ~ION SHALL MEET THE
_/~/. ~ - ~/, ~EQUlREMENTS OF THE CODES OF N~W
~, - YORK $~~ESPONSIBLE FOR
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~/?/a,,',¢,X' ~','~,M~ /'~d,~)~ ~ ............
b. Intended useandoccupancy r'~,~d,~t/~>-,, ' ~',¢,¢'r5 /e~,~.-4c ,~7z:' ,"~,~,,,)'e-
Nature of work (check which applicable)LNew Building
Repair Removal ~ Demolition J
Estimated Cost ~ .~-~ Fee
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. __
t
7. Dimensions of existing structures, if any: Front ZS~,~. ,,7 Rear Depth
Height Number of Stories /
Dimensions of same structure with alterations or additions: Front
Depth Height Number of Stodes
Rear
8. Dimensions of entire new construction: Front
Height Number of Stories
Rear Depth
9. Sizeoflot: Front
10. Date of Purchase
Rear Depth
Name of Former Owner /r~('r/" /-~/~ r'/~a''7
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-graded7 YES V/ NO Will excess fill be removed from premises? YES
14. Names of Owner of premises/~,-/~ ~ r~,d'o,~' Address Phone No.
Name of Architect Address Phone No
Name of Contractor Address Phone No.
15 a. Is this property within 100 feet ora 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 v/
__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 survey.
STATE OF NEW YORK)
COUNTY 0~:
(S)~He(e i~n~' c°-~n~ nam~~m'~7°s~s~s ti~s)he.~s;~f~'~t
(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 tx
Nota~ Public
Signatt~e o~A~plic~It
Il