HomeMy WebLinkAbout31615-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. 31615 Z Date NOVEMBER 18, 2005
Permission is hereby granted to:
THOMAS C JEROME
305 MAPLE AVE
SOUTHOLD,NY 11971
for :
DEMOLITION OF BUILDINGS AS APPLIED FOR
at premises located at 47070
County Tax Map No. 473889 Section 069
pursuant to application dated NOVEMBER
MAIN RD SOUTH/PEC
Block 0006 Lot No. 004
17, 2005 and approved by the
Building Inspector to expire on MAY 18, 2007.
Fee $ 342.15 ,,
ORIGINAL
Rev. 5/8/02
Long Island Power Authority
117 Doctors Path
Rtvefl~eac] NY 11901
November 7, 2005
Mr. Kenneth Seiferth, Jr.
140 Whitehall Blvd.
Garden City, NY 11530
RE:
LIPA Eel. #T100564964
47070 Main Road, Southold
Dear Mr. Seiferth:
This letter is to advise you that the electric and gas services have previously been removed
according to our records.
If you have any questions, please contact Dianne Danek at (631) 548-7234.
Very truly yours,
Ste~en Aylward
Design Engineer/Y
Electric Design & Construction
SNam
08/25/9v
TOWN OF SOUTHOLD
BUILDING DF, PAP TMENT
TOWN HALL~. ~
SOUTHOLD, 5/Y 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www. northfork.net/Southold/
Examined
Approved
Disapproved a/c
Expiration_
PERMIT NO. i~/ ~/~-~'-
15ut O~g l~spector
APPLICATION FOR BUILDING PERMIT
Date
INSTRUCTIONS
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
4 sets of Building Plans
Plmming Board approval
7 Survey
Check
Septic Form
N.Y.S,D.E,~-
Trustees
Contact:
Mail to: ·
,20 0.5-
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 l~urP0se 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. 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.
APPROVED AS NOTED
DAT 'E~ /// /~/ i/~, # '~ I/ ~ / -<')'''--~
NOTfFY BUILDING DEPARTMENT AT
(Signature of applicant of name, if a corporation)
(Mailing address of applicant) ~"~fi/5/5o
S .... 765-1807- 8AM~-O~4-~g FOR THE
tare wnetn~SLatl~,~h~lq~.ssee, agent, architect, engineer, general contractor, electrician, plumber or builder
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2, ROUGH - FRAMING & P~:1~' 'r
Name ofov~d~ses ,A'?~,'~ ~ /,,5/ ~' ~c //'~'/e / 2/ 'a re.
4. FINAL - C
(As on the tax roll or latest deed)
If apphcant ~ !~0ratlon,_.,~ slgnatui'e of duly authorized officer
(Name :a~d: title o ~ ¢ o rl:guTglce~ [fl131_~) FO h.
· ,:',:~ Cd CC, i,,;3ihUC,iO'q ERRORS,
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. I000 Section_
Subdivision
(Name)
Hamlet
Block ~ 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__
Nature of work (check which applicable): New Building
Repair Removal
Estimated Cost
If dwelling, number of dwelling units
if garage, number of cars
Addition Alteration
Demolition / Other Work
(Description)
Fee
(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
Height Number of Stories
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
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
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 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
* IF 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 10 feet or below, must provide topographical data on survey.
STATE OF NEW YORK)
SS:
COUNTY OF
,,q/~,'°~.'KTTJ ~, 5'K'/,'r~,el'g ,./~,,- being duly sworn, deposes and says that (s){~is the applicant
(Name of individual signing contract) above named,
(S)~sthe 0~£/*-
(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 tree to the best of his knowledge and belief; and that the work will be
performed in the mmmer set forth in the application filed therewith.
Sworn to before me this
da/of No qd ///h~g.
Notary Public
5EiFERTH
' State of New York
, -8910110
Queens Cour~y
',~ Sept.
Signature bf Apl~Iicant