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Home My WebLink About31616-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. 31616 Z Date NOVEMBER 18, 2005 Permission is hereby granted to: FIRST BAPTIST CHURCH OF CUTCHO~0'~ PO BOX 534 CUTCHOGUE,NY 11935 for : DEMOLITION OF EXISTING STORAGE SHED & WALKWAY AS APPLIED FOR. at premises located at 21405 CR 48 County Tax Map No. 473889 Section 096 pursuant to application dated NOVEMBER Building Inspector to expire on MAY Fee $ 35.00 CUTCHOGUE Block 0001 Lot No. 013.001 17, 2005 and approved by the 18, 2007 . 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 ~//I? ,200_5__ Approved Il ] I ~ _, 200~ Disapproved a/c__ Expiration__ 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 Check Septic Form N.Y.S.D.E.C. Irustees Contact: Mail to:__ Phone:~3~- c]o(o ~ ,- Building Inspector APPLICATION FOR BUILDING PERMIT Date 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. F' 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 issuartce 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 pemfit shall be required. APPLICATION 1S HEREBY MADE to the Building Department tbr 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 ~uPtP~ioCriazn~;ignr:;;;tOo~ oTlpYre~tihse~sllana~I~lniCbaubill~Ina~rO~deicneas~;~, ibn~edictnigo~sC ~e~housing code, a¢iegulations, anI to admit (Signature of a~ corporation) (Mailing address of applicant) Z) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremises ~-/~-~ ~r~Ji- O..~i~4 (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. 2-1 House Number 'Street County Tax Map No. 1000 Section qLl) Block Subdivision _ Filed Map No. (Name) Hamlet 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 Demolition Estimated Cost Fee If dwelling, number of dwelling units If garage, number of cars Addition Alteration Other Work Demi) (Description) (To be paid on filing this application) Number of dwelling units on each floor If business, commercial or mixed occupancy, specify nature and extent of each type of use. Dimensions of existing structures, if any: Front Height Number of Stories Rear Dimensions of same structure with alterations or additions: Front Depth Height Number of Stories Rear Depth 8. Dimensions of entire new construction: Front Height Number of Stories 9. Size of lot: Front Rear Depth Name of Former Owner 10. Date of Purchase 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__ 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. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. NO Depth Rear NO 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. STATE OF NEW YOP,~) COUNTY OF %)C~ ~): 4~ ~qCL ~ ,_~(~1.£ ~[ ~ being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the (Contrac~,~rporate Officer, etc.) of said owner or owners, and is duly authorized to perfbrm 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 mariner set forth in the application filed therewith. Sworn to before me this --~ / ~, -~4~x. day of Jk~ 0 '~ .,20~_~ ~ Claire L. Clew Notary Public, State of NeW ¥or~ NO. 01GL4879505 Qualified in Suffolk Coutff~. j-~/~/'_ Commission Expires Dec. 8, ~"-~' ~'~ gnature of Applicant ~_~)