HomeMy WebLinkAbout31636-ZFORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUII~DING PER)4IT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 31636 Z Date NOVEMBER 29, 2005
Permission is hereby granted to:
REGINA M ABERSMITH
PO BOX 62
ORIENT,NY 11957
for :
DEMOLITION OF UNHEATED COTTAGE AS APPLIED FOR
at premises located at
County Tax Map No. 473889 Section 024
pursuant to application dated NOVEMBER
Building Inspector to expire on MAY
460 OYSTER PONDS LA ORIENT
Block 0001 Lot No. 003
28, 2005 and approved by the
29, 2007.
Fee $ 107.00
Authorized Signature
ORIGINAL
Rev. 5/8/02
0 '~
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MAP OF PP. OPERT¥
JOSEPH J. L~LAWSKI
,ORIENT
NEW
o
TOWN OF SOUTHOLD
BUILDING DEPART~MENT
TOWN HALL
SOUTHOLD, N'$11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www. northfork.net/Southold/
PERMIT NO.
Examined I~ [2-~q ,20 0 ~
Approved I ~)~ , 20 ~t~~
Disapproved aJc
Expiration
Building Inspector
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.
Trustees
Contact:
Mail to:
Phone: 323 -
~_ ~ ?_~ 'j. APPLICATION FOR BUILDING PERMIT
"-J t Date
L ' 2%c~-------' INSTRUCTIONS
a. This application MUST be completely filled ~ by t~ewriter or in i~ and submitted to the Building ~spector with 4
sets of plus, acetate plot plan to scale. Fee according to schedule.
b. Plot plan show~g location of lot and of buil~ngs on premises, relations~p to adjoi~ng premises or public s~eets or
areas, and wate~ays.
c. ~e work covered by this application may not be commenced before issu~ce of Building Pe~it.
d. Upon approval of this application, the Building ~spector will issue a Building Pe~it to the applic~t. Such a pe~it
shall be kept on the premises available for inspection t~oughout the work.
e. No building shall be occupied or used in whole or in pa~ for ~y p~ose what so ever until the Building Inspector
issues a Ce~ificate of Occupancy.
~ Eve~ building pe~it shall expire if the work authorized has not commenced within 12 months a~er the date of
issuance or has not been completed within 18 months from such date. If no zoning ~cndments or other re~lations affecting the
prope~y have been enacted in the interim, the Building ~spector may authorize, in writing, the extension of ~e pe~it for an
addition six motors. Thereafter, a new pe~it shall be required.
~PLICATION IS HE,BY M~E to the Building Depa~ment for the issuaqce of a Building Pe~it pursuant to the
Building Zone Ordin~ce of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordin~ces or
Re~lations, for the const~ction of buildings, additions, or alterations or for removal or demolition as herein described. The
applicant a~ees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to a~it
autho~zed inspectors on premises and in building for necessa~ inspections.
,20 off-
(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
APPROVED AS NOTED
DATE. 't/>'?/5~ B.P.# ~I~L~
Nameofownerofpremises /,q¢- ff/ d~e'/'..~,,~/'¥/ geE: /07'/ _B¥:._~/o~ :,
(As on the tax roll or latest d~l!~ a~-,- z., AT
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. Location of land on which proposed w/ork will be done:
House Number -- Sffeet
FOLLOWING ,,~SP~_...'; .ON$:
1. FOUNDr,.TION - YWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATION
4. FINAL - CONST~!CTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
YORK STATE. NC? EESPCNSI3LE FOR
DESIGN OR CONSTRUCTION ERRORS.
Hamlet
County Tax Map No. 1000 Section
Subdivision
(Name)
Block
Filed Map No.
Lot
Lot
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ~"mf, 7/ v~ ~ ~'c~5 ~ '
/
b. Intended use and occupancy
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
Addition Alteration
Other Work
4. Estimated Cost
5. If dwelling, number of dwelling units.
If garage, number of cars
(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 Rear
Height Number of Stories
Depth
Dimensions of same structure with alterations or additions: Front
Depth Height Number of Stories
Rear
8. Dimensions of entire new construction: Front Rear
Height Number of Stories
9. Size of lot: Front ~'- ~ Rear ,~tg, ~ ~ 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
Nan~e of Architect
Nan~e 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 R.F,,OUIRED.
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 I 0 feet or below, must provide topographical data on survey.
STATE OF NEW YORK)
SS:
COUNTY OF
being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the
(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 manner set forth in the application filed therewith.
Signature of Applicant