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HomeMy WebLinkAbout31652-ZFORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 31652 Z FULL Date DECEMBER 6, 2005 Permission is hereby granted to: CAROLE A & KEITH LOSCALZO LEONIA,NJ 07605 for : DEMOLITION OF AN EXISTING DWELLING AS APPLIED FOR at premises located at County Tax Map No. 473889 Section 126 pursuant to application dated DECEMBER Building Inspector to expire on JUNE 6495 GREAT PECONIC BAY BLVD LAUREL Block 0010 Lot No. 021 2, 2005 and approved by the 6, 2007. Fee $ 147.05 ~ ...... Autb~ri z~Si. gnat ure ORIGINAL Rev. 5/8/02 JP~1-25-2~ ~: 16 F)ARENT EDUCAT I OH F~ROE~ P.02 TOTAL P.02 TOWN OF SOUTHOLD BU1LDING DEPARTMENT TOWN HALL I~ ~ SOUTHOLD, Nag 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 Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Phone: Building Inspector iAPPL1CATION 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. 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. fi 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 auth°rized inspect°rs °n premises and in building f°r necessary inspecti°n~,d [ t/~L.,,._.- (Signature of applicant or name, ifa corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Sameofownerofpremises (/~¢~.q {-' ~"~,'.¢-[v% C_~o\Xi'~-~]it0V[[~PtSN0'I'ED [ (As on the tax roll or lates{ d ~f. B.P. tt .~.~-~---~- If agl¢~ican}~is a corp, qration, sigIlatu[e of duly auth,orized officer DATE:_ I ]~ (Name and title of corporate officer) NOTIFY B IL¢!;"~i~' ~ ' ~N~ ~ Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on w~,.'c~h proposed work will be do House Number Street County Tax Map No. 1000 Section Subdivision (Name) 765-1802 FOLLOWING 1. FOUNDAdC ' - FOR POUEE''~ t 2. ROUGH - FR, !~ 3 P ~' ;~G 3. INSULATION 4. FIN,~L ' C~"? BE C;OM, Pt R~E~t 3 (.'~ ~E :d.'~ ES OF NEW YORK o ~ A'r~;~ ,.,;~ Filed Map No. 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 ~ hO i'~xZy--~' ~ Fee 5. 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. 7. Dimensions of existing structures, if any: Front ~ {) Rear ~2~ © Height Number of Stories [ '[ 0 Dimensions of same structure with alterations or additions: Front Depth Height Number of Stories Depth 3 Rear 8. Dimensions of entire new construction: Front Rear Height Number of Stories 9. Size of lot: Front ~ CkO Rear &,c,~ Depth Depth 10. Date of Purchase [ O / ,,3 ~'- 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 7>( 14. Names of Owner of premises Name of Architect ~ Name of Contractor ~-~ Address Address Address Phone pqa/kLPhone 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 __ ) .]77,. [~ ~ ~) ~/\ trl~4 being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)Heis the (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to pertbrm 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,, -- r~ dayof ~~ 20~ ¢I.)P-,',/E"¢' O!= PP-,.OPEP-,.T"r' 51TUATE.. LAUI:~L TOINN: 50t)THOLD 5,1JFPOLK COUNTY, NY $UP-.VE"PED' Oq~2q-2005 SUFFOLK COUNTY TAX # 1000-12,S-10~21 ,~,0( ~",. /% %,, N TEST HOLE NcDONALD ESROWN SANDY LOAN OL PALE DROWN SAN[D'r' SILT NIL PALE DROWN FIEN SAND SP ITl NO WATER ENCOUNTERED NOTES: · NONUMENT FOUND AREA = 50,000 S.F. TIE DISTANCE FROhl SUFFOLK COUNT1' TAX NAP GRAPHIC. SCALE 1"= 40' JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.¥.S. LIC, NO. 50202 RIVERHEAD, N.Y. 11901 369-8288 Fax 369-8287 REF.Z:\pros\05\05-311.pro