HomeMy WebLinkAbout31698-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. 31698 Z Date DECEMBER 28, 2005
Perm=ission is hereby granted to:
MANAGEMENT CO NJ
ST JAMES,NY 11780
for :
DEMOLITION OF A 924 SQUARE FOOT BUILDING AS APPLIED FOR
at premises located at 4735 WESTPHALIA RD MATTITUCK
County Tax Map No. 473889 Section 113 Block 0013 Lot No. 001.002
pursuant to application dated DECEMBER 27, 2005 and approved by the
Building Inspector to expire on JUNE 28, 2007.
Fee $ 98.55
zed S
ORIGINAL
Rev. 5/8/02
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TORN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502 /p
www. northfork.net/Southold/ PERMIT NO. Vj
is f
Examined Z , 20
Approved Z- 2 , 20
Disapproved a/c
Expiration_ , 20__�
I
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 — —
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Mail to:
/- Phone: _
t ing s cto
APPLICATION FOR BUILDING PERMIT -- --
Date —,200
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.
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 ijL�1�
(Signature of appl ant or nam6, if a corporation)
DATE: c� ���
FEE FsY—�— 3� !� Ftj Ace RcI. �tSGme . lv' �g0
NOT FY BUILDING ', 'ARTMENT AT (Mailing address of applicant)
765.1802 8 AM TO 4 P,1, FOR TNF
State whethe'Ffflidima i8!> ih?It&eew nt, architect, engineer, general contractor, electrician, plumber or builder
1. FOUNDATION -
RFOUIR
tfOR POURED CGS:CRFfE
omit
Name of
2.
4. HNAL
isa.C6ru -
Oloratioia 2RAw4b
DESIGN OR
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which propos(
(,035 We54-phc,1 ICc-
House Number Street
e -Me l- t 1_>—C
(As on the tax roll or latest deed)
1164torized officer
NEW
work will be done:
jck lla5a
County Tax Map No. 1009 Section 11-3 Block 1 3 " 1 6-1: L
Subdivision N/ Filed Map No. Lot _fes) /A
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy A R Y k c_ � l ✓
b. Intended use and occupancy ./��'r'', C E " c
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Demolition --/- Other Work
4. Estimated Cost � l i So vc
5. If dwelling, number of dwelling units U
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 1-614 Rear , Depth
Height '2D` A�,-o-f Number of Stories
Iv(A
Dimensions of same structure with alterations or additions: Front N (+) Rear tJ }N
Depth N �/- Height N/�4 Number of Stories N ( A
8. Dimensions of entire new construction: Front N � A- Rear Depth
Height Number of Stories
9. Size of lot: Front i a 1 Rear �' Depth
10. Date of Purchase F&—b (o . I Q 8 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 4 Will excess fill be removed from premises? YES_ NO
14. Names of Owner ofpremi eAddresses -,�� ` < `nau Phone No.
Name of Architect t -J A Address Phone No _
Name of Contractor Norrruv% V e ,1 Address s% A Phone No. b3 y
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)
COUNTY OF cc -01
Nb� fy' av-\ ` � being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the Uwe V" -
(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.
to before me thi
day of Lf�20.6_
Public
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' TRANSFER 23
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AA T7t9SCALE H� °EED J qo C I •50• �•n�, �00/ RECORDED OR UNRECORDED ATE NOT GUARANTEE; � t)�E•EASEMENTS ANDIOR SUSSUFFACR STRUCTURES �E° •`•• -�• 1
C t2q'- DxII. }4� O Al IIL,` 1` L/ UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT
7X5�' 1E 0' rwj �a0 \ o \ ( _ // HE TIME OF SURVEY. \
S, G�� THE OFFSETS ON DIMCNDIDN,.HOWN HEREON FROM ' oA- 00- P4. Yt rv-1 L,j,,-2 Canc-e CENL.
fMoY '1 E, 4UU S PROPERTY LINES TO THE SINUCTURES ARE FOR 'v LS T- 1�N ��'I �M✓NL OIC EKIfT/N �j \d�V„/
SPECIFIC PUOPOSE AND USE. THEREFORE, THEY 1/
LINES ONI TO NDED TO S OE THE MONUMENT
MOTION OE MM "RrY� w ATs! /Q.IfL,y�Q,l
GUARANTEED TO : Al •0 J MANAGEMENT, LLC �'�j,�
/NORMAN KE/L cl� JEAAJAIE KE/L I IMPROVEMENT. iTRUCTUREi ON pryy CTHEII
IMPROVEMENF. 1�l SA0ClR L. S✓�1Sn-1'+�S
- A01ANTA6E r/TL6AGENC)'/NC, SURVEY OF DESCRIBED PROPERTY AT MATTI TUCK l V
TOIYN OF SOUTHOLD. SUFFOLK COUNTY. NEW YORK
oWNEOBy+ AREA=/B•75D,mmeS ei �P��9 1O
SV: IIH l l 330 46, SALUE W. WELLS JAMES¢ MAR YELLE/✓ RUHF CO 9�
/Q WESTPHAG/A ROAD Q MR42,15 WESTPHAUA ROAD h ,1:.
mArrirve,<,NY. A-07-/r41CK,AZ r :� �
-`•.�-IliB C I-�''
!'�'''-!'.+�I'Ldaa SURVEYED, JANUARY 24. 1997 .' ' rr HARRY. P. HILLEBRAND
SUFFOLK COUNTY TAX MAP <i_rn; aza0a LAND SURVEYOR
DISTRICT SECTION BLOCK LOTS SCALE, ' If - /00'S�o4ArdU 11 CHURCHILL LANE - SMITHTOWN. NEW YORK
ZOs
/000 /i3 /3 /s2 0 50 /00 n oo
TEL. f5/6J 543-5/39
�/L E
970/.4