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Home My WebLink About31721-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. 31721 Z Date JANUARY 10, 2006 Permission is hereby granted to: PARK DIST MATTITUCK PO BOX 1413 MATTITUCK, NY 11952 for : DEMOLITION OF AN EXISTING BARN STRUCTURE AS APPLIED FOR at premises located at 11280 GREAT County Tax Map No. 473889 Section 126 pursuant to application dated J~qI3ARY Building Inspector to expire on JULY Fee $ 76.40 PECONIC BAY BLVD LAUREL Block 0006 Lot No. 018 6, 2006 and approved by the 10, 2007. ri~d Si_~gna~ure ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUIL. DING. DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.netJSouthold/ . Examined Approved Disapproved a/¢ Expiration BUILDING PE1LMIT APPLICATION CHECKLIST Do you have or need the following, before applying7 Board of Health 4 sets of Building Plans Planning Board approval Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Building'fzn~pecto'F'"-- APPLICATION FOR BUILDING PERMIT · ~.~ Date ~, ~ ,200fa I~STRUCTIONS ~: This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 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 afl:er the date of issuance or has not been completed within 18 months fi.om 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 ora Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinanens 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. /)')/fgfT~/--Ft)(_j(' '7>/4/'~./~ .Z)/s-r-,~ I CT' . ROVED AS NOTED /J ~{~gna01re ot'app~ic-an~ or name, State wheth_~f,~l~t)~cafli~ oT~ot,Pl~ss~l~qa~Bt, architect, engineer, general contractor, electrician, plumber or builder FOLLO~)LLOWlNG ~NSPECTIONS: '. _F_O_UN_DATION3~ EQ UiR ED run rtauH~-IJ ~DNCRETE 2.RO ...... 6. II'd~Ul~AI ION 4. FINAL - ^"'~-- (As on the tax roil or latest deed) ~ ~5TRUCTI If applicant is~¥,~e~ klY a,utho~ officer (]',/affiJt3U~N(p~ q~tPl(J~]) NEW YORK STATE. NOT RESPONSIBLE FOR Builders LiJ~N/,/~ CONSTRUCTION ERRORS Plumbers License No. j '7 = V Electricians License No. Other Trade's License No. House Number Location of land on which proposed work will be done: Street Hamlet ....., /Z6 ;" ' ' Block ~ "' ~, t ' --'--- ' Filed Map No. ~; . . } , .; ;Lot .-to County Tax Map No. 1000 Section Subdivision 2. State existing use and occupancy of premises ~l~d intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy ~o~/~ 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. Est[mated Cost ~'/_~c~(Z) 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 ~ 'Z- Rear Height ['~, / :~ Number of Stories [ Dimensions of same structure with alterations or additions: 'Front Depth. ~ Height (2) 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 I 1. 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 fi.om premises? YES__ NO 14. Names of Owner of premises ~ar-f, 7~,~ o/~rAddress fo~5./~'/~ /72a~ Phone No. 2~'- Name of Architect Address Phone No Name of Contractor ~o/~,'k (~r; ~0~;~ Address ~)~,cd~/~ Phone No. * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS/MAY BE KEQUIRED~[ b. Is this property within 300 feet cfa tidal wetland? * YES v NO 16. Provida survey, to scale, with accurate foundation plan and distances to property lines. 17. ,If elevatign at an~t point on progerty is at,10 feet or below, m,ust,.grovide,topographi~l dam)an ~urv~ey. / ,~ berg d~y sworn, deposes ~d says ~at (s)ho is ~e app~c~t ~me of~id~ si~ng con~t) above ~, (S)He is ~mctor, Agent, Co,orate Officer, etc.) of said owner or o~e~s, and is duly authorized to perform or have performed thc said work and to make and file this application; that all statements contained in tiffs application are true to the best of his knowledge and belief; and that the work will be performed in the rnnnnetr set forth in the application filed therewith. Sworn t~before ~te thisf~ ~ .~of Vw~*l. 20~, (~ Notary Public / Sig~atur-o of Apvfi~ant - DONNA MOGANAN Nota~/Public, 8rate of New No. 0tMC4851458 _ Qualified_in Suffolk OommlMlon Explr~ Aug. 18, Suffolk Coun~ Department of Health Set'vi~es Approval for Constnt~on - Other Th~ Sin~e supply and sewage'disposal. Regardless of any o~ssions, ,]~ .. SUFFOLK COUNTY D~T. CF [.~ALTH SERVICES. ~' CALL %~F2...'2.Gg"'/ 48 HOUR~ IN ADVANCe, . .. FOR SANITARY SYSTEM BY HEALTH DEPARTMENT . ~' .. · ~ _ - . :~.~ · . . I of '? ,~,.. '- 'F-- ~q~'l (o ~.F''~,