HomeMy WebLinkAbout31878-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. 31878 Z Date APRIL 3, 2006
Permission is hereby granted to:
TA~A P O'SHEA
1533 YALE ST - APT D
SANTA MONICA, CA 90404
for :
DEMOLITION OF AN ACCESSORY GARAGE AS APPLIED FOR
at premises located at
County Tax Map No. 473889 Section 141
pursuant to application dated MARCH
Bui].ding Inspector to expire on OCTOBER
Fee $ 74.00
11365 SOUND AVE MATTITUCK
Block 0003 Lot No. 006.002
22, 2006 and approved by the
3, 2007.
ORIGINAL
Rev. 5/8/02
~erfV
50uNO
AVENUE
SURVEY FOR
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502 .....
www. northfork.net/Southold/
;,!AR 2 9 "
PERMIT NO.
Examined ~l% ,20~
Approved 20__
Disapproved age ~
Expiration ,20
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:
' Buildi~tg Illsp~.~'~
APPLICATION FOR BUILDING PERMIT
Date~N"kc-oxO~ "~L. ,20 ~
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 pan 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 ai2er the date of
issuattce 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 intern, the Building Inspector may authorize, in writing, the extension of the permit for an
add?ion 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 heroin described. The
applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit
anth°rized inspect°rs~°n premises and in building f°r necessary inspecti°ns' ~~m, i 'f a' c~-~orpo a?*on) 'r
(Mailing address o~ appficant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises - "~ ?,
(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. ?~'ae ~2)O~ -- ~
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed ~vork w.~ll be done:\ \,~t o~'''~ 60~d~Jc fx~t~_.. ~"~13,-'3~'~'~[JC-~'~ ' \ ['~
House Number Street Hamlet
Connty Tax Map No. lO00 Section \t-~\ ,~(~ Block ("3%,60 Lot ~)(~)(.~ . 00~).x
Subdivision Filed Map No. Lot
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy r'~O~xo~ ~ ~ ~--')ooor% \ ('~oyxO.Ol~
b. Intended use and occupancy ~,,o~u~0~L t.k~'~,~°~,C'~ OOX~_~ L~
Nature of work (check which applicable): New Building
Repair Removal_ Demolition ~.,,
Estimated Cost \ ~ Fee
If dwelling, number of dwelling units
[f 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__e, xisting structures, if any: Front
Height_,.~ ~'~' Number of Stories
Rear
Dimensions of same structure with alterations or additions: Front
Depth ~ Height (:D Number of Stories
~)SQ Dimensions of entire new construction: Front Rear
Height Number of Stories
Rear ~'~
Depth
9. Sizeoflot: Front Rear Depth
10. Date of Purchas~[~o~i~tE~x~_ Name o f Former Owner
11. Zone or use district in which premises are situated ('(~t~'~
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 p. remises? YES~K/ NO
14. Names of Owner of prem,ses"To.,,o.~ ~:'~mr-.~Address
Name of Architect Address Phone No
Name of Contracto~tgn'mfi ~'laex'{ lb:Eob Address~OUk ~.~,xc[ ~. , Phone No. 6~1'~1[ -.'~(r~-
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 ora tidal wetland? * YES__ NO
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
16. Provide survey, to scale, with accurate fbundation 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 YOm)s: ~ ~..~ O ~ V~x~
C~[.~NTY OF ) ,
'y~" 8%_(~ being duly sworn, deposes and says that (s)he is the applicant
(Na~e of ind~ '"vidual signing contract) above named,
(S)He is ther~ ~ ~ ~-7~~
(Contractor, Agent, Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perfon~n 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.
Sworn to before me this
'~b- day of Pto~c/,, 20 O ~
Notary Public
Signature of Ap'pt/effnt~---/
SAM FOX
COMM. #1606546
NOTARY PUBLIC-CALIFORNIA
LOS ANGELES COUNTY