HomeMy WebLinkAbout32059-Z
FORM 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.
32059 Z
Date MAY
31, 2006
Permission is hereby granted to:
DAVID NELSON (GARY A. LAUBE)
575 ACKERLY POND LA
SOUTHOLD,NY 11971
for :
DEMOLITION OF DWELLING AND GARAGE AS APPLIED FOR
at premises located at
575 ACKERLY PD LA
SOUTH/PEC
County Tax Map No. 473889 Section 069
Block 0005
Lot No. 010
pursuant to application dated APRIL 21, 2006 and approved by the
Building Inspector to expire on NOVEMBER 31, 2007.
Fee $
191.00
~{~
Authorized Signature
ORIGINAL
Rev. 5/8/02
MRY-26-2006 13:08
P.01/01
LIPA
117 Doctors Path
Riverhead, NY 11901
Long Island _ Authority
..,
r;: ;"\ \
\ . .~, i
'.
May 26, 2006
'2.6
.~J
Mr. Gary Laube
310 Ackerly Pond Lane
Southold, NY 11971
RE: 575 Ackerly Pond Lane, Southold
LIPA Ref # T100622702 & 622707
Electric Mtr #093009006
Gas Mtr # 1134962
Dear Mr. Laube:
This letter is to advise you that the electric service to the
above referenced premises was removed on May 25, 2006 and the gas
service was removed on May 19, 2006.
If you have any questions, please contact Fred Perez at (631)
548-7037.
Very truly yours,
eve Aylward
Design Enginee
Electric Design & Construction
SA/am
I c, '"' I '-
lJ")'- )
TOTAL P. 01
PERMIT NO.
J)tJ n c-
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:
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/SouthoId/
Examined
20 OJ,
,~
,20~
Approved
Disapproved ale
Mail to:
1/( ?:> I ,20-.2Z
Phone: ? (p 5 - ~ro5
Expiration
L~.J,.~I -0.,,,, ;~! P f1
\ ; ~
.,.. \l.../I..<A.<~.' ,,, "TV
/~
Building Inspector
: A:P17(~ION FOR BUILDING PERMIT
,.I Date
, INSTRUCTIONS
.. i
a. This application MUST be completely fillJd in by typewriter or in ink and submitted to the Building Inspector with 4
sets of plans, accurate plot plan to scale. Fee,ae:cor~g to schedule.
b. Plot plan showing location oflot and'ofbuildings 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 South old, 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.
~
(Sig
..... \,
C.or-i'e '..0.
i 2 I ()(,
,20_
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
~
Name of owner of premises
c...
(Name and title of corporate officer)
(As 0 the tax roll or lat~~t deed)/)I
ly authorized officer F, _ d" ttt...-:, .
Nr Ir- 0,"~,,'
7E' 1:'2 ,,'
F',.;~~ ,:~.;(; r',~_ ",:.v ;l" .',
',T'k',' n
: FOi- T"E
If applicant is a corporation, signature of d
1. FC,,-,!\1C'A~i('\I~
o ~,-:CJ!_";:.;'r:D
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
1.
work will be done:
FOR POUr',:.
2. ROUGH.. FF', , ,,,'
3. INSULATION
4. FINAL.. CO.:' . " 'jJST
BE COMPLETl ..' '. .),
ALL CO STRUCT U': Sr,;,LL MEET THE
I MENTS OF THE CODES OF NEW
TE. NOT RESPONSIBLE FOR
l!lIIsleN OR CONSTRUCTION ERRORS.
loLBlock OS
Filed Map No.
Lot 10
Lot
County Tax Map No. 1000 Section ,JOtleJ,.
Subdivision
(Name)
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)~ew Building
Repair Removal ~ Demolition ---
Addition
Other Work
Alteration
(Description)
4. Estimated Cost
Fee
5. If dwelling, number of dwelling units
If garage, number of cars
(To be paid on filing this application)
Number of dwelling units on each floor
6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front 2(~,'!"
Height 1 ~' Number of Stories I
<;a. xl< <y(.. 3l..(:)'3). n.
Dimensions of same structure with alterations or additions: Front
Depth Height Number of Stories
Rear
12.' q.
Depth <;,\' 9 I,
q~O'yfH,OT'A I
Rear
8. Dimensions of entire new construction: Front
Height Number of Stories
Rear
Depth
9. Size oflot: Front
I
~(n
I
Rear~q
Depth
I
~oi
tJQ.\c:;.ON
10. Date of Purchase
Name of Former Owner _D\\\JI~
II. Zone or use district in which premises are situated
f\c__
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 Address Phone No.
Name of Architect Address Phone No
Name ofContractorJbw. rA..........y Address3/()I!.ck....\lf~~\}. Phone No. +/.,,<;.10105-
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES _NO V
* 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:
COUNTYOF~\~
(be....":} kCU-.J \,~ being duly sworn, deposes and says that (s)he is the applicant
(Name 0 individual signing contract) above named,
(S)He is the OW,,",.., 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.
Sworn to before me t .
,~.\S,... day of
~<>OC___...
20 oJ.v
Notary Public
BARBARA ANN RUDDER
Notary Public, State of New York
No. 4855805
Queliflad In Suffolk County"~., v
gemmIU"" '.~i/l" A"" ,......
-----~
%~
!:;~~
Que
~
~~
"'::s
;y",
Co"
,
,
,
,
,
> ,
.,
~,
"
0,
.,
6,
,
,
.."
,
,
----
IWNo'i
CONe MON.
-~------
_ullUT'1' POLE '1.
-{ __ ~R~ WIR~__
ACKERLY POND ROAD
(BOWERI LANE)
N 85.35'00" [\ __~_~~~~OG[ or P~VtM[Nl
~-..,--~--T ---\ /HE~~W
I ~. -~~ /_._"'_)
~..../"_~------- FOliNO
t---- \ COlltC 1010"'__
,
i
'"
.
a
.
6
,~
a
i;j
,".
c-"<
"'~
'<",
a
It
"
fOUNDI
CONe_ MO
- ,
,
,
,
",'
.,.'
r--.." i
"',
,
,
.. , ,
., ,
"', ,
, 0
Q ~ "
,. Q ,
~I <
" ,
0, v ,
, i! ,
,
,
W
t~1.J
Q:;(..J~ 6
~S~ ~
3t'l10
1<10
~
"
~
~
~
0
,
'3
<
,
"
.
~
z
~
o
~
u
z
~
Q
~
"
;;
,
C"----
,
,
,<
/f
,
,U
Z
'0
U r
I
"_
'"
lO
.,.'
o
'"
~.
u~-
':i~
~>
,
.
N
'2'
~
"'w~
o,,~
~.."
~"'O
-Q,.
O.
N
9,2'
4}'
...!-J.
) ~2 ..,
8;1 ~
,
L
,
.
,
"00,
CEU,ARcl-tER
ElVTf./AA.,
~~Oor- .......[
cOfvc 0\1/.1;.
S'-'8
"
..,
'"
;;;
;;
"
~
o
E;
it
r
~
z
""
,
<
,
~
6
""
o
f!
.;\
Co
V)':::i~
a~",
~i;ji;j
a t;
~~~"
~f:1~
".aa
0:'"
"
s
o
.'"
'"
.'"
'"
'"
-----.....__--<:IF?R[GU~
FE"K . :------..... ....__:Rf FElvcr
03"/. --0- -........-__....
~O'lV. 'ST~~ FOuIv_D PIP[
N 79.'3' F[~CE~""" -------
'9 00" Lv 'F[Ner -30'
~ .00'" ' S
N/O/
CLAUDE' / F
CA1?LSON
-.J'--
227'f:
SURVEY OF PROPERTY
SITUATE AT
SOUTHOLD
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000-69-05-10
SCALE '''=30'
MARCH 4, 2006
/
!
C:)
~
Q:;
,Q:
"<.l
~
o
-...;;
CERTIFIED TO
COMMONWEALTH LAND TITLE INSURANCE COMPANY
GARY LAUBE
A
/
/
/
AREA = 11,048 sq. ft.
0.254 ce.
NOTE.
ZONING USE DISTRICT: AC (AGRICULTURAL CONSERVATION)
u......ul"HORllW ..... TERAHON OR #'oDITIO,"
TO rHl'; SURvn I'; A. VlOlA11QN Of
SECTlQf<t 7209 lY THE ~EW vORl< ST"fE
[OUCAllOHl.M"
CoPtES or THIS SURVEY rr.IAP "lOT BUoRlNG
TIi[ lAHOSu~OR"s INKED SEAl OR
EW80'5srn SEAL SHALl HOT BE CONSIOUtED
TO Elf A WLJO TRUE: <:OPY,
CEImFICATlOHS IHOlCATED HEREQH SHAlL RUN
ONlY TO THE PERSON FOR WHOW THE SLJRIIfY
IS PAU'M[(), NoID ON HIS IllEI'W5 TO T'H[
mLE COWPAHY, ~T"'- .-a:HC'r' .tHO
LEfIl(lI<fC ...SllTUTlOH U'iTED HEREON. ANI)
TO THE ASSlGNEE:S Of THE LOoIOING INSTI-
TUTlC>>ol. C[fmF"ICAllOHS ARE: 11I01 TRANSfUtIt,RU
Nathan Taft Corwin III
Land Surveyor
THE EXISTENCE Of RIGHT Of WAYS
AND/OR t,U[W[NTS or ReCORD, IF
ANY, NOT SHOWN lRf NOT GUARANTHO.
992 Roanoke Avenue
Riverhead, New York 11901
PHONE & FAX (63' )369-5473
r.l.ATmF