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Home My WebLink About29536-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. 29536 Z Date JULY 1, 2003 Permission is hereby granted to: EDWARD SANDBERG MATTITUCK,NY 11952 for : DEMOLITION OF THREE EXISTING ACCESSORY BUILDINGS AND A PORTION OF AN EXISTING DWELLING WITHOUT UTILITIES AS APPLIED FOR at premises located at MATTI TUCK 20105 MAIN RD Block 0003 Lot No. 005.003 County Tax Map No. 473889 section 108 pursuant to application dated JULY 1, 2003 and approved by the Building Inspector to expire on JANUARY 1, 2005. Fee $ 81. 35 ORIGINAL Rev. 5/8/02 "y .' :, ~'{d' "pO-OO' ./~ c.'" ...c? r. .. iA...? '{.V' ..>> " .~.I;O'~' · . ..-- ,~ .,. \~ -. ~. ~ ., j" N/O/F ~R 1tt:MEs: #Ie. I , f I r : f r I : I .tN '...... .. ,Co,. .. $. 1/$"25':;0' Co /3J.97' .. ~ ---- ~-- {.. tJ .,..... ~ ,. . k ;. III \' g i .. OF. F'flOFlMTr $(RVEr 'UCK T MATm. . TO~rc~J?r SUFFOL. .. _ DI- 5.3 .. - . 1"""'11' . $cIie: = ...." -- ~ f(JQ3 ?l 1'/41' -.- 3~ 105r ~.o ba9~SO/ -/_.. ct ~ .\') . oJ '5 vl6?) . 15P ~~/~< ~~f NEW YO .~.;:::. ,. M'r~1} . 'P.f' e:,' +-~ .... ,0 ~'" oM ~.~/f,"'~~;'~. ... ;:-' ..;~\~- . .~ 1 j I J l .'~ l J . ...; .. U ~ I ~ .. .~ , . I ,f I I I , .." ~ ~ I I 1 j J I ~ 'J Iri ~- o i'-~ ("" "'f!. - /~ ".7' . ...-. I ~ 1,#1"-6, /1:411..... ~.. ~'- , .. /p'A'. ,_~ ~ oj ..... I I I ~I " I 1 I I ,.-" ~" . N. 85"25'50' W. '"... "",,-. 250.00' , MAIN ROAD (N. rs . ~.i;',? i;:~,~'.1"~:; ~ . , I (., ~.';:l"~~!; . ~.n 1rJr .... ~'lF'~"! '. t ; ; ,- ~. ~ . l-j :~ '.j .. . .~ii+1~;'i;~'~_~--""'''_'':''''~__''''_~_'''' ..~, ,..:.. ._........... 08- 114 J 1 ~ ~ ~ ~ .A '1, . ~. --.........-~...._-""..:........""--_..-.-- ~"';,-~~~< :"..,-.-:..;._....""'.~"..;~-.....". ... ..;.. ,,~-, '. TOWN OF S9UTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www.northfork.net/Southold/ BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 3 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Contact: PERMIT NO. c:1qS~b~ Examined Approved Disapproved ale 1/ ~ 7 It ( ? ,20_ ,20~ ,20~ Mail to: Expiration Phone: Building Inspector r; I: !r; , -, APPLICATION FOR BUILDING PERMIT . ! Date 2/:J,/t) J i ' . " . '..-J INSTRUCTIONS / a. 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 oflot 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 p=it 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. ~//A - (Signaturc(':r:;,r?c:~r name, if a corporation) ~AS NOtED .,b6' d.-3 195"" /l( 41 J1 If ~ Co r~ 0 rr-c. 11 1'3 017)'7,( 2:- V (Mailing address of applicant) (/ DAlE: ,. ./0 &.P.' --- N. r. 1/13 r State w~slW<n~(,?~ avent, architect, engineer, general contractor, electrician, plumber or builder NOTFY IULDIiIG DEP~ AT 715'1_ 'AM TO 4PM ,.. THE FtlI.LOWlNG._ ..... ""'*' . . Nameo~oW~~ {j-/YfJ~S ,_g._~_'.FfIAMlNG ~u... (As on the tax roll or latest deed) If appl~~ratlon; sIgnature or duly authorized officerf .. F.IIAl. ~$TDIII"TINl ...... (Nw'U:...3 tiI~.:toRII)Riate officer) AU. CONSTRUCTION SHAll MEET THE Builder~ OF THE CODES OF NEW Plumber~QflISe%~,*o.NOT RE5PONlIaI: fOR Electricigli'@M}ft;e~ 11'lu\; j IUN EfblIumi. Other Trade's License No. < J 2003 ,20_ I. Location of land on which proposed zyrk will be done: ;;)-0 I 0 5" fI.1 A. I lA... t+P tIf. ~ House Number Street )1A Ai-=h -f1< ck Hamlet County Tax Map No. 1000 Section / O~ Subdivision (Name) Block ~~ Filed Map No. Lot S-. 3 Lot 2. State existing use and occupancy of premises and in ended use a. Existing use and occupancy ~ '/-'7 b. Intended use and occupancy S / J.-t :; Le.. r-;; )//'f / 11 oposed construction: o v J-c. A. ~ l/;..-c. 3. Nature of work (check which applicable): New Building Repair Removal .".Demolition ,X , ....."1 (rU/r'-I-) 4. Estimated Cost V Fee Addition Alteration OtherWorkcl....4Jo1-t: ( escription) (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling unit" on each floor If garage, number of cars r e.>"\.A.O v '.....1 le,f r ., ve..".- jY4' rr 6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of St~ 8. Dimensions of entire new construction: Front Height Number of Stories Rear Depth Rear Depth g: / _~~ it'/ j;<:rj 9. Size oflol: Front 10. Date of Purchase 7/1/t>3 , I 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 b( Will excess fill be removed from premises? YES NO N.-t../ . .)..)/ '1 r /114./"1 RJ. - - 14. Names of Owner of premises erA, L<- C-~ Addresc..n:i....~.:.. JJY Phone No. 73'-1 ~J / I J> Name of Architect Address Phone No Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES _NOX * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.e. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES_NO K- * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide. survey, to scale, with accurate foundl\tion plan and distanlli:S to prop~ 03VOAW 17. If elevation at any point on property is at 10 feet or below, must providp. tnpnlP""ph;,,~'" nn .nn'~' :iTAQ ." :J3~ STATE OF NEW YORK) T. TM3"TR~j al"lGJIU8 V'liTOIA SS: 3HT RO'l .,",9, ('~ ~ 8 soaf-i!ai COUNTY OF ). .a14Oln3'1<!I4! aMiWOJ.JC'l M G Q3AllJOaA OWT .. 1ol000AOlo\UO:; t1 d r a / L'\. e...s being duly sworn, deposes and says ~~~~.J1}.. .Atli...,. (Name of individual signing contract) above named, QMISMU.I"! " ;:',1H.1AA~. ',;)UOA VlOlT A. J2lo1i . T8U., ",Olr) " - . :c::) . ji.I1I'l "'-, ;\' .~-:' jjGftC<:: J& 3,.,1' T33M J.,AHZ ,.."i';:;l''''?'' JJA of said owner or owners, and is duly authorized to perform or have performed the IMilIl~SltlIlldlllIa1tilliiiillill~iffiijj;lij'iMication; that all statements contained in this application are true to the best of his knowledglOl:jJ.(ll1l8t8KPliIIdfua:tlll.e w~\(avltIlGl! performed in the manner set forth in the application filed therewith. .ZAORR3 1'10\ f:H.!'1T2I>\C':"' ?O lI!l)I!r;r (S)He is the tJw I? ~ (Contractor, Agent, Corporate Officer, etc.) Sworn to before me this y ,I -vi- day of . ~ 20 0-3 ~l~ ~M Sigl'lature of Applicant -t UND" J. COOPER Notery Public. S- of New Volt No. 482258.3. Suffolk CollfllY ,,, r_ T9I'm EllpII'8ll December 31. a..cI-lJO 'f"