HomeMy WebLinkAbout32446-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.
32446 Z
Date OCTOBER
23, 2006
Permission is hereby granted to:
JOSE & IVONNE HERNANDEZ
22950 MAIN RD
ORIENT,NY 11957
for :
DEMOLITION OF AN ENTRY WAY AS APPLIED FOR
at premises located at
510 FLINT ST
GREEN PORT
County Tax Map No. 473889 Section 048
Block 0002
Lot No. 020
pursuant to application dated OCTOBER
17, 2006 and approved by the
Building Inspector to expire on APRIL
23,2008.
Fee $
35.00
/l /0/1,
,(~~
, Authorized Signature
ORIGINAL
Rev. 5/8/02
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/Southold/
BUILDING PERMIT APPLICATION CHECKLIST
PERMIT NO.
'3 J--t1& ::e;
Do you have or need the following, before applying?
Board of Health
4 sels of Building Plans
Planning Board approval
Survey
Check
Seplic Form
N.Y.SD.E.C.
Trustees
Contact:
Mail 10:
Approved
Disapproved ale
it) I;) ~, 20 D1
'1 -
lo/y~,2~
1
Examined
Expiration
flrj,2~
(
P;eJl.
I Building Inspector
Phonellb}I-5c1 }:17a
, ) I 2 7 C 7 7 ~ ~- y
I 7 O~
APPLICATION FOR BUILDING PERMIT
Date
/0 /11
1
20 0 b
'-
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 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 l2 months afier 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.
APPLICA nON 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.
/
/
~ (Signature of applica
~;;< 9 5~ () ;11C1 m /I? ()I)r~ ()/?/ (J~-
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
C) lA TY7 P /I
Name of owner of premises CTc;,~e -t- I VoVlnc> N CO'if? fie. p V) e ::>_
(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.
Plumbers License No.
Electricians License No.
Other Trade's License No.
I, Location of land on whichyroposed work will be done:
I {- I - .s-_
House Number Street
County Tax Map No. 1000 Section_
Subdivision 1
(Name)
~9-, Block
Filed Map No.
2 iLot
Lot
?c,
2. State existing use and occupancy of premises a in,tl'l'rded use and occupancy of proposed construction:
a. Existing use and occupancy 8';.1~
b. Intended use and occupancy ~ S I ,0 ~.P (~ tA.,1 t\)
3. Nature of work (check which applicable): New 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 22- Rear
Height Number of Stories ~.,
Dimensions of same structure with alterations or additions: Front 2 2-
Depth Height Number of Stories
4,
Depth
Rear 42-
l /L-
8. Dimensions of entire new construction: Front
Height Number of Stories
. i-/!-' 4[ -- q
9. SIze oflot: Front~_, -J Rear~ .' :::J __Depth _. . (C'\
... I. I c;>a 7 I
10. Date ofPurchase_c:,>~1Q t- I. J _Name of Former Owner ~_ ,O::=:,
I ,::::-"",", ~t
11. Zone or use district in which premises are situated
Depth
Rear
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 ,',/
~ames of Owner of premises Address Phone No.
Name of Architect Address Phone No
Name of Contractor Address Phone No.
IS a. Is this property within 100 feet ofa tidal wetland or a freshwater wetland? *YES_NO/
* 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 ~
* 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)
r' SS:
COUNTY OF\..\~lt)
,JD<;~ ~ E'/UVAlJ \) ['2-- being duly sworn, deposes and says that (s)he is the applicant
(Name of indIvidual signing contract) above named,
(S)He is the
lJlulltv
(Contractor, Agent, Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perform or have perfom1ed 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.
/?C~,
Signature 0 )c\pplicant
.//
MELANIE OOROSKl
NOTARY PUBLIC, State of New 'l'"1I
No. 01004634870
Qualified in Suffolk County ",1\ \ f\
Commission Expires September 30~ v
/
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