HomeMy WebLinkAbout30971-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. 30971 Z Date FEBRUARY 18 , 2005
Permission is hereby granted to :
j,OY J SCHOENHAAR
NA EASTWOOD DR
CUTCHOGUE,NY 11935
for
FOUNDATION REPAIR AND MAINTENANCE ONLY AS APPLIED FOR PER TRUSTEES
ADMINISTRATIVE AP$JpVAL WITH FLOOD PERMIT
at premises located at 64300 MAIN RD GREENPORT
Countax Map No. 473889 Section 056 Block 0007 Lot No. 002
pursuant t application dated FEBRUARY 4 , 2005 and approved by the
Building Inspector to expire on AUGUST 18, 2006 .
Fee $ 300 . 00
4hoiZedSi
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Rev. 5/8/02 ORIGINAL
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FIELD INSPECTION REPORT DATE j COMMENTS
FOUNDATION(1ST)
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FOUNDATION (2ND)
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ROUGH FRAMING& --
PLUMBING
INSULATION PER N.Y. y
STATE ENERGY CODE
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FINAL - -
ADDITIONAL COMMENTS (�
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TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMEN Do you have or need the following,before applying?
TOWN HALL ( Board of Health
SOUTHOLD,NY 11971 CJ `Y � 4 sets of Building Plans
TEL: (631) 765-1802 �� Planning Bo approval
FAX: (631) 765-9502p Survey
www.northfork.net/Southold/ PERMIT NO. J C)� Check /Q 3�
Septic Form
N.Y.S.D.E.C.
Trustees
Examined 120__g7 Con ct: -
Approved ,20_�� Mail to:
Disapproved a/c
Phone:
Expiration ,20
r^= - - - _ uil g specto
r FEB 4
APPLICA I-N E0.,_ UILDIN RMIT
Date r6 3 52005
TQtr INSTRUCTIONS
d ' ;ili_ _ILD
a. This application MUST be completely<ftlled��in by typewriter or in ink and submitted to the Building Inspector with 4
sets of plans, accurate plot plan to scale. Fee accord `tbschedule.
b. Plot plan showing location of lot and of bur ding on premises,relationship o adjoining premises or public streets or
areas, and waterways.
c. The work covered by this applica� may not be,comtnenced before issuance of Building Permit-
.Upon approval of this application,t e Building Inspector will issue a Building Permit to thd-p icant. S%ch a permit
shall be kept'on the premises"a adable for inspec io throughout the work.
e.No building shall�b scup ed or used in whole or in part for.any purpos /�Ihat so eve'r'until the Building Inspector
issuesCertificate of Oeu ncy. 7/£ Every building perxmt s�hllexpire if the wor a torized ha�sS commenced wztlun 12 months after the 4 late of
issuance or has not been completed 6hin 1�onths from.such date. If no zonr,ng amendments or other regulations affecting the
property have been enacteh the Lterim,theBuilding Inspector may autho e, in w .it' g,the extension of the �ermit for an
addition six months. Thereaft , a nempermit halll�be required.
APPLICATION IS HEREB MADE to the Building Depa men for the i nuance of a Building Per of pursuant to the
Building Zone 0 finance of the Town of��,Southold,Suff�k Couniy,.LNefw York,�A other applicable Laws/Ordinances or
Regulations, foci e onstruction,of bui dings, addihons,;or�alterations or\for re} oval or demolition as herein described.The
applicant agrees t gplly with all�appli& le laws, ordinances,buildin�code,Housing code, and re lations, and to admit
authorized inspectors on, remises and in btu ldi g for necessary inspection1IvC6�0
ignature o"'ap lic or name,if a corporation)
rte•®-�� y� Sa�iT�c b iu
11?7/ (Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engi ere general contractor, electrician, plumber or builder
�f -S. wup r SQ • OWNS t
Name of owner of premises
(As ontGhe tax roll or latest deed) "
pli s a corpora ion, signature of duly authoriz d officer
ame and itle f corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which pro osed work will be done:
X00 �i9•/�t! '� �
House Number Street Hadet
County Tax Map No. 1000 Section %WO Block ,% 'Lot 2- "+
Subdivision DW Myap No. Lot
r�i�!
(Name)
2. State existing use and occupancy of px�mises and intended use and occupancy of proposed construction:
a. Existing use and occupancy +
b. Intended use and occupancy 1,:NgM 1
3. Nature of work eck which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work
4. Estimated Cost $50.4106 Fee (Description)
(To be paid on filing this application)
5. If dwelling, number of dwelling units NN Number of dwelling units on each floor
If garage, number of cars Na °
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of ex)sting structures if any: Front 51
Rear (,�� Depth COS ZS Number of Stories 2.
Dimensions of same structure with alterations or additions: Front S-*VK Rear we--
Depth SdNla! Height S^W Number of Stories 2-
8. Dimensions of entire new construction: Front, /V/� Rear Depth
Height Number of Stories
9. Size of lot: Front 1%701 Rear JX7 Depth 62,51
10. Date of Purchase 001 Ja ,644 Name of Former Owner 4y �� /�di 9-ow/1-4
11.Zone or use district in which premises are situated (
J I
12.Does proposed construction violate any zoning law, ordinance or regulation? YES NO 1
13. Will lot be re-graded? YES NO rWill excess fill be removed from premises? YES NO
L
14. Names of Owner of premises iiZ1Wd JQLJW1 >34ddress ?-oA% 8 /V ,Phone No. m /�'t'As.-Azu
Name of Architect �N Address Phone No / �a (-A 3/S
Name of Contractor 1 Address Phone N1731- lQ
15 a. Is this property.within 100 feet of a tidal wetland or a freshwater wetland? *YES te--."NO
* IF YES;SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE REQUIRED..
b. Is this'property within-300 feet of a tidal wetland? *YES �i'"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) v
SS:
COUNTY OF .
ZC, J. 9xi 4 e yD ZSZL being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the `OAM'Sclw 4- G*fM07&- dvocI'il�
(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 this
6rri day of r i,( 20_Q_,�
Notar Public' Signature of plic t
filR t RESP
New York
Qualifies in Suftoik •:ounty � fNow V k;
Canmission Expires Au,us; 18,2001ry�.g �g7127
Quali@ed iii S1WkCCUOY 18,2007