HomeMy WebLinkAbout31853-Z
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
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NOT bLLl LT
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO.
31853 Z
Date MARCH
15, 2006
permission is hereby granted to:
R & S PALMER
PO BOX 920
CUTCHOGUE,NY 11935
for :
CONSTRUCTION OF AN INGROUND SWIMMING POOL AS APPLIED FOR, FENCED
TO CODE
at premises located at
9204 BRIDGE LA
CUTCHOGUE
County Tax Map No. 473889 Section 073
Block 0002
Lot No. 003.006
pursuant to application dated MARCH
14, 2006 and approved by the
Building Inspector to expire on SEPTEMBER 15, 2007.
Fee $
150.00
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, Authorized Signature
ORIGINAL
Rev. 5/8/ 02
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FIELD n'<SPECTION REPORT DATE COMMENTS .
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STATE ENERGY CODE
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JOHN G. EHLERS LAND SURVEYoR
IS EAST MAIN STREET
RIVERHEAD,NY.IIC!OI
36'1-8288 Fox 36'1-8281
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SURVEY OF LOT :11= 2
REeE." MINOR SUBDIVISION
SUFFOLk _ ,~~IN f\. ~RN $
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lOOI DEe 13 AM 9: 20 5111JA11:. ClJTCH06lE
t.... TOWN OF 5OUTHOLD
d'tPT OF f1CAlTli SER'I SUFFoLK COUNlYt NY'
FFICE WAST[WATEr~ ~GCfl~ SURVEYED 03-17-00
j' I AMENDED 04-27-00.
Ob-01-00,Ob-23-00,
07-07-00.03-01-01,
EL. EASE. 04-23-01,
FND. LOC. 04-30-01,
OS-14-01. FNL 10-03-01,
11-12-01
SC T . 1000 073 02 3.b
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. MONUMENT FOUND
o PIPE FOUND
/'111.1.1.1.1 PRIVET HED<;;E
AREA . 44,780 SF OR
1.03 ACRES (TO TIE LINE)
ELEVATIONS SHOY'lN REF. N<;;VD '2g
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CERTIFIED TO,
ROBERT PALMER
SYLVIA NOTEN PALMER
ULSTER SAVIN",S BANK,
ITS SUCCESSORS AND OR ASSI",NS,
FOR THIS TRANSACTION ONLY
BROADY'lAY ABSTRACT CORP.
FIRST AMERICAN TITLE INS. CO.
TITLE . BDY'lY 434g
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Ref# 20-098
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TOWN OF SOUTHOI,D \
BUILDING DEPARn/EN''t
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/SouthoId/
PERMIT NO.
31 '1153 b
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: Robert Palmer
Mail to: POBox 920
?>/15 ,20-2L
"?fls , 20~
Examined
Approved
Disapproved ale
Phone:
Cutchoque NY
631-734-7470
516-526-8915
11935
- .home
Expiration
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Building Inspector
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. MAR I it J ' APPLICATION FOR BUILDING PERMIT
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L.__ TQ~~~~-x'~_.;;;')UT;"iOLD _
Date
March 14
,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 pla1;1 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 pennit
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 builcling 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 pennit 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
Bnilding Zone Ordinance of the Town of Sonthold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction ofbnilclings, additions, or alterations or for removal or demolition as herein described. The
:~~~~~:~:k::~~~0~~::~~~~e~I~~P~c:0~~~~;;;;6~~~iEE~~ housing co; and regulations, and to admit
" '" M!6j'T~,E REQUIREMENTS OF T~ Db'u\-t (tL ~ ~
IMME DI A TE L Y CODES OF NEW YORK STAtE; (Signature of applicant or name if a corporation)
ENCLOS.E PQQL, 1'0 CODE' . ,
UPON COMPlETION POBox 920
BEFORE "WATER" RETAIN STORM WATER RUNOF~utchogue NY 11935
PURSUANT TO SECTION 4S-10C . (Mailing addre.ss of applicant)
S h h I.. qFTHE TOWNnQQ.QE.. I I" I b b 'Id
tate w et er app Icant IS owner, essee, agentilJNOER.~~C~era contractor, e ectnclan, p um er or Ul er
. REQUIRED APPROVED AS NOTED
, DATE: g/Id" 8.P.# ;:>'1'%1::'1 c
and Sylna Noten t~mer /~ ,\1: lUL'
(As on the tax roll or laIMMOSUILDING D~PART
If applicant is a corporation, signature of duly authorized officer 765.1802 8 AM TO ~ PM F~~N~H~T
FOLLOWiNG INSPECTIONS'
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATION
4. FINAL . CONSTRUCTION MUST
BE COMPLETE FOR CO
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
YORK STATE. NOT RESPONSIBLE FOR
@Efl!G>'lh<li>!jluOONSTRUCTION FRRORS.
Hamlet
InMllAwAOIATA'! .
B1~l.@@lll@~Je .~,ldu'! ~1610Wl
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Filed.Map,No," .,.' '., .
owner.
Name of owner of premises Robert
~
P';l:1mer
(Name and title of corpora@€J€>ttPANCY OR
USE IS UNLAWFUL
Builders License No.
Plumbers License No.
Electricians License No,
Other Trade's License No.
OF OCComCY
TE
1. Location ofland on which proposed work will be done:
9204 Bridge Lane
House Number Street
County Tax Map No. 1000 Section 073. 00
Subdivision
Lot 0 0 3 . 006
Lot
(Name)
--r
>
2. State existing use and occupancy of premises and intended use and occupancy of prop'bsedlconstruction:
a. Existing use and occupancy "
b. Intended use and occupancy
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
Addition
Other Work Pool
Alteration
\<;'"(-7,(,,'
(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 '
Height Number of Stories
Rear
Depth
Dimensions of same structure with alterations or additions: Front ~ear
Depth Height Number of Stories I
8. Dimensions of entire new construction: Front
Height Number of Stories
Rear
Depth
9. Size oflo1: Front
Rear
Depth
10. Date of Purchase
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_Will excess fill be removed from premises? YES_NO_
Phone No.
Phone No
Phone No.
14. Names of Owner of premises
Name of Architect
Name of Contractor
Address
Address
Address
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 of a tidal wetlalid? * YES _NO:' ,lA'
* - -,. c-c
IF YES, D.E.C. PERMITS MAY BE REQUIRED..' .
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16. Provide survey, to scale, with accUrate foundation plan and distances to property lines..- v3~O,..!~:V;3
\' ,..",' ,,0'''-'
~40V~ 'p'~,\:,,-~,j f\f;;:l,(",iT;.; ,~/~~Ar~r~t "p,,:;, ./' 3?~('H3a
17. If elevation at any point on property is at 10 feet or~?elow, must proyide.\qR~~,p/tfcal data on survey.
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STATE OF NEW YORK)
SS:
COUNTY OF SU Fr-OL-\~)
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I< o,g-uzx VI\-i..M. E f2...- being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the owner
(Contractor, Agent, Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perform or hay,e ,pe;1;Qf)fe4 ,the said work a,nd to make and file this application;
that all statements contained in this application are true to the beslM1iisikfiowledge.and belief; and that the work will be
performed in the manner set forth in the application filed theJ;()wi,lJ;.. T iJ --. ", 'Y
:.2 ir\\,..." ": j 1'! ",_:; '",,...' i
Sworn to before me this ;" /\" :::.
\'-\.~ dayof March 2006 kobV\t V~L~
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Notary Public
Signature of Applicant
PATRICIA WMNER
Notary Public S1at8 of New 'tllIlI
No.OIWA6140448
Qualified in Suffolk County
Commission Expires Januarv 3C\310 { 0
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REVISED 5/03 H. ROY JAFFE, P.E.
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I:XCAYATK*.. If' CJIIOUtO,WAYCJt t:X.ISTS WlTHIIC ~"~O"a€;lDW ;~tftlPDt.Ar1 ;,.:-: :..";
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