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Home My WebLink About33355-Z FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. rJ. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 33355 Z Date AUGUST 28, 2007 permission is hereby granted to: SHORES COMMUNITY BREEZY PO BOX 546 GREENPORT,NY 11944 for : DEMOLITION OF AN EXISTING BUILDING (NEAREST ROUTE 25/MAIN ROAD) AS APPLIED FOR 65490 MAIN RD GREEN PORT at premises located at County Tax Map No. 473889 Section 053 Block 0005 Lot No. 012.006 pursuant to application dated AUGUST 24, 2007 and approved by the Fee $ 166.30 Building Inspector to expire on FEBRUARY 28, ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN lfALL 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 4 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: \70,{., If,h9 f ~:;:/~::;r:i:1flr7J PERMIT NO. 333652. Examined Approved Disapproved alc ,20~ , 20---.:L Expiration ,20_ 02, , {l.llG L A \ -; ~. ..c>~ APPLICATION FOR BUILDING PERMIT Date ~/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 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 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. It) .~/ /86 ,w~/1I1!fr/l ~;LA Y IJr7J (Mailing add ess of applican State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder #rYP /! T- Name of owner of premises /3/'-ep-<..y 5~t9,.yo7 t"O/?1/?! <.t11 (~...J;;-r C ' f ( on the tax roll or latest deed) If applicant is a corporation, signature of duly authoriz officer 'rf'f. 11 ~. (Name and title of corpo te offi r) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which p'roposed work will be done: I?fp.;)~ House Number Street ('~~r Haml Section '-I 7 ) '3 ~ C( Block sj - S-It? 6 Filed Map No. Lot Lot County Tax Map No.1 000 Subdivision (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy /l /,(7,( c/o;1 pif 14 rl vqf t' ~'7 ) qI;,d':,o / b. Intended use and occupancy J20 419 /r ';L /' 6l /7 3. Nature of work (check which applicable): New Building Repair Removal Demolition V-- Addition Other Work Alteration 4. Estimated Cost ~ ~/~ 5. If dwelling, number of dwelling units I If garage, number of cars ,t./dJl/ f (Description) Fee (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 ? I Rear a.3 ( Depth ~ "7 r Height Number of Storie~ . ...2- Dimensions of same structure with alterations or additions: Front A/ / ff Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front ~ / ~ Height Number of Stones Rear Depth 9. Size oflot: Front Rear Depth 10. Date of Purchase :; /.;J.O~ Name of Former Owner / II. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO t./ 13. Will lot be re-graded? YES ~NO_ Will excess fill be removed from premises? YES~1fc;_ Phone No. Phone No Phone No. 14. Names of Owner of premises Name of Architect Name of Contractor Address Address Address IS 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 ~QUlRED. 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. (!),i/ h'le 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES_NO_ * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF 5~/1() I (Name of individual signing co being duly sworn, deposes and says that (s)he is the applicant above named, (S)He is the 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. 20fl Btl'! ,ly J. PM;.:,,,,~~i Notary Public. SlL\e vI NlWt No. 01PEe011~ ~1~1k ~ Term ExtlIrll f t'l ~