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HomeMy WebLinkAbout33405-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. 33405 Z Date SEPTEMBER 19, 2007 permission is hereby granted to: VICTOR DIPAOLA PO BOX 379 MATTITUCK,NY 11952 for : DEMOLISH AN EXISTING IN-GROUND SWIMMING POOL AS APPLIED FOR at premises located at 14605 MAIN RD MATTITUCK County Tax Map No. 473889 Section 114 Block 0008 Lot No. 006 pursuant to application dated SEPTEMBER 12, 2007 and approved by the Fee $ 220.00 Building Inspector to expire on MARCH ORIGINAL Rev. 5/8/02 \ John l' I L..L... ''IV. /.-. po~~:".. .~____. . ~...--. 71.66 \ < '"" \ m , ~ <::> ! ~ -\ b ." '" \J \ '" b <. '" "2- c:. '" f.-L- -.J \J 1 '-.J.......>J " II I I +- I oJ>.O r. tJlJ>.\~ / / / NOTE . : MONUMENT - f~~n ~~I ~~ ...~} - Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M. #: _ ---1d -L -.L District Section Block Lot THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A STORM-WATER, GRADING. DRAINAGE AND EROSION CONTROL PLAN CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. ---------------------------------------------------- Item Number: (NOTE: A Check Mark ( </) for each Question is Required for a Complete Application) Ves No ---------------------------------------------------- -If [il ~ c;] :fJi' ~ ~ ~ ~ ~ ~ 1 Will this Project Retain All Storm-Water Run-Off Generated by a Two (2") Inch Rainfall on Site? (This item will include all run-off created by site clearing and/or construction activities as well as all Site Improvements and the permanent creation of impelVious sulfaces.) 2 Does the Site Plan and/or Survey Show All Proposed Drainage Structures Indicating Size & Location? This Item shall include all Proposed Grade Changes and Slopes Controlling Surface WaterFlowl 3 Will this Project Require any Land Filling, Grading or Excavation where there is a change to the Natural Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? 4 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand (5,000) Square Feet of Ground Surface? 5 Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction or within One Hundred (100') feet of a Wetland or Beach? 6 Will there be Site preparation on Existing Grade Slopes which Exceed Fifteen (15) feet of Vertical Rise to One Hundred (100') of Horizontal Distance? 7 Will Driveways, Parking Areas or other Impervious Surfaces be Sloped to Direct Stonn-Water RunMOff into and/or in the direction of a Town right-of-way? 8 Will this Project Require the Placement of Material, Removal of Vegetation and/or the Construction of any Item Within the Town Right-of-Way or Road Shoulder Area? (This Item will NOT include the Installation of Driveway Aprons.) 9 Will this Project Require Site Preparation within the One Hundred (100) Year Floodplain of any Watercourse? NOTE: if Any Answer to Questions One through Nine is Answered with a Check Mark In the Box, a Storm-Water, Grading, Drainage & Erosion Control Plan is Required and Must be Submitted for Review Prior to Issuance of Any Building Pennltl ---------------------------------------------------- EXEMPTION: Ves No Does this project meet the minimum standards for classification as an Agricultural Project? Note: If You Answered Yes to this Question, a Storm-Water, Grading, Drainage & Erosion Control Plan Is NOT Required! ---------------------------------------------------- STATE OF NEW YORK, COUNTY OF ...f?~ffi?.~""... SS That!, \!.\.c.1::v..i".".J>..Lp.?\.o.l.t6-""""""""""" being duly sworn, de~oses and says that he/she is the applicant for Pennit, And that he/she(~:::1 ;ndi~~~.~::.:~~:~~.~=Ih~~.........:...................................................................................................... (Owner, Contractor, Agent, Corporate OffICer. etc.) Owner and/or representative of the Owner of Owner's, 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 herewith. Sworn to before me this; .......!..~......\.................... day of ......~...t........................ ,20..Q I Notary Public: ...~~...~.t:.~MEl:ANlEy:~ ~...~.....1L...t:.?~~............. NalIry I'lMct, SlIIlI Ill.... York (S'gnature 01 App',canl) .-. Qllllldln aM~ Clalmllllon ElipRI Ocl. 19..,,< 0 ~ FORM - 06/07 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.N orthFork.net PERMIT NO. 33\..\ 0 'S :c 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 "$/) 0 . OC) Septic Form N.Y.S.D.E.C. Trustees Storm-Water Assessment Form_ Examined ,20 Expiration ,20 Contact: Mail to: Approved Disapproved ale ,20Y' Phone: APPROVED AS NOTED ~ Q.3l.{()5~ DATE' 1 u) :r B.P. # f. . d /), -;7)(Je . ~B? 7 9 ~ "h1 ~1Il Tv</.. k FEE: ::ZZ. .~. '. ilTMENT AT (Mailing address of applicant) NOTIFY BUILDIN',O ; PM FOR THE State whether appl1l!~~~G 1~!~~~~l!gent, architect, engineer, general contractor, electrician, plumber or builder FOLLOW " REQUIRED fil1.&lW~N' T:Ij~ V FG ED CC,N"P.ETE 2. ROUGH. FRAMIi,c; & PLUMtlll,<3 . Name of owner ofm.-~SltIA~,I"rr \';lr~N ~~Tf.1. c L.ri - 7!JI~.,:z (2,.14 Ill\- (it"rl-t> ~ ~~lUr- 01 t. ~L4 4. FINAL. COI', '~:. "0 (As on the tax roll or latest deed) If applicant is a corpoJijii~~lJi1h,;~ o!~~ mtt!lt:>lImted officer ALL CONSTR'UcmJ, F NEW E'.'PlTC OFTI-H:r,ODESO (Name and t~~F~@raNoqJfRl1ef')DNSIBLE FOR YOR ~ I. TION ERRORS. DESIGN OR CONSTRUe Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. . I ~"" i~:'-,~ \l (~ ~'~\',.,', APPLICATION FOR BUILDING PERMIT ~o)\. \0\ \\ 1\\ \ ' ) \ 2. \.\ Date \1...1 L- -~~.J INSTRUCTIONS a. Thi~llt[<lllJi5ii"M~T'oeC(;mpletelY filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets ofpl~'ciirate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot 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. APPLICA nON IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance ofthe 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. -V~ V, f~ (Signature of applicant or name~ if a corporation) ,20_ I. Location of land on which proposed work will be done: /Lf60$ Y'VlAIVI/ ~o4j) Yvlrt-T/ITvc.K: tv y House Number Street Hamlet County Tax Map No. 1000 Section I ( '( Subdivision Block 1S Filed Map No. Lot f.:, Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Repair Removal Demolition Addition OtherWork f".~'- Alteration 711r IfVrPJ<ll/iJ (Description) ~~L 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 Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Height Number of Stories Rear Depth 9. Size oflot: Front 'i?'f. <J9 Rear 7/. b b Depth JiQ't.og' 10. Date of Purchase 0 c-T: '[;) 0 () 0 Name of Former Owner Ii. 0 tV S ~ It w ii nO. ~ 12- 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_ NO C/ 13. Will lot be re-graded? YES~NO_Will excess fill be removed from premises? YES_ NO~ 14. Names of Owner ofpremisesi", nIL J), f4"'''''' Name of Architect Name of Contractor Address ttt6017 '\'\.t~11li /!O Phone No. Address Phone No Address Phone No. J'1?(J(J?d 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES _NO r * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. 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. 18. Are there any covenants and restrictions with respect to this property? * YES_NO t/ * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY 0I6vffQL14- \; 1 C~-f VI tau) fl _ being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the ~ (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 thi~ =-t day of ~ 20~ /Y\.i. i~Y' ~ MElANIEV.1lRO'iM ~ D, p~ Notary Public NalIry NIle, SIIII 01.... Yolk Signature of Applicant No. 4llOI712 CUIIIed In UaII CauIty Clnlrnlllloll &pAl Oel. 19. )- ~a ~.