HomeMy WebLinkAbout33975-ZFORM N0. 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. 33975 Z Date JUNE 11, 2008
Permission is hereby granted to:
SIMEON BY THE SOUND SAN
PO BOX 2122
GREENPORT,NY 11944
for
MINOR INTERIOR DEMOLITION TO AN EXISTING HEALH FACILITY AS APPLIED
FOR
at premises located at 61560 CR 48 GREENPORT
County Tax Map No. 473889 Section 045 Block 0002 Lot No. 002
pursuant to application dated MAY 30, 2008 and approved by the
Building Inspector to expire on DECEMBER il, 2009.
Fee $ 250.00
cure
ORIGINAL
Rev. 5/8/02
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
SoutholdTown.NorthFork.net
Examined ,20
Approved ,20
Disapproved a/c
Expiration , 20
', 3 0 !J
/~ BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
4 sets of Building Plans
Planning Board approval
q Check
PERMIT NO. ~ ~ I ~~
Flood Permit
Storm-Water Assessment Form
Contact:
Mail
Phone:
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Date January 20 08
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 of lot and of buildings on premises, relationship to adjoining premises or public streets or
azeas, 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 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.
(Signature of ap icant or name, if a corporation)
61700 Route 48, Greenport, NY 11944
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Owner
Name of owner of premises San Simeon By The Sound, Inc.
(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.
1. Location of land on which proposed work will be done:
61700 Route 48
House Number Street Hamlet
Septic Form
N.Y.S.D.E.C.
Trustees
County Tax Map No. 1000 Section 45 Block 02 Lot_
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy Nursing Home
b. Intended use and occupancy Nursing Home
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Demolition X Other Work
4. Estimated Cost 30,000 (Description)
Fee 250.00
(To be paid on filing this application)
5. If dwelling, number of dwelling units N/A Number of dwelling units on each floor N/A
If garage, number of cars N/A
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. Nursing Home
7. Dimensions of existing structures, if any: Front 234.3 Rear 234.3 Depth
Height 15 Feet Number of Stories one
194.2
Dimensions of same structure with alterations or additions: Front No change Rear No Change
Depth No Change Height No Change Number Of Stories No Chanoe
8. Dimensions of entire new construction: Front No Change Reaz No Change Depth No Change
Height No Change Number of Stories No Change
9. Size of lot: Front 390 Feet Rear 390 Feet Depth
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated
400 Feet
12. Does proposed construction violate any zoning law, ordinance or regulation? YES_ NO X
13. Will lot be re-graded? YES_ NO X Will excess fill be removed from premises? YES_ NO
14. Names of Owner of premises Address Phone No.
Name of Architect Thomas Campiglia, Architect PLidAddress zva*nVe^ue,Na„~VO*,Nr,ome phone No 212.245.6300
Name of Contractor Address Phone No.
I S a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO X
* 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 X
* IF YES, D.E.C. PERMITS MAYBE 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_
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF )
a
GAIT -~ /J~ri/Sa h~ being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the
~ S/~I~v J' iyf P a .v p
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.
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Applicant
i LEGEND: �p n
N'IL• N.LG• N'I•G , - DENOTES EXISTING CONSTRUCTION TO BE DEMOUSRE P0. RTv�� AS WT ED- �
G DATE: Ir.'"^'-IrX
DENOTES CONSTRUCTION TO REMAIN.
AT
r- - --- --- ---- - - --- 1 ---- --- - ----- -- -- i i- ,------ ------- - -_---� -- --i I ® EXISTING DOORS TO REMAIN. FO-1802 GINSPECTIONS:TMENT E
----- ------------------- -----
1 - - _ FOR THE
I m i 1. FOUNDATION - TWu REQUIRED
1 i i I FOR POURED CONCRETE
1 NOT IN CONTRACT AREA -
I )fit 2. ROUGH • FRAMING & PLUMBING
3. INSULATION
4. FINAL - CONSTRUCTION MUST
1 i I I i BE COMPLETE FOH CO
I I i I I II GENERAL DEMOLITION NOTES: ALL CONSTRUCTION SHALL MEET THE
F NEW
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REQUIREMENTS
NOT RESPONSIBLE SLODES OE FOR
- - -' - 1 1 .8-m- --- - --- ---- ----.--- " CONSTRUCTION ERRORS. '
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