HomeMy WebLinkAbout34086-Z
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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.
34086 Z
Date AUGUST
4, 2008
permission is hereby granted to:
JEROME E ZUHOSKI
440 FREEMAN RD
MATTITUCK,NY 11952
for :
DEMOLITION OF AN ACCESSORY IN-GROUND SWIMMING POOL AS APPLIED FOR
at premises located at
440 FREEMAN AVE
MATTITUCK
County Tax Map No. 473889 Section 139
Block 0003
Lot No. 040
pursuant to application dated AUGUST 4, 2008 and approved by the
Building Inspector to expire on FEBRUARY 4
Fee $
200.00
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ORIGINAL
Rev. 5/8/02
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Town
of Southold
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PROPERTY LOCATION: S.C,T,M.#:
Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM
0iSirict ~ ~ l:Ot
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.
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Item Number: (NOTE: A Check Mark ( ~) for each Question Is Required lor a Complete Application)
Ye.
No
1
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2
3
4
5
6
7
8
9
Will this Project Retain All Storm-Water Run-Oft Generated by a Two (2") Inch Rainfall on Site?
(This item will include all run.off created by sUe clearing and/or construction activities as well as all Site
Improvements and the permanent creation of Impervious surfaces.)
Does the Site Plan and/or Survey Show AU Proposed Drainage Structures Indicating Size & Location?
This Item shall Include all Proposed Grade Changes and Slopes Controlling Sur1ace WaterFlowl
Will thls,Project Require any Land Filling, Grading or Excavation where there Is a change to the Natural
Existing Grade Invoivlng more than 200 Cubic Yards of Malerial within any Parcel?
Will this Application Require land DIsturbing Activities Encompassing an Area In Excess of
Five Thousand (5,000) Square Feet of Ground Surfece?
Is there a Natural Water Course Running through the Site?
Is this Project within the Trustees jurisdiction or within One Hundred (1 DO') feet of a Wetland or Beach?
Will there be Site preparation on Existing Grade Slopes which Exceed Fifteen (15) feet of Vertical Rise to
One Hundred (100') of Horizontal Distance?
Will Driveways, Parking Areas or other Impervious Surfaces be Sloped to Direct Storm-Water Run-Off
Into and/or In the direction of a Town right-of-way?
Will this Project Require the Placement of Material, Removal of Vegetation and/or the Construction ot
any Hem Within the Town Right-ot-Way or Road Shoulder Area?
(This item will NOT include the Installation of Driveway Aprons.)
Will this Project Require Site Preparation wilhin the One Hundred (100) Year Floodplain of any Watercourse?
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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 Permit!
EXEMPTION:
--~----------------------------------------~--------
~
Yes
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 Requlredl
----------------------------------------------------
STATE OF NEW YORK,
COUNTY OF .SlJrEI:?L,1<, .. SS.
That I, Te,~&:-.E+.PeAM.AN:l!.:?Vjf1>&/'6.,'Ul~ duly
.
~\\'()lll, depo,<;e.s and says that he/she is the appucant for PClllljt,
(Name of individual signing Document)
And Llnt"b":i;:, I/:l~'" ..TfJ..,-, ...../l..t..>.NeA-..
(Owner, Contractor, Agen\, Corporate Of ricer, elc.)
Owner and/or representative of the OWller or O\~11er's, and is clul)' aulhorizecllo perform or have perrormed the said work and to
make and file this application; that all statements contained in this application are true Lo the best of his knowledge and belief; and
thlL the work will be perrormed in the manner set fOrlb ill the application filed hercvvilh.
Sworn to before me tbis;
3.~. . .. . day of .:;;72.. ..,20 cJ <?
Notary PUblic~........ .....~..
MELINDA .
FORM 06/07 TATE OF NEW YORK
- SUFFOLK CO. . NO. 4'08364
COMMISSiON.liXPlRESMAY31 ~Ol(
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TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
SoutholdTown.NorthFork.net
PERMIT NO. ~orb ~
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 7C'
Septic Form
N.Y.S.D.E.C.
Trustees
Flood Permit
Stonn-Water Assessment Form_
Examined
,20_
Contact:
Expiration
,20_
APPLICATION FOR BUILDING PERMIT
Date
7/3
,
206J"
'-
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 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.
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.
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I'~€:. B \\.O\\'Ise:','I:,'\-I\ rOR i\-l~ (Mailing address of applicant) IIQ
NOi\1' 8"'~ ';" ,\-\S, {5:L
State whether1liiol~~\tiW~~S/l.e6l\.\\~'ik architect, engineer, general contractor, electrician, plumber or builder
{a\'l,,; ,,:(\0\" ".p\c,S G
"OIJN'" r '"C" , - , \J,~\)\l<
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'2. RO\JGrI ';\QN--) nN ~\Jsi 'J
Name ofownerc~,f~,etQl'i"4~!~'.~(" E i~ I etj<:>~/.HI L.U 1-f"iJSk..r
4. I'\N"'\. O~?\.[.\'c ,v'''\-\i'-.\.'.. \~\t:~~ NttAs on the tax roll or latest deed)
If applicant is a cO~~~~~~iJd'1iI~~ed officer
~~"'iJ\t}\I~ rC3POl'l \~\l.I'lORS.
(Name and ~€'Cl>irro ~~\'l
O~S\GN OR C
Builders License No,
Plumbers License No.
Electricians License No.
Other Trade's License No.
1
JLO.;..,.z { I
n)
I. LocatiTj.:tsand on whic
House Number
proposed work wiJ,l be done:
Ie.. e ~1Y\"hV ILd. ffi4 TTi 7Ll<- "-
Street Hamlet
County Tax Map No. 1000 Section
Subdivision
i31
Block . -3
Filed Map No.
Lot 40
Lot
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 -p.~ I
Addition
Other Work
Alteration
5. If dwelling, number of dwelling units
If garage, number ofcars
:k70.
(To be paid on filing this application)
Number of dwelling units on each floor
(Description)
4. Estimated Cost
Fee
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 oflol: Front
Rear
Depth
10. Date of Purchase
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_
13. Will lot be re-graded? YES_ NO_Will excess fill be removed from premises? YES_ NO_
14. Names of Owner of premises
Name of Architect
Name of Contractor
Address
Address
Address
Phone No.
Phone No
Phone No.
15 a. Is this property within lOa feet ofa 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 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_
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF s:'vl'':;Olf4.
..,- c 2 .' fD /I >"7 'I~DSI<-l
.jot"""... _ /- ., Iff) $1< I eb(),<JI.,,/, ;L <J being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) al:lOve named,
Tht..'( 1J1l€.-
(S)He IS the Owt./f'A-
(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.
MeliN"" I.. TOPF'!"'~"JOTARY
PUSLIc;.S', AT' (.; :<If,' YORK
SUFFOi.~ CJ.. ,'08364
COMM~"""... ,.,.. """ "'Y3 II
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Sworn to before me this
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.3 /( D day of) VLr 20~
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Notary Public
J/A~~~t::t;Pl~ant .
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NOTIFY 8U By - 'OJ. L,
7""" I LOIN D"F'ART\'Crn ,;;;:"
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FOLLOWING INS? CT~'~~ J:OP THE
, FOUNDATION .
FOR POuRED TWO REQUIRED .
2. ROUAW NCRETE.
3. INS~Ti~RA ING" PLUMBING
4. FI~ . CO STR
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