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HomeMy WebLinkAbout29030-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. 29030 Z Date DECEMBER 20 , 2002 \401. 6 Permission is hereby granted to: No �— RHR REALTY 32 CREEK RDS WADING RIVER,NY 11792 for CONSTRUCTION OF A NEW SINGLE FAMILY DWELLING WITH ATTACHED ONE AND A HALF GARAGE WITH COVERED FRONT ENTRY AS APPLIED FOR at premises located at 1100 CHESTNUT RD SOUTHOLD County Tax Map No. 473889 Section 059 Block 0003 Lot No. 016 . 004 pursuant to application dated DECEMBER 19, 2002 and approved by the Building Inspector to expire on JUNE 20 , 2004 . Fee $ 1 , 372 . 50 Authorized Signature ORIGINAL Rev. 5/8/02 jWN OF SOUTHOLD O BUILDING PERMIT APPLICATION CHECKLIST 6UILDING DEPARTMENT Do you hav or need the followin , fore applying? TOWN HALL 70d of Health S SOUTHOLD,NY 1164. =fa • sets of Building Plans TEL: (631) 765-1802ra FAX: (631) 765-9502 ✓Survey --- www. northfork.net/Southold/ PERMIT NO. ,0,5 O-, ✓Check 0Septic Form X.Y.S.D.E. . T�stces Examined j.:d �4r' ,20 Contact: Approved �� ,20 y Mail to:e D v ©�l Disapproved a/c Phone: — �. Expiration - Building Inspector APPLICATION FOR BUILDING PERMIT .� Date / / 1�/ g, , 20 INSTRUCTIONS a. 'I�s application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 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 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 applicant or name,if a corporation) 00 01A� W2 E X1.91 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises (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. ! I-la LIZZ'" Plumbers License No. Electricians License No. Other Trade's License No. 1. Locatio of land op-tyv ' ropo��rk ' 1 be c 30 u T� /� House Number [i Street IP—,P V Hamlet County Tax Mapo 100 e tion �- � Block Q Lot Subdivision > /t1 Filed Map No. Lot (Name) i 2. State existing use and occupancy of premisesd int nded use occu y f op ed c1PRU ction: a. Existing use and occupancy /� ;��400 b. Intended use and occupancy 3. Nature of work(check which applicable): New Building Addition �� Alteration Repair T Removal /Demolition Other Work (Description) 4. Estimated Cost 0 ©d0 Fee //,�-- (To be paid on filing this application) 5. If dwelling, number of dwelling units .914 GlT,�Number of dwelling units on each floor If garage, number of c 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. A--- 7. Dimensions of existing structures, if any: Front Rear .CM- Depth Height Number of Stories Dimensions of same structure with alterations or additions: Frontf� . Rear 111111.4Depth ' 6— Height I ( Nubbcr of St ories 8. Dimensions of entire new construction: Front Rear Depth Height Number of StoriesEU 9. Size of lot: Front / Rear ��4 Depth / 10. Date of Purchase ` o Name of Former Owner 11. Zone or use district in which premises are situated z6�a RK7c:M � 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO- 13. Will lot be re-graded? YES NC Will excess fill be removed from premises? YES NO 14. Names of Owner of premises � Address hone No. Name of Architect (.6 Address Phone No Name of Contractor 0 Address s Phone No. 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 MAYB EQUIRED. 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. STATE OF NEW YORK) SS: COUNTY OF ) nn - ��'C. being duly sworn, deposes and says that(s)he is the applicant (Name of individual l siigning contract)above named, V (S)He is the NL6?F, 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 performed in the manner set forth in the application filed therewith. Sworn to be m t 's da Mv. 4 20 0 Z— No Public" Signature of Applicant RUDOLPH H.BRUER NOTARY PUBLIC,STATE OF NEW YORK NO.52-0465530,SUFFOLK COUNTY COMMISSION EXPIRES MARCH 30,_Z—OQ Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 12/16/02 Receipt#: 0 Transaction(s): Subtotal 1 Septic Permit- Construct- Resid. $10.00 Check#: 2960 Total Paid: $10.00 Name: Glasser, Frederick 220 Oak Avenue Southold, NY 11971 Clerk ID: JOYCEW Internal ID:64732 'a i Applicant/ Date Owners Name: `` —�� Reviewed: v ,V/Q3 Architect/ Date Engineer: _ /i- � ��Q Submitted: It/Op SCTM #: District: 1,000 Section: _ Block: Lot: Projectt Subdivision Location: 6 (� -- .— Name: 4M111�11"' Sin&Ie& separate Required 4/f eerdfication: (Yes/No ! Req. Req. Zoning District: '` ILot size: _�b6rfD AcluaL `� � I (Lot coverage I'ropascd I Req. /� / j Req. r Rey, / y jr°roni Yarde Propos" ) (Side Yard Propos e8y I .(Rear Yard �� Proposed �L"I Project Description: 44 AGENCUERMITS Permit . RQUIRED FOR REVIEW N.A. ISO kWmber Suffolk County Health Dept. New York State D. E. C. Town Trustees Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation??? Flood Zone: $ SURVEY OF • , s LOT 3 X06 jl MINOR SUBDIVISION PREPARED FOR �,,,o, RHR REALTY CO. O s FILE IM. wii nm ="non 13. ion Q ' �► SITUATZD AT ��� 4, ?• N'osTOWN OF SOUTHOLD �,� s ewnura '" :+► SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-59-03-16.4 \ O SCALE 1"=10W =NER 22 •\\\ 1 AOb 2002 i'b 2001 ti \ _ _ � FEBRtAARY 262001 kY�ED AS PER P21T'ER oA 02/24/02 AREA = 132.187.41 sq. ft. '`tom�'+ •/ 3.033 oc. xALI 101 �EQ01tt8D � / \ CRATnPra�_.FO 0�1N5�-u SYSTEM 4 44 \� ,�; FREDERICK E. GLASSER S Gp�VATivTA RTM I. aswosww AM W AM AMRRM MRT . 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