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HomeMy WebLinkAbout34793-ZFORM 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. 34793 Z Date JUNE 17, 2009 Permission is hereby granted to: BREEZY SHORES COMMUNITY P.O. BOX 1186 WESTHAMPTON BEACH,NY 11978 for : DEMOLITION OF EXISTING 3 BAY SHED AS APPLIED FOR atpremises located at County Tax Map No. 473889 Section 053 pursuant to application dated JUNE Building Inspector to expire on DECEMBER 65490 MAIN RD GREENPORT Block 0005 Lot No. 012.006 9, 2009 and approved by the 17, 2010. Fee $ 142.00 Authorized Signature ORIGINAL Rev. 5/8/02 TOW/q:QF SOUTHOLD ~BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown. NnrthFork.net PERMIT NO. 1 BUILDING PERMIT APPLICATION CHECKLIST Do you h~ve or need/he follow, g, before applying? B~ard of HeaRh 4 sets of Building plans. planning Bored approval Septic For~ Building Inspector LICATION FOR BUILDING PERMIT Date INSTRUCTIONS nely filled in by typewriter or in ink and submitted to the Building Inspector with 4 ~ according to schedule. and of buildings on promises, miationship to adjoimng premises or public steers or ation may not be commenced before issuance of Building Permit d. Upon approval of this applicafioo, the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the promises available for mspoc~don throughout the wodc. e. No building shall be occupied or used in whole or in pa~ for any puq)oss what so ever until thc Building Inspector issues a Certificate of Occupancy. £ Every building-permit shallovpi~ iftbe wod~ antberizcd has not conunonocd within 12 months after dic date of issuance or has not been completed within 18 months from such date. If no zouing amenthnents or other regalatiolls affecting file 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 n~luired. APPLICATION IS HEREBY MADE to the Building Department for tha issuance of a Building Permit pursuant to the Building Zone Ogdinan. ce of the Town of Southold, Suffolk County, New Yofl~, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein deson3ed. The applicant agrees to comply with all applicable laws, ordinances, building code, honsing code, and regulations, and to admit authorized inspectors on premises and ui building for necessuty inspections. - ($igntflure of'appli~tm or name, if a ¢orporati6ff) / (i~aailing adch~ 0 f applieanI) State whether applicant is owner, lessee, agent, architect, engineer, general ¢on~t, ~ r, fle~:ffiiia~ ~lYmlbev o~ build ,e~ Name of ownek¥/of premises '' - / ~'-[As°n'flietaxr°ll°rlatcst:-0~0g0~/~Avl :© gPt~ ry If applicant ~s a c,qvpomUon, s~g~tu~ori~ ~) LOV/ING ~' ~?ECT C)NA, ~r! POURED CONURETE BnildersLiocnscNo. 2. ROUGH - FRAMING & PLL '3:NG Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on v/hich proposed work will be done: 3. INSULATION 4. FINAL. CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTR~_TION SHALL ME~-T THE (/~.,~./~1~_ ~ OF THE CODES OF NEW - ~ ~A]E. NOT RESPONSIBLE FOR House Number ' ' ' S~recT' s-D~SG.Nt~OR CONSTRUOTION EERORS. Co=WT~No. I000 s aonVT ff Bl~k3-~ ~ ' ~' Su~vision Fil~ M~ No. ~t 2. State existing use and oecupancy of premises and mtcaded use and occupancy of proposed construction: a. Existing use and occupancy '-/"~'/,~ ,~-~' /~ ,,'/k / e"~> ~t° ~ b. Intended use and oecupancy f_~-~/9'l~/t'_~'/'e~'~7 3. Nature of work (check which applicable): New Building__ Addition Alteration Rapair Removal Demolition 4. Estimated Cost _3~ ~// OOC~) 5. If dwelling, number of dwelling umts If gamoa, numbar of mrs 3 6. {f lyash~ss, cc, mm~eial or mixed ooeupancy, specify untur~ a~d extent of each type of use. 7. Dimensions of existing structures, if any: Front ~ ~) Rear ~:) Depth / ~ Haight Numbar of Stories / Dimensions of same structure with altamtions or additions: Front /~;,'//,~ Raar Depth Height Numbar of gtofies 8. Dimensions ofentire new constmcfion: Front ,d~J~ Rear Depth Height Number of Storie{/ ~¢r Work Fee (De on) (To be paid on filing this application) Number of dwelling units on each floor 9. Size of lot: Front Rear 10. Date of Purchase .2_./..xt~ Name of Former Owner / 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES 13. Will lot be re-graded? YES b'/'NO 14. Names of Owner of promises Name of Arohitect Name of Contractor Will excess fill be removed from premises? YES NO Address Phone No. Address Phone No Address Phone No. 15 a. Is this propeay within 100 feet of a tidal wetland or a freshwater wetland? *YES NO ~ * IF YES, SOUTHOLD TOWN TRUSTEES & DEC. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES__ NO__ * ~F YES, D.E.C. PERMITS MAY-BE R-mlqRED. 16. Provide survey, to scale, with accurate foundation plan and distances to pmparty lines. ~,/~ fi//~:> 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on sm'vey. 18. Am there any covenants and restrictions with respect to this prope~x'y? * YES NO ~ * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: cotrm ~e of ~dual ~c~t) a~e mmV, (S)He is ~ ~~ ~ ~ /(~tor, ~g~k Co~mte ~cer, etc.) of ~d ow~ or ow~ ~d is dffiy ~d to ~ffo~ or ~e ~ffomed ~ ~d wo~ ~ to ~e ~ file ~ ~p~cafion; ~t ti ~e~m comi~ ~ ~ app~mfion am ~e to ~ ~m of ~s ~wl~ge aM be~ef; ~ ~t t~ wo~ wffi ~ ~ffomed ~ ~ met set fo~ ~ ~e application ~ed ~wi~. Sworn to ~om me~s ~/ NO~ ~b]tc NO. 01E~998698 ~ ~ ~1~o~ Qualified in Suffolk Coun~ Commi~ion E~ires J~