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Home My WebLink About35028-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. 35028 Z Date SEPTEMBER 25, 2009 Permission is hereby granted to: MARION J F LEYDEN 119 WEST LANE 2ND FL STAMFORD,CT 06905 for : DEMOLITION OF EXISTING SEASONAL RESIDENCE AS APPLIED FOR at premises located at 3050 CAMP MINEOLA RD MATTITUCK County Tax Map No. 473889 Section 123 Block 0005 Lot No. 007 pursuant to application dated SEPTEMBER 17, 2009 and approved by the Building Inspector to expire on MARCH 25, 2011. Fee $ 148.00 Authorized Signature ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEP~RTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net Exam/ned { Approved ~<, 20 Disapproved a/c Expiration ~ /~"~C ,20 i! 8EP 1 7 ~,~ TOWN OF SOUTH'OLD PERMIT NO. , 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 Septic Form N.Y.S.D.E.C. Trustees Flood Permit Storm-Water Assessment Form Contact: Mail to: Building Inspector APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ,20 a. This application MU5 t bi :ompletely 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 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 appli~kar~t or'fi'~am~', ~f a corporation) (Mailing address of a[plica~t) t State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner ofpremises ~ ~ ~,o~ DATE:~_ E.~., ,fi,~ [/~[ If applicant is a co¢oration, si~ature of duly authorized officer NOTI~,,~ ~ ; ASTMENT AT 76548~2 ~ ~' - ,-~ ~ ;~,~ FO~ THE (Name and title of corporate officer) Builders License No. oQ_[ Plumbers License No. Electricians License No. Other Trade's License No. ! Location of land on which proposed work will~};~e d~one: House Number ¥ Street FOLLOWING INSPEC'NONS: 1. FQUNDATION * ?WO REQUIRED FOR POURED <C; CRETE 2. ROUG!4 - F! %',ilG & PLUMBING 3. INSUL,:d 4. FINAL - CO l~'"r4 lqT!ON MUST BE COLIPLE7 E ;,3:-~ C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF °~at~)e~;Ur4~ I H UCTiON ERRORS. County Tax Map No. 1000 Section I Z_ ~ Block -~ Subdivision Filed Map No. Lot "-7 Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~-O. ~:::' '~- b. Intended use and occupancy ~"~,~ ~. ~ 3. Nature of work (check which applicable): New Building_ Repair Removal Demolition 4. Estimated Cost Fee 5. If dwelling, number of dwelling units If garage, number of cars Addition Alteration Other Work (Description) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, 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 Depth. Height. 8. Dimensions of entire new construction: Front Height Number of Stories 9. Size of lot: Front Rear Number of std,rii~s Rear I ...... Depth Depth 10. Date of Purchase Name of Former Owner 1 I. 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 Phone No. Address Phone No Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES * 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. NO 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 · IF YES, PROVIDE A COPY. NO STATE OF NEW YORK) SS: COUNTY OF 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 perfom~ 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 t.,~before me this ~-' Notary vuouc N0. Oualffi~ in S~lk Commissi~ ~pir~ July 28,20 -- ~i~nature of Ap~cant TOWN OF SOUTHOLD P~I~0PERTY RECORD CARD TYPE Of BUILDING LOT ~ES. ,,~ ~ d:~ SEAS. ~ VL FARM COMM. LAND IMP. TOTAL DATE REMARKS AGE NEW NOP, A4AL Farm Acre BUILDING CONDITIOF ABOVE Value FRONTAGE ON WATER FRONTAGE ON ROAD Fillable 1 BULKHEAD ; ,illable 2 DOCK Fillable 3 ~Voodland , }wampland }rushland I douse' Plot fetal Est. Mkt. Value I i J r ] [ Foundation ~ . Bath ,.Bldg. /,~'~ .- 3~o ~ /'1 ~ement //0 Floors (tension ~,~ ~ : ~ ~ ~ ~?-D j~ ~ <tension /~ ~ / ~ /~~ Ext. Walls ~$ ~. , Interior Finish <tension Fire Place A/x~ Heat ~X ~ ~ /~o /~ / ~ ~ ~ Porch Roof Type ' < Porch Rooms 1st Floor reezeway Patio Rooms 2nd Floor or~o~ Drivowoy Dormer 147 L I ._.