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HomeMy WebLinkAbout35207-Z TOWN OF SOUTHOLD BUILDINGDEPARTMENT TOWN CLERK'S OFFICE oy . SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE,KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 35207 Date: 12/10/2009 Permission is hereby granted to: Ovsianik, Allen 618 Ridge Ave Ephrata, PA 17522 To: REMOVAL OF FUEL TANKS AS APPLIED FOR At premises located at: 32930 Route 25 SCTM # 473889 Sec/Block/Lot# 97.-2-15.1 Pursuant to application dated 12/7/2009 and approved by the Building Inspector. To expire on 6/10/2011. Fees: FENCES/WD STV/SATT/TENNIS CT $250.00 Total: $250.00 Building Inspector I TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans = TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 _ Survey SoutholdTown.NorthFork.net PERMIT NO. J d67 � Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Examined /la ,20 Storm-Water Assessment Form c Contact: Approved ��� ,20 / Mail to:,6A Disapproved a/c 7�/�.�u�'�r1/,9n/, 'c• ��nx�erJl�[E✓S7k'/y� Phone,/L 5,23-V7,T6 Expiration eq ,20/l/ ® E LW E Building Inspector �® 2 200 APPLICATION FOR BUILDING PERMIT Date // /9 52007 DG.DE . INSTRUCTIONS TOWN OF SOUTHOLD 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 Southold, Suffolk County,New York, and other applicable Laws, Ordinances or Re lat' ,;,fir tl yt ildings, additions, or alterations or for removal or demolition as herein described.The a t r t c+ v h1 blicable laws, ordinances,building code,housing code, and regulations, and to admit as a 'in building for necessary inspections. DEC 7 2009 �.� a- L.' �i o (Signature of applicant or name,if a corporation) BLDG.DEPT. TOWN OF SOUTHOLD 7/p�'A11mA,0 AI)c', Lii9d,-A)�trs7-/V. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor; electrician, plumber or builder ° A I`P t`111-1 i'�.P AS, I'd09 Name of owner of premises /few 4)° °,F _ % 3 r7 (As on the tax roll or 1 es­ deed) If applicant is a corporation, signature of duly authorized officer FF`E'� �' - - - F t': ,FWWAa eb,- Pc-s;tear/ N07iF4" B �Ci s,;MIEENT AT Name and title of corporate officer 765-1802 B , .; +' FOR THE F01 LO',TNIGS Builders License No. F(311­; ;OUR"C; Plumbers License No. -'O 8 13 7 2. ROUGH - H_UIv!SING Electricians License No. 3. INSULAT!0N Other Trade's License No.Nhsso i o4.vly r-,e149-1/,s/ ;WWW i '0191/l 'NAL ` CO!`51 r,UCT!ON MUST BE COMPLE i E FC C.O. 1. Location of land on which proposed w rk will be done: ALL CONSTRUCTION SHALL MEET THER ENTS OF THE CODES OF NEW :3�z 1,730PSf 02's- li.#;k Aer OF we- If_)_QTATE. NOT RESPONSIBLE!BLE FOR House Number Street �-7 DES!G RileONSTRUCTION ERRORS. County Tax Map No. 1000 Section Block 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 ee-t ,l e Sdes b. Intended use and occupancy JCe hl-�- S/,o 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal ,/ Demolition Ll-*- Other Work (Description) 4. Estimated Cost '�'�� �- Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. Gsdlt�e Stato,v 7. Dimensions of existing structures, if any: Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Depth Height Number of Stones` .....d i j I..t 6 8., Dimensions of entire new construction: Front Rear Vepth Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase Naive of Former Owner 11. Zone or use district in which premises are situated leusl+ess 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO_Z 13. Will lot be re-graded? YES NO /Will excess fill be removed from premises? YES NO t/ 14. Names of Owner of premises 411coiJ- 0iS14,y k Address� &e . Phone No. 611' 74-5- 12V97- Name of Architect Address Phone No Name of Contractor s Cd Address 7G r.llfl1mea Avg_Phone No.0 7- L��cfe��iu�s7' 75-7 51b 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES;;:- ",`:NVQ.`--, '; ;-- * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAYBE REQ� D.�IRE1'"1 ,J ' I 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 propert lineL­-._r .-._m-•�T`a„� 17. If elevation at any point on property is at 10 feet or below, must provide topogr phiEalata on•suruey� ,�.,.,q, 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 ) I�Vlae / � being duly sworn deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the ( ontracto , 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 state ' nts contained in thisation are tine to the best of his knowledge and belief, and that the work will be performed in he manner set forty in the pplication filed therewith Sworn to b fire me this �. Ilday of s.1 Ov 0 _ Not Pub- FB A D C _- tate o-►v.�9 Yo,4 t, otary Publ alifia 'M-_-W-” Signature of Applicant Comm ro�Coanty sioee Exair®s vcI-S' l b z� � Town -.of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENTPORM l [COO LOCATION: S.C.T.M. THE FOLLOWING'ACTIONS MAY REQUiRE THE SUBMISSION OFA L�G L STOlIiXl�IiATER,G UINGy DRAIN GE AND EROSION CONTROL PLAN District St ctipn Block . Lot CERTIFIED BY�1 DESIGN PROFESSIONA IN THE STATE OF NEW - YORK. —� ------- -------------------*---=-------- ______ Item__ Number. (NOTE: A Check Marc(4)for each Question is Required for a Complete Application) — _----- Yes No ———— -------- ------------ ___ ___ __ Will this Project Retain All Stonr>~Water Run-Off Generated by a Two(2")Inch Rainfall on Site? — — (This'item will,indude all run-off created by site Clearing and/or construction activities as welt as alt Site Improvements and the permanent creation of impervious surfaces.) 2 Does the Site Plan and/or Survey Show All Proposed Dfainage Structures Indicating Size&Lobation? This Item shall include all Proposed Grade Changes and Slopes Controlling Surface WaterFlowl — 3 Will this Project-Require any Land•Fiiling,Grading or Excavation where there is a change to the Natural Existing Grade Involving more than 20a Cubic Yards of Material within any Parcel? _ 4 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of V/ Five Thousand(5,000)Squaw Feet of Ground Surface? _ 5 Is there a Natural Water Course Running through.the Site? Is this Project.w)thin the Trustees jurisdiction or within One Hundred(100')feet of a Wetland or Beach? El Will there be Site preparation on Existing Grade Slopes which Exceed Fifteen(15)feet of Vertical Rise to One Hundred(100')of Horizontal Distance? 0 —/ 7 tNll Driveways,Parking Areas or other Impervious Surfaces be Sloped to Direct Stohn-Water Run-Off into and/or in the direction of a Town dght-:of--way? $ Will this Project Require the Placeirient of Material,Removal of Vegetation and/or:the Construction of El ` any Item Within the Town Right-of-Way-or Road Shoulder Area? _ (This item will,NOT include the Installation of Driveway Aprons.) + 9 Will this Project Require Site Preparation within the One,Hundred(100)'Year Floodplain of any Watercourse? NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark in the Bdx, a Stbrm-Watery Grading, —— Drainagej&Erosion Control Plan Is Required and Must be Submitted for.Review Prior to Issuance of Any Building Permit! EXEMPTION' ----------------------- ' Yes Na Does this project meet the minimum standards for dassifica"ri as an Agricultural Project? Note: if You Answered Yes to this Question,it Storm-Water,Grading,Drainage&Erosion Control Plan Is NOT Requiredl• STATE OF NEW YORK, _-- '—" —_----- - --------LL-----------.----— COUNTYOF..........................................SS That r,��A�� t'_"l... �� ............... /..' k k..... ... ..............................being duly sworn,deposes and says that he/she is the'app icantfor Permit, (Name of Individual signing Documen) Andthat he/she is the C.I 4A rc!: '.� .. ......................... ... ................................... .............................. (Owner,Contractor,Agent,Corporate Officer,etc.) Owner and/or representative of the Owner Of Owner's,and is duly authorized to perform or have performed the said work and to make and hie this application;that all statements contained in this application are true to the best of his knowledge and belief,and that the wor k will be pe an ved in the m t forth in the application filed'herewith. Sworn to before me thi .............. .................�. .......day.of: ,:.. ............ 200.0� , ., GEBF)ARD Notar� to c SPaf dvd York 1�iotary Pub .... � .Gdj.. ........ .. .... . o,.� .......................... 1 S ... .............. Q alified in Suffolk Gounly- t +9nature-of Applican() FORM'- 06107 ommr stun EGros OGr%ti'w Is Telephone (631) 475-1450 E-mail: gmdege@optonline.net Facsimile (631) 475,-1238 www.gmdege.com G or- N DJEGE, Inc. Est. 1961 • SERVICE • MAINTENANCE • INSTALLATION Service Station Construction • Tank Removals & Installation Pumps & Dispensers • Electronic Tank Monitoring System Tank Testing • Signs & Lighting • Lift Installation 250 ORCHARD ROAD, EAST PATCHOGUE, NEW YORK 11772 March 1,2009 To Our Valued Customer, G&M Dege,Inc,is a full service pump and tank contractor, Our hours of operation are Monday thru Friday-7:30 A.M.-4:30 P.M. In the event of an emergency,after hours services are available. G&M Dege,Inc.provides the following services: INSTALLATION AND MAINTENANCE OF GASOLINE/DIESEL PUMPS INSTALLATION AND MAINTENANCE OF ELECTRONIC ALARM MONITORING SYSTEMS ON TANKS CERTIFIED TANK AND LINE TESTING TANK INSTALLATIONS AND REMOVALS 1 INSTALLATION AND MAINTENANCE OF AUTOMOTIVE/TRUCK LIFTS INSTALLATION AND MAINTENANCE OF AREA LIGHTING AND SIGNS Please do not hesitate to call with any questions and we look forward to having the opportunity to provide our services to you in the near future. Sincerely, �'�/J ,- � ��J� � � � , ��6v ® ECE � � � NancyP Galli oli-Barrie -- G&M Dege,Inc. DEC 1 1 2009 BLDG.DEPT. TOWN OF On,"'.OLD t�' ..� - t• ._.._...r.r- •'� I •t .• ,.� mss, � � ' A 41 , J / O `' '` ,•c ,` ,.;1 KKK �y,; T}//, �; '� r'✓' r,i SIV• ` � ' � >t F�c.r E/. +'' • � "V -� •`r �•r � ..- ,yam '� ., •, �. Lly .3 E! 1 ,} En/2.4 f/�/2.9 ��� E/},/�•G •,1 �'yi/J.L / •.