The URL can be used to link to this page

Home My WebLink About28808-Z FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT '11 ' Town Hall Southold, N.Y. 1� BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 28808 Z Date OCTOBER 8, 2002 Permission is hereby granted to : G STANKEVICH (PARISH OUTREACH) 260 HORTON LA. SOUTHOLD,NY 11971 for CONSTRUCTION OF A HANDICAP RAMP TO AN EXISTING DWELLING AS APPLIED FOR at premises located at 260 HORTON LA SOUTHOLD County Tax Map No. 473889 Section 061 Block 0001 Lot No. 003 pursuant to application dated SEPTEMBER 5, 2002 and approved by the Building Inspector to expire on APRIL 8, 2004 . Fee $ 0 . 00 Authorized Signature COPY Rev. 5/8/02 FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION(1ST) y x C FOUNDATION(2ND) �f z _ o y ry�y3 ROUGH FRAMING& y PLUMBING INSULATION PER N.Y. a y STATE ENERGY CODE / o FINAL J ADDITIONAL COMMENTS . O z z m Lis fiv �r n 0 x x 0 1 . TOWN OF SOUTHOLD BUILDING PERMIT APPLIC.�TION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 3 sets ofBuilding Plans ✓ TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey . PERNIIT NO. S O e-p,- Check Septic Foam N.Y.S.D.E:C. Trustoos Examined 1!?� 7 ,20-0-1- Contact: //�� Approved l o�/Q ,20_V Mail to' f' A d!( 1 P7 b-i Disapproved a/c I+�U)ci� 4 W Phone:f �.3 Expiration 20a AV C' Building�Inspector -`' — 5 29L APPLICATION FOR BUILDING PERIVIIT BLDG. DErT Date� ;J 2002— . .7 OF c ,un-rac.p INSTRUCTIONS a. This 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. ?-0,60)( � Q o app or n rne,if a corporation) 'f•O.170 S �OGt7710� Waft address of applicant) q 7 State whether applicant is owner, lessee, agent,architect, engineer, general contractor, electrician,plumber or builder Name of owner of premises e3 c02rgE a4 f\)kE (As on the tax roll-or latest deed) I p icant is corporation, s'patme of y authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: C9 bo 0 2To.0 S J-4 NE sOc.cT o� House Number Street Hamlet �..� .R� An,°V.s �hoYw:,t+ 1 YiIA;OO County Tax Map No. 1000 Section Q G, Block Subdivision Filed MapoN ',ija :I (Name) 2. State existing use and occupancy of premises and intended-use and occupancy of proposed construction: a. Existing use and oc c%mcy 'f H 21 r-r 210 Re a ,a T* b. Intended use and acrupancy S" "� 3. Nature of work(check which applicable):New Building Addition Alteration Repair .Removal Demolition 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. 7. Dimensions of existing structures,if any: Front Rear Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction:Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase 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 NO 13. Will lot be re-graded?YES NO Will excess fill be removed from premises?YES NO 14. Names of Owner of premises Address Phone No. Name of Architect Address Phone No Name of Contractor Address 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.PERIVIlTS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? *YES NO * IF YES,D.E.C. PERMITS MAY REQUMED. 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) "Jc S: COUNTY OF "'?A u L imc W i 0TE726ott-v m being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He the G 0j?-- (Conhactor,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. Swom to before me this day of=r 20 0 a Notary Public efelict LYNDA M.BOHN NOTARY PUBLIC,State of New Ybtk No.01806020932 � Qualified.in Suffolk Countv- Term Expires March 8,200 r Y FK AIMS vi �o i c I QCT. ! o m x 0 E r X1 E D q y�l y 015244 OF NEVN , s u ff Gain T,%r. l l asi�ai t'OM. is t 10QQ0 'sf. 06 1 , Bfk, l , F f. . BUILDING--ID-I440II�' IZL�I-F-W--GH EC K-US-J- __ Applicant/ Date Owners Naive: Reviewed: /� D Architect/ Date Engineer: -tea Submitted: SCTM P: District: I,000 Section: (31ock �_ Lot:—3 Project _ Subdivision Location: ` �Pd � Name: Single & separate Required certification Yes/No CD (� Q� Req. Rcq. ( — 7_oning District: 1 [J (I of s c: _l� 0 U AcRial: T3 J (�� ( (Lot covcragCt Prulxscd d Rey. / ! Rcq. / Req. ((=roa Yard`_Proposed: J (Side Yard Proposedd/ J [Rear Yard -2A Proposed _ ( Project Description: Plnrl-� AGENCUERMITS Permit REQUIRED FOR REVIEW N.A. NO YES Number 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: Notes.: