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HomeMy WebLinkAbout35455-ZFORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 35455 Z Date APRIL 9, 2010 Permission is hereby granted to: T CLEVELAND WOODALE RD GREENWICh, CT 06830 for : REMOVAL OF UNDERGROUND FUEL TANK AS APPLIED FOR at premises located at County Tax Map No. 473889 Section 012 pursuant to application dated MARCH Building Inspector to expire on OCTOBER GREENWOOD RD FISHERS ISLAND Block 0001 Lot No. 007.001 29, 2010 and approved by the 9, 2011. Fee $ 250.00 /!'~ ~u~th~ri~~ature ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork. net PERMIT NO. Contact: Approved ¢/4,20/(~ Mail to: Disapproved a/c Phone: 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 Expiraton /~) '~ 20 //  , Building Inspector /1 ~~//~I~LICATION FOR BUILDING PERMIT ~p~~tely filled in by typewriter or in ink and submi,ed to the Building Inspector with 4 sets of ~ t~cale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or ~e~, and wate~ays. 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 applic~t. Such a pe~it shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pa~ for any purpose what so ever until the Building Inspector issues a Ceaificate of Occupancy. fi Eve~ building pe~it shall expire if the work authorized h~ not commenced within 12 months aRer the date of issu~ce or h~ not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the propeay have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the pemit for ~ addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Depa~ment for the issuance of a Building Permit pursuant to the Building Zone Ordin~ce 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 ~ herein described. The applic~t agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, ~d to admit authorized inspectors on premises and in building for necessa~ inspections. ~f_ .~ ,--~~ (Signatu~of applicant or name, ifa co~omtio ) (Mailing add,ss of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises -~ [h~, t~S C c[_v~_c_,~uD If applicant is ~.c~orporation, signature of duly (N[~me and title of corporate officer) Builders License No. ,, i'? ~, - Plumbers License No. : ' Electricians License No. Other Trade's License No. (As on the tax roll or latest deed) .APPROVED authorized officer , '-~-, t:b ' 3 . Location of land on which proposed work will be done: House Number Street County Tax Map No. 1000 Section Subdivision _ 3L Ham~L CON:~'ff:~U~T~CN SEALL MEET THE Block 0 Filed Map No.~~k5 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy x/^&C~w'r - Fcr~ g/~7~U * ~'-~LCl~,6 5r-n'ooaJ b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Repair Removal Estimated Cost 'x ~o Addition Alteration Demolition Other Work I K Fee a v~ ''~ (Description) (To be paid on filing this application) If dwelling, number of dwelling units ~ - Number of dwelling units on each floor If garage, number of cars ,o ,x 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 Dimensions of same structure with alterations or additions: Front Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size oflot: Front ~0~ Rear ~?1 ?'5'~ Depth ~o~ .'{7 Rear .Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated G ew,~;~a 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO X' 13. Will lot be re-graded? YES NO 5~ Will excess fill be removed from premises? YES NO >' 14. Names of Owner of premises T~t-o~ ¢~ c~&/6_t~dAddress ! ¥o ~u. '4~'~' 5'r b%?Phone No. NameofArchitect ~,~ Address t~oo~sroO<, ~r PhoneNo t;6o- Name of Contractor ~v~C 0,% Address ~,.o .,4.~v~,,o, c! PhoneNo. 2o~ - / 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO 5/ '/' * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. ls this property within 300 feet ora tidal wetland? * YES__ NO k~ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. z 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__ NO · IF YES, PROVIDE A COPY. c2:r' STATE OF NEW ¥©¢,K) ss: COUNTY OF &/~,.o ~-~c5,~_ ~' rv~ ~ r-~ 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 perform or have performed the said work and to make and file this application; that all statements contained in this application are tree 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 to before me this {~ ¥~" dayof ///4 ,t r'c ~ 20 to ~(Nott~lic ~OT~ ~' PUBLIC · Signature of Applicant