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Home My WebLink About35550-ZFORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS BUII~)ING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL COMPLETION OF THE WORK AUTHORIZED) FULL PERMIT NO. 35550 Z Date MAY 12, 2010 Permission is hereby granted to: R KLOS B PETRUCCI 150 GRIGONIS PATH SOUTHOLD,NY 11971 for : DEMOLITION OF EXISTING DECK AS APPLIED FOR at premises located at County Tax Map No. 473889 Section 063 pursuant to application dated MAY Building Inspector to exl~ire on NOVEMBER 150 GRIGONIS PATH SOUTHOLD Block 0007 Lot No. 004 3, 2010 and approved by the 12, 2011. Fee $ 70.00 / Aut~horized Signature ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HAEL SOUT~IOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown. NorthFork.net Examined B/~ , 20 / O Approved i//ffL, 20 /O Disapproved a/c Expiration ///,&20// / - 3 2010 BIOG. DEPT. TOWN OF SOUIHO[D PERMIT NO. ~, 5~ Building Inspector 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: Phone: APPLICATION FOR BUILDING PERMIT Date 5 '~ 3 ,20 lO INSTRUCTIONS a. tnls appncation MUST be, :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 promises, 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, Suftblk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alteritions 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. ~ p~) (Signature of applicant or name, if a corporation) 150 Gric oni S [3o- h, oo-t% ld NV '"/(Mailing address ofappl cant) I Iq -/ I State whether applicant is owner, lessee, agent, ard0itect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremises~e,lo, er~r T'. ~,~o~ cc~ck -~e,,~booto, ~. (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. N k Plumbers License No. IX/' h- Electricians License No. /V ,~ Other Tmde's License No. AJ )k Location of land on which proposed work will be done: House Number "~ Street County Tax Map No. 1000 Section Subdivision ~acve~c H~m~ ~sJ~,:be.q Hamlet Block '-'/ Lot Filed Map N. o.~Lot Oo~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:. a. Existing use and occupancy C[ec-~ b. Intended use and occupancy ~:x3~-~ ~ (~ Nature of work (check which applicable): New Building Repair Removal v/ Demolition - 4. Estimated Cost 5. If dwelling, number of dwelling units If garage, number of cars Addition Alteration Other Work Fee (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 ,~ O J to'~ Rear 30'. ~" Depth Height I~" Numberof Stories Dimensions of same structure with alterations or additions: Front Depth__ Height. 8. Dimensions of entire ne..,~w construction: Front Height ~- Numberof Stories N 9. Size oflot: Front }q-to,-/$ Rear 10. DateofPurchase ~O,~'~-1, G~DD~ Name ofForrner Owner Rear Number of Stories_ Rear ~ ~ ' .Depth 11. Zone or use disthct in which premises are situated NO ~ 12. Does proposed construction violate any zoning law, ordinance or regulation? YES __ 13. Will lot be re-graded? YES __ NO ¢/'Will excess fill be removed from premises? YES__ NO ~ 14. Names of Owner ofpremises~ ff. P~ - ~ess ~5o G,,5~x ~ Phone No.~3~' 96~ -3~ Name of Architect Address ~ ~. ~ ~ ~t~n~ Phone No Name of Con,actor Address Phone No. 15 a. Is this property within 100 feet ufa 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) COUNTY being duly swum, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, CONNIE D. BUNCH Notary Public.State of New YorN (S)He is the No, fll RIIIi1R~fI~/1 (Contractor, Agent, Corporate Officer, etc.) Qualified in Suffolk Coun~ , ,., Commissio, Expires April 14, 20J~,~. 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 day of ~/~'X~.~-4 20 [ ~) Notary Public Signature of Applicant LOT 4 MAP OF HARVEST HOME ESTATES SECTION ONE SOUTHOLD, TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. FM~ 5~37 TM# 1000-063-07-004 SURVEYED FOR: ROBERT T. KLOS BARBARA J. PETRUCCI GUARANTEED TO: ROBERT T. KLOS BARBARA J. PETRUCCI STEWART ~TLE INSURANCE CO. TEACHERS FEDERAL CREDIT UNION SURVEYED BY STANLEY J, ISAKSEN, JR. P.O. BOX 294 NEW SUKFOLK, N.Y. 11956 //NYS Lic./No.' 49273 08R1671 I LOT 5 754.~0' t LOT 3 SURVEY OF LOT 4 MAP OF HARVEST HOME ESTATES SECTION ONE SOUTHOLD, TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. 146.75' HARPER ROAD FM# 5337 DATE FILED JULY 18, ?969 TM# 1000-063-07-D04 SURVEYED FOR; ROBERT T, KLOS BARBARA J, PETRUCCI OUARANTEED TO: ROBERT T. KLOS BARBARA d. PETRUCCI STEWART ~TLE INSURANCE CO. SURVEYED DY STANLEY d. ISAKSEN, JR P.O, BOX 294 NEW SU/~-FOLK. N.Y. 1 ~956 //NYS Lic,/No? 49273 08R1671