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Home My WebLink About35590-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. 35590 Z Date MAY 26, 2010 Permission is hereby granted to: DORIAN J & DENNIS C HARKOFF 475 WELLS RD LAUREL,NY 11948 for : DEMOLITION OF SWIMMING POOL AS APPLIED FOR. at premises located at 475 WELLS RD LAUREL County Tax Map No. 473889 Section 126 Block 0008 Lot No. 019 pursuant to application dated MAY 26, 2010 and approved by the Building Inspector to exq)ire on NOVEMBER 26, 2011. Fee $ 70.00 Authorized Signature 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 Examined ,20 Approved ,20 Disapproved a/c Expiration ,20 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 /1~"'"~ o .C_.) ~ Septic Form N.Y.S.D.E.C. Trustees Flood Permit Storm-Water Assessment Form Contact: Mail to: ~0/'] Building Inspector i LICATION FOR BUILDING PERMIT Date ~ ~' ,20 /O INSTRUCTIONS ,letely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of ~.e according to schedule. 'bTPlot 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. fi 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. 'g --pp ' t~i~me, ifa corporation) lQ£q I /+TTirvCP .Mv' (lqr '(Mailing addres~ of applicant) ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofownerofpremises D~f~./(//~/ ; ¢ pt~ [~/l~fiff /"~f'~[QC] [~'cI (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. Plumbers License No. Electricians License No. Other Trade's License No. Location of land on which proposed work will be done: House Number Street Hamlet County Tax Map No. 1000 Section I ~ ~' Block ~ Subdivision Filed Map No. Lot /~ Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Repair Removal 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 Height Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Depth Height. Number of Stories Rear 8. Dimensions of entire new construction: Front Height Number of Stories Rear Depth 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 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 __ NO * 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. 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 sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, CONNIE Dm BUNCH (S)He is the Notary Public,State,~ New No. OID'J~I~,OS~ (Contractor, Agent, Corporate Officer, etc.) Qualified in Suffolk C0un~ . Commission Expires April 14, 20 ~.. 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. Sworn to before me this . ~d~ dayof "~/~) 20JO Notary Public ' ' /~'nwH OF 'SOUTHOLD PROPERTY RECORD CARD ' OWNER ' Tiltobte 1 TiilalSle' 2 '['illable 3 Woodland Swampland Brushland House P~ot 7 uF'~~ WATER FRONTAGE ON ROAD DEPTH ~D ~ t66 ~ lie ~ w. Total ~ ' ]~Foundation ~ J'~ IBath ,~.z, =/~ ~ ,. '~ · ~ ~ePlace :~ .Heat ~/Z ~. t~ DR. Breezeway Garage :' Total . t / I ,