HomeMy WebLinkAbout35661-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. 35661 Z
Date JUNE 21, 2010
Permission is hereby granted to:
JAMES FRY
8045 NASSAU PT RD
CUTCHOGUE,NY 11935
for :
DEMOLITION OF AN EXISTING GAR3~GE AS APPLIED FOR
at premises located at 8045 NASSAU POINT RD CUTCHOGUE
County Tax Map No. 473889 Section 118 Block 0004 Lot No. 008
pursuant to application dated JUNE 14, 2010 and approved by the
Building Inspector to expire on DECEMBER 21, 2011.
Fee $ 190.00
~A~ ho r i z~- ~e~/~k t u r e
ORIGINAL
Rev. 5/8/02
TOWN OF SOUTHOLD
BUILDING DEPARTME~[~£e °
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
SoutholdTown.NorthFork.net
Examined ~/?//, 20 /O
Approved ~/f2/, 20 fO
Disapproved a/c
Expiration / ~ J zJ, 20 f /
PERMIT NO.
"B~uilding 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 ~{~'lDO
Septic Form
N.Y.S.D.E.C.
Trustees
Flood Permit
Storm-Water Assessment Form
Contact:
Phone:
JUN 1 4 2010
BLDG. DEPI.
I'OWN OF SOUIHOLB
FOR BUILDING PERMIT
Date
INSTRUCTIONS
20/o
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 ora 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, housin~Lc~e, and regulations, and to admit
authorized inspectors on premises and in building for necessary inspections.
of applicant or natorporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises
(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
Cc;
Hamlet
z/g-
Block
Filed Map No.
County Tax Map No. 1000 Section z/73oa,~? Lot & o~
Subdivision Lot
State existin use and occu anc of remise a ' in
g p y p ~agd tenoeouse ano occupancyotproposeo construction:
a. Existing use and occupancy /~esrff/erlC, e
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 ~ C,~/~
Addition Alteration
Other Work
70~) ¢ (Description)
Fee
(To be paid on filing this application)
Number of dwelling units on each floor
If business, commercial or mixed occupancy, specify nature and extent of each type of use.
Dimensions of existing structures, if any: Front .,~D'~' Rear
Height /,5~ / Number of Stories /
Depth ,~o
Dimensions of same structure with alterations or additions: Front
Depth_ Height Number of Stories,
Rear
Height
9. Size of lot: Front
10. Date of Purchase
Dimensions of entire new construction: Front
Number of Stories
Rear Depth
Rear .Depth
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~q,/,0L:~ h .~}/ Address<~ P~o(e (,~i~ l~e ,Nv7~/'l~(~tone No. ~/~'d"6 ~-~/
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 * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet ora tidal wetland? * YES __ NO__
* 1F 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__ NO ,~'
· IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF~ Ut ~j-~
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.)
CONNIE D. BUNCH
Notary Puhlic. Stata of New York
C quaJi~-[~'§~f~l~"~_~untv,.,
omrmesion Expires April 14, 20~/oL
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.
Swo~ tq~ before me this
[L{.~ dayof (~(k_A,/x-~ 20
Notary Public
Signature of Applic~
Ad,~P OF ~ROm~'t~CT"'r'
GEORGE [-/ FRY AND DA F~Y
NA$$A (J
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