HomeMy WebLinkAbout35872-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. 35872 Z
Date SEPTEMBER 17, 2010
Permission is hereby granted to:
A KURITA & A BARR
385 COTTAGE PL
SOUTHOLD,NY
for :
DEMOLITION OF ACCESSORY WORKSHOP AS APPLIED FOR
at premises located at
County Tax Map No. 473889 Section 062
pursuant to application dated SEPTEMBER
Building Inspector to expire on MARCH
385 COTTAGE PL SOUTHOLD
Block 0003 Lot No. 017
3, 2010 and approved by the
17, 2012.
Fee $ 280.00
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 ~/{ [a , 20
Approved ?/720
Disapproved a/c
Expiration
3//720
SEP 3 2010
BLDG. DEPT.
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
Septic Form
N.Y.S.D.E.C.
Trustees
Flood Permit
Storm-Water Assessment Form
Contact:
Mail to:
}3uilding Inspector
Phone:
PLICATION FOR BUILDING PERMIT
Date
INSTRUCTIONS
\ ,20 I~
,ietely 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 premiies 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 lbr 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, Suflblk 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.
(Signature of applicant or name, ifa corporation)
~ r ' _/ (Mailinfl ad~es.s of applickt)4 l l
State whether applicant is owner, lessee, agent, architect, elSgineer, general contractor, electrician, plumber or builder
Name of owner of premises Avll&,oO K~[~J[k ~ ~t~.~l.I krr
(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 et
Hamlet
Block ~
Filed Map No.
County Tax Map No. 1000 Section /~,~ Lot ( 7
Subdivision 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 BuildingK,
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 ~"O~
Height [bt Number of Stories
Rear
Depth
Dimensions of same structure with alterations or additions: Front
Depth Height. Number of Stories
Rear
""9. Sizeoflot: Front [ ~7.. I
10. Date of Purchase ~o,a[~t' 2001)
8. Dimensions of entire new construction: Front Rear
Height Number of Stories
Rear IJ0~! Depth
Name of Former Owner ~ffc'C.~'~t.)¢.
Depth
'-' 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
14. Names of Owner of premises/~1¢~ ~ ~,~tr
Name of Architect
Name of Contractor ~,la,'ii ~,~1 \~.
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 of a tidal wetland? * YES__ NO ,~Z
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
NO '~ Will excess fill be removed from premises? YES NO__
. ,,
AddressT., Sl~./l~r~ ~ ~ I~one No. ~]/'
Address Phone No
Addressed ~x ~h~ ~PhoneNo.
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.
· 1F YES, PROVIDE A COPY.
STATE OF NEW YORK)
COUNTY
/~{~6~' L. {~.ttr 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 ('~ -- .
."~ _~.ay of ~ OA 20 [ ~)
,.,.~,s.,..u~,_~.I~ 0t N~ Yo~
Nota~ Public ~o. u1~190696
~mmission ~i~ July 28,
Signature of Applicant
ToWn of Southold
): & S,torm-Water Run.off ASSESSMENT FOR,,~
Erosion,
Sedimentation
THE FOLLOWING ACTIONS MAY REQUIRE THE SUBM!~_~!_~."_ OF A
PROPERTY ~(~AT]ON: ~ S.C.~ ~
STORM-WATER, GRADING~ DRAINAGE AND EROSION CONTROL PLAN
~ DiSb'lc! eecfl0n Block '~ CE~TIJPIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK.
SCOPE OF WORK - PROPOSED CONSrliUCTION ITEM# / WORKASSE~q~
a. What is the Total Area of the Proj~ Parcels?
(I.dedeTotalAraaofellParceislocatedwilhlrl [,~1~) S~' I WlllthisProjectRetalnNIStorm-WatorRun. Off
the Scope of Work for Proposed Conslruc~n) Generated by a Two (2") Inch Rainfall on Site?
b. What is the Total Area of Lend Cleagng (s.F.;nc~s) (This item will include all mn-off created by site
clearing and/or construction ~ as ~ as all
and/or Ground Disturbanca for the proposed ~:~r ~[ z ~11 / ,.~,.t~,. S'ite Improvements and the permanent creation of
constniction activity? impervious surfaces.)
(s~.,)=,) 2 Does the ~te Plan and/or Survey Show All Proposed
PROV]]DE B]U]Q~ PROj-E, CT D,~.eCIUJ/tlON ~)~,~nM~aN~d) Drainage StoJcturas Indicating Size & Location? This
Item shall include all Proposed Grade Changes and --
P~I~T ' I ['~I~ If _.~'i~l~ t., ~af ~4~ Slopes Controging Surfase Water .ow.
tjt,~ ,~/~p t · and sediment contr°l Practlces that will be used ta
control site er(~on and storm water discharges. This
item must be rnaintalned throughout the En~'e
Construction Period.
4 Will this Project Require.any Land Filling, Grading or
Excavation where there is a change to the Natural r'"'l
Existing Grade Involving more than 200 Cubic Yerds
of Material within any Parcel?
5 Will this Application Require Land Distt.~ng Acth4~es
Encompassing an Area in Excess of Fiva Thousand
(5.000 S.F.) Square Feet of Ground Surface? --
6 ~s them a Natural Water Course Running through the
Site? Is this Project within the Trustees juriedlcBon
General DEC SWPpp Requirements: or within One Hundred (100~) feet of e Wetland or
Submleslc~ of a SWPPP is mqufl~d fc~ all ConstuJction acth4ties tnvoMng soil Beach?
diStlJ~bances o~ one (!) or more ac, ms; including disturbences of le~s toan one acre that7 Wlli' there be Site preparalJon on Existing Grade Slopes
are pert of a isrger common pisn that wiJl ultimately disturb one or mom acres of land; which Exceed FiEeea (t5) feet of vertical Rise t°
including ConshucUon actlvl~es ~n~lv[ng so4 disturbances of less than one (t) acre where
toe DEC has delermined thai a SPDE$ permit is required for storm water discharges. One Hundred (100') of Horizontal Distar!ce?
SWPRP*s She# meet the Minimum Requiremeofs of the SPDES General Permit 8 Will Driveways, Parking Areas or other Impervious
I°r Sthnn Wathr DbChel~Jss fr°m C°nsth~ct~°n actlv#Y ' Permit N°' GP'O't 0'001') Surfaces be Sloped to Diract Storm-Water Rut. t-Off ~'~
$. The SWPPP shall be p~epamd p~or to the submittal ot toe NOI. The NOi ~# ~
submitted to the Dej)arlment IXtOr to Ine comrnencerr, mt of c~,.structlon acavlty, into and/or in the direction of a Town rightLof-way?
2. The SWPPP NM" dsscrlbe 1he Mc~len ~.xlse~meof conb~ pra(:~ee and where 9 Will Ihis Project Requlra the Placemont of Mateflal,
requin~, post-cemth~ stom~ ~ man~en~nt pracUces that wll ~ used and,~' RemOVal of Vegetall~n and/or the Construction of any r'~
, conslmcte~ to reduce I~e Ix)bJtan~ is stomt water discharges and to e~jre
comp,ance with tl~ tom~ and ~ ot tols pem~ In a~litlon, the SWPPP she, Item Within the Town Right-of-Way or Road ShoUklorI~1
COUNTY OF ,........~J......~...L..I J....~.. ........... SS
I, ~'k~.,~.a~..~.~.~.~.ii~.~;~-- ................... being duly sworn, deposes and says that he/she is the applicant for Permit,
That
And thathe/she is the ~..142~ ............................ ~ .......................................................................................................
I , $~trac~x, ,N~t, Cx~p~at~ 0~x,r. etc. ) -.-
Owner and/or representative of the 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 flied herewith.
Sworn to he, fore me this;
........................... ....... ....... ................. !.
¥1¢~1 IOIH .................................................
FORM - 06110
Qualified n Suffolk Count,,, ,,
Commission Expires July 28, ~f3J~
TOWN OF SOUTHOLD PROPERTY RECORD CARD
O..V~ER ~ -- . J STRE~ ~..~ VlL~GE DIST.I SUB.
~. ~ S~.z VL FA~ ' j C0~
~ND .' IMP. TOTAL DA~
LOT
· L~LoD
AGE BUILDING CONDITION
NEW NORMAL BELOW ABOVE
FARM Acre
Till=ble
Woc~lb',nd
M~adO~l~ncl
House Plot
Total
Vafue Per Value
Acre
FRONTAGE ON WATER
FRONTAGE ON ROAD
DEPTH
BULKHEAD
DOCK
AA. Bldg.
Extension
Extension
Extension
I t
Porch
B re ezewey
O. Bo
Total ,
Fire Place
· .<"-= ,-/.~ Z., ~YPe Roof
/, ~- L.~L~ ~ Recreation, Room
I
Bath
Floors
nterior Finish LR.
He~ ~ ~d' DR. J
Rooms Ist Floor
P.o~ms 2nd Floor
Driveway
N.7~ !0 O0 E.