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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.