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Home My WebLink About36155-ZFORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUII2)ING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 36155 Z Date JANUARY 26, 2011 Permission is hereby granted to: CYNTHIA KAMINSKY WOODCLIFF DR MATTITUCK,NY 11952 for : DEMOLITION OF A FIRE DAMAGED BUILDING IN EXCESS OF 50% at premises located at 80 MILL RD County Tax Map No. 473889 Section 106 pursuant to application dated JANUARY Building Inspector to expire on JULY MATTITUCK Block 0004 Lot No. 003 26, 2011 and approved by the 26, 2012. Fee $ 371.00 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 Examiner, S. ~t~ .20 //" Approve~- o~ ,20 /rt'' Disappro-ved: a/c Expiration ~ O~ ,20 /'~) JAN 2 6 2011 BLDG. DEP[ TOWN OF SOUTHOLD 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: BuildingXlnspector ~ APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS Phone: (.(o () og. q1'*' Aq3 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 author/zed 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 constraction 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. v 0Signature of applicamtor name, ifa corporation) (Mailing address of applicant) /1 q 5'.Y State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises 0 ~ Iq°I- ~ t~LL .~,/1 D~; ~ Sk}/ - ' (As'on fhe t~x roll or latest If applicant is a corporation, signature of duly authorized officer deed) (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which vroposed work wl~l,~e done: 8-o ct ! House Number Street Hamlet Block q Filed Map No. County Tax Map No. 1000 Section I 6 b Lot '~ Subdivision Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing useandoccupancy .A_~_.~_,62.~ 3t.~,~.,,/.,.,~ ~ ~LL.t?t~r~_/[~.~.t~ b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition ~/' Other Work 4. Estimated Cost ,~ I ~'-~ tO _tO (') 5. If dwelling, number of dwelling units If garage, number of cars 10. Date of Purchase 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. ?5' ~~., , 7. Dimensions of existing structures if any: Front ~-t.o ~ Rear 5--{~ Depth L~ O Height i ~ Number of Stories Dimensions of same structure with alterations or additions: Front : ~: .... ~,=~, ......... Depth. Height. Number of StOnes 8. Dimensions of entire new construction: Front Rear i ; Depth Height Number of Stories ! t. ................. j 11. Zone or use district in which premises are situated ~ I { 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO / 13. Will lot be re-graded? YES__ NO v/Will excess fill be removed from premises? YES __ NO 14. Names of Owner ofpremises~¥n~ttL ~ ~, t~/ddress~J~~Phone No.~O~t~,=,o.-q Name of Architect ~ ' ~ddress ' - /q-J Phone No Name of Contractor Address Phone No. 15 a. Is this property within 100 feet cfa tidal wetland or a freshwater wetland? *YES t// * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet cfa 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 NO V/ · 1F YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF ) k/I,q'~Fk [ 0[, ~ ~ Y~ .q ~ being duly sworn, deposes and says that. (s h...Q..~j&the apphcant (~,!a~e~o'f'i~divi~tual s'igning contra~t) a~ove 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 true to the best of his ka~owledge and belief; and that the work will be perforn~ed in the manner set forth in the application filed therewith. Sworn to bqfore me th'!~ ~ day of ~,,~,~..o_,~t2z4 20}/ · -~ t Notary Public '5, 1MG 4458.jpg (JPEG Image, 475x325 pixels) '~--~ ~'l. ..... http//su~'tb ktin'~s timesreview,co~Wfiles/IMG_4458~jpg Iofl 1/26/2011 9:36 AM Kaminski 106-4-3 01/23/11 Kaminski 106-4-3 01/23/11 Kaminski 106-4-3 01/23/11 Kaminski 106-4-3 01/23/11