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Home My WebLink About36549-ZTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit #: 36549 Date: 718/2011 Permission is hereby granted to: Bokina, Bertha 640 Village Lan® Mattituck, NY 11952 Toz Demolish an In-Ground Swimming Pool, as applied for. At premises located at: 640 Village Lane, Mattituck, NY SCTM # 473889 Sec/Block/Lot # 114.-6-18 Pursuant to application dated To expire on 1/7/2013. Fees: 6/29/2011 and approved by the Building Inspector. DEMOLITION $100.00 Total: $100.00 Building Inspector TOWN OF SQUTHOLD BU 1L DII~-G DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork. net PERMIT NO. Approved Expiration dull 2 9 2011 BLDG. DEPT. Building Inspector /~ICATION FOR BUILDING PERMD]~e 10WN 0[ SOUIH0tD '~ INSTRUCTIONS BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans x,%Planning Board approval Survey Check '{i~k~,oC) Septic Form N.Y.S.D.E.C. Trustees Flood Permit Single & Separate Storm-Water Assessment Form Conta~ Phone: /~'1- I ~ ,2O a. his app~ation MUST be completely filled in by typewriter or itl ink and submitted to tile Building Inspector with 4 sets of plans, accurate plot plau to scale. Fee accordiug to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, alld 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 ~vill 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 pan lbr 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 uot commenced within 12 months a~er the date of issuance or has not been completed within 18 months from such date. If no zoning mnendments or other regulations aftbcting the property have been enacted in the iuterim, the Building Inspector may authorize, in writing, the extension of the pemit for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Depamnent tbr the issuance ora Bailding Permit pursuant to the Boildmg 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 fbr removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances, buildiug code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. / (Sig~atm'~ppli~t or nam~'~c~ormio.) ' ' (~iling nd&ess oFapplicadt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name ol'ownerofprenrises._X"~'~dj ~(ALnt~a~'r~atestdeed) 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 z Hamlet County Tax Map No. 1000 Section Sobdivision Block (4v Filed Map No. Lot ~) Lot 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 Addition Alteration Repair Removal Demolition '-~ Other Work Estimated Cost Fee If dwelling, number of dwelling units If garage, number of cars (Description) (To be paid oil 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 8. Dimensions of entire new construction: Front Rear .Depth Height Number of Stories ~ ' ' 9. Size of lot: Front Real' .Depth Rear 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate ally' zoniug 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 Oxvner 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 xvetland? *YES * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERM1TS 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. 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 ,~ · IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF ) -:~" - o ONNt O BUNCH C~,,.~_~:)_~ ~ ~., ,,L~,,~ ~'~, ....-- be i n = d t, ly swo,-n, d e pose~o~i~l~lt~ ~'~ p I ic ant (Name Of i~.idual Signin~ above named. ~a~ (S)He is the (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perlbrm or have performed tile said work aad 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 rammer set forth in the application filed therewith. Sworn,to before me this ~c~F-~/~ day o[~ Notary Public ~,hature o(ApplicanL-~ff ~ :½ % APPROVED AS NOTED N !TIFY BUILDING DEPARTMENT AT 7~5 1302 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1 FOUNDATION- TWO REQUIRED FOR POURED CONCRETE 2 ROUGH- FRAMING, PLUMBING, STRAPPING, ELECTRICAL & CAULKING 3 INSULATION 4 FINAL - CONSTRUCTION & ELECTRICAL MUST BE COMPLETE FOR C.C. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. COMPLY 'WITH ALL CODES OF .EW ¥o~ s~-^-~ ~ TO~V. CO~ES ENCLOSE POOr. TO CODE UPON COMPLETION BEFORE "WATER"