HomeMy WebLinkAbout36079-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. 36079 Z
Date DECEMBER 7, 2010
Permission is hereby granted to:
KAREN C BROWN
22 SOUTH WASHINGTON ST
PORT WASHINGTON,NY 11050
for :
CONSTRUCTION OF A PORCH ADDITION WITH BASEMENT & DECK ADDITION
TO A/~ EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR
at premises located at
County Tax Map No. 473889 Section 064
pursuant to application dated NOVEMBER
Building Inspector to expire on JUNE
1300 FOUNDERS PATH
SOUTHOLD
Block 0004 Lot No. 006.001
29, 2010 and approved by the
7, 2012.
Fee $ 527.60
Authorized Signature
ORIGINAL
Rev. 5/8/02
~.,,u.~ ~0~ mnt, o~ D,,.~ ¢ .om,ms'rs
FOUNDATION (IS'r)
. ~o~a ~ ~ "
~ON PERN. Y,
STA~ E~ CODE
TOWN OF SO
BUILDING DEl
TOWN HALL
SOUTHOLD, N~
TEL: (631) 765-1
FAX: (631) 765-!
www. northfork.
ZN~0V 2 9 20/0
BLDG. DEPI.
;02 TOWN OF SOUIHOLD
~U§~.dmm! PERMIT NO.
Approved
Disapproved a/c
Expiration ~/7 , 20 /~J.~.
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
che k
Septic Form
NYS.DEC.
Trustees
Contact:
Mail to:
Building Inspector
APPLICATION FOR BUILDING PERMIT
Date November 12 , 20 10
INSTRUCTIONS
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Buildthg Inspector with 3
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 s~eets or
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 w/thin 18 months from such date. I f 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 construction of buildings, additions, or alterations or for removal or demolition as herein described. The
applicant agrees to comply with all applicable Iaws, 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)
160 Main Street, Suite 200, Sayville, NY 11782
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Architect is applicant
Name of owner of premises Karen Brown
(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.
1. Location of land on which proposed work will be done:
1250 Founders Path
Southold
House Number Street
County Tax Map No. 1000 Section 64
Subdivision
(Name)
Hamlet
Block 4
Filed Map No.
Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy Single Family Residence
b. lntended use and occupancy Same as Existing use / occupancy
3. Nature of work (check which applicable): New Building Addition ~' Alteration
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost Fee $425.60
(To be paid on filing this application)
5. lfdwelling, numberofdwellingunits 1 Numberofdwellingunitsoneachfloor 1
If garage, numberofcars 2
6. lfbusiness, commcrcial or mixed occupancy, specifynatureandextcntofcachtypeofuse. N/A
7. Dimensionsofexisting structures, if any: Front 39.6' Rear 39.6' _Depth 27.4'
Height. 17.6' Number of Stories 1
Dimensions of same structure with alterations or additions: Front 39.6' .Rear 39.6'
Depth. 51.4' Height. 17.6' Number of Stories 1
Dimensions of entire new construction: Front 22.3'
Height 15.6' Number of Stories I
Rear 22.3' _Depth 12.0'
Size of lot: Front 76.56'
Rear 75' Depth 268.94'
10. Date of Pumhase
Name of Former Owner
l 1. Zone or use district in which premises are situated R-40
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
22 South Washington St.
t4. Names of Owner of premises Karen Brown Address Port Washington, NY 11050 Phone No.
Address 160 MainStreet SuRe 200 Phon N
NameofArchitect NemschickSilvemlanArchitects, PC SawilleN¥11'/~ e O {631)563-2130
Name of Contractor Address Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED.
b. ls this property within 300 feet of a tidal wetland? * YES NO
* IF 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.
STATE OF NEW YORK)
SS:
COUNTY OF Suffolk )
Raymond W. Nemschick, RA being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the Agent
(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 knowledge and belief; and that the work will be
performed in the manner set forth in the application filed therewith.
/ / NotaryPublic, State of New~¢o~l[
~.ialified in Suffolk County
,/' No. 01 SC472508_9_
l'er m Expires May 31,
OWNER
vi.
RES. :?.~/~ if_AS. VL.
LAND IMP.
S
TOTAL
..3 f~0
NBC,/ NORMAL
FQl'm
Tillable
DATE
BELOW
VaTue Per Acre
IOLD
E
W
I~OPERTY RECORD
VILLAGE 'DIS-IrRICq SUB.
ACREAGE ~
TYPE OF BUILDING
COMM. JlND. ICB. MISC.
jREMARKS
CARD-
Est. Mkt. Value
Value
- cr-.,~ ¢/
FRONTAGE ON WATER
Swampland
Brushland
House Plot
Total ~
Wacdland
Tillable 2 DOCK
TiJJable 3
FRONTAGE ON ROAD
BULKHEAD
64-4-6 9/00
~ Foundotlon~J Bath
Bosement
Fire Place
j Patio
Driveway
j Floors
! . ~.; jjnterior Finish
Porch R~f Type
Porch E~ms 1st Flcor
Rooms 2nd Fleor
i Dormer
T STREET
T VILLAGE
r DISTRJCTT SUB.
i_
OWNER
IVIL. LAGE
DISTRICT SUB.
ACREAGE
TYPE OF BUILDfNG
RES.
LAND
SEAS.
IMP,
VL.
TOTAL
DATE j REMARKS
AGE BUILDING CONDITION
NEW NORMAL BELOW ABOVE FRONTAGE ON WATF. R
Farm Acre Value Per Acre Value FRONTAGE ON ROAD
Tillable
Tillable
BULKHEAD
DOCK
Tillable 3
Woodland
Swampland
Brushlond
Ho~se Plot
Total
Z ' ~ HINI~M LOT WImTH I~' 7~.00'
HINIHUH ~ONT YA~ ~5' ~1.~ ' EXISE TO ~HAIN
MINIMUM ~TH 51~ YA~ 25' ~1. 7' ~15~ TO ~MAIN
MINIMUM LIV~LE FLOOR A~A ~'
.' /' NAXI~N ~I~ING HEIGHT ~5' EXISTING - NO 6HANGE
N~l~N N~NBEN OF 5TO~IE5 2-I/2 EXI~TING - ~ ~NANGE
DE~K~ 2~2 5F DA~ ~NE
APPROVED AS
RETAIN STORM WATER RUNOFF
PURSUANT TO CHAPTER 2~6
OF THE TOWN CODE,
PLOT PLAN ELECTRICAL
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1250 FOUNDER5 PATH SECTION:
E~UTHOLD, NY' I/qT/
RESIDENT~AL ZONE: R-d0 LOT:~ ~,
DE~NIPTION ~I~HENT EXISTIN~ /
NINI~ LOT 51ZD ~,~ 5F I~ 5F EXISTIN~
HINI~H LOT NIPTH /~'
HINI~H LOT ~EPTH 175' 25~.~'
NININUN ~ONT YA~ ~5' bL~ ' EXIS~ TO ~HAIN
HINI~H 51DE YA~ I0' 11.4' EXIS~ TO ~HAIN
NININgH ~TH 51~ YA~ 25' ~1. 7' ~15~ TO ~HAIN
NINI~N ~N YA~ ~5' I~ Z 7' / 144.2'
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