HomeMy WebLinkAbout37245-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 #: 37245
Date: 5/24/2012
Permission is hereby granted to:
Galante, Carlo & Galante, Anne
21 Grant St
To:
Copiague, NY 11726
Demolish an inground swimming pool as applied for;
At premises located at:
515 Mayflower Rd, Mattituck
SCTM # 473889
Sec/Block/Lot # 107.-8-22
Pursuant to application dated
To expireon 11/23/2013.
Fees:
5/1812012 and approved bythe Building Inspector.
DEMOLITION
Total:
$100.00
$100.00
Building Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
SoutholdTown. NorthFork. net
Examined
Approved
Disapproved a/c
Expiration ,20
BUILDiNG PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
PERMIT NO. ~7~ ?_~J
},lAY 1 8 2012
BtDG DEPI
TOWN OF SOUIHOkD
Board of Health
4 sets of Building Plans
Planning Board approval
Survey.
Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O. Application
Flood Permit
Single & Separate
Storm-Water Assessment Form
Contact:
Mail to:
Building Inspector
APPLICATION FOR BUILDING PERMIT
~Date
INSTRUCTIONS
,20/
a. This application MUST be completely filled iu 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 ot' 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 luspector will issue a Building Permit to the applicant. Such a permit
shall be kept on the premises available tbr inspection throughout the work.
e. No building shall be occupied or used in whole or in pad for any ~rpose what so ever until the Building Inspector
issues a Ce~ificate of Occupancy.
f. Eve~ 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 n0 zoning amen&nents or other regulations affecting the
prope~ have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the pemit for an
addition six months. Thereaften a new permit shall be required.
APPLICATION IS HEREBY MADE to the Building Depamnent for the issuance of a Building Pemit pursuant to the
Building Zone Ordinance of the Town of Southold, Suflblk Couuty, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions, or alterations or for removal or demolition a~rein d~bed. The
applicant agrees to comply g"ith all applicable laws, ordinances, building code, ho~ode, and re(ul~io~and ~o admit
authorized inspectors on premises and in building for necessa~ inspects. ~~~
~ ~ ..... ' , ~ignature o~applican~m~ ff a collation)
(Mailing address of applicant)
State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
"'N Name of owner of premises ~-'J~/~
(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.
'NNI' Location,.qo f~2/Eland on which~4~(~proposed, A._._/~ 0 t,~°m'k will ~b~_ne :,,,__
House Number ' Street Hamlet
County Tax Map No. 1000 Section Block Lot
Subdivision Filed Map No. Lot ~
State existing use and occupancy of premises and intended use and occupaucy of proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy_
3. Nature of work (check which apl~cab)e): New Building Addition
Repair Removal ~ Demolition Other Work
Estimated Cost Fee
If dwelling, number of dwelling units
If garage, number of cars
Alteration
(Description)
, (To be paid on filing this application)
Number of dwellirig units on each floor
If business, commercial or mixed occupancy, specify nature and extent of each type of use.
Dimensions of existing structures, if any: Front
Height Number of Stories
Rear
Dimensions of same structure with alterations or additions: Front
Depth Height Number of Stories
8. Dimensions of entire new construction: Front Rear
Height Number of Stories
NO
Will excess fill be removed from premises? YES __
9. Size of lot: Front Rear _Depth
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES
13. Will lot be re-graded? YES__ NO
14. Names of Owner of premises Address
Name of Architect Address
Name of Contractor Address
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 MNAo~_REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
16. Provide survey, to scale, with accurate foandation plan and distances to property lines.
Depth
Depth
Phone No.
Phone No
Phone No.
Rear
NO
NO
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
· IF YES, PROVIDE A COPY.
NO
STATE OF NEW YORK)
SS:
COUNTY OF )
bcing duly sworn, deposes and says that ts)be is the applicant
(Name of individual signing contract) above named,
tS)He is the
(Contractor, Agent, Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perform or bave 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.
Sworn to before me this //~ (~ / )/ /~ ~ day of ~'~a-O'/ 20/d. ,p~t~~,,/~ . / ) ,~1 ~
~" - Notary Public ?.anmm~mt,,~o~ '~7 Signature of App~Nm'fi