HomeMy WebLinkAbout38323-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
~ ® ~ TOWN CLERK'S OFFICE
'ffi~ ~~°4 SOUTHOLD, NY
s
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 38323 Date: 9116/2013
Permission is hereby granted to:
Internod_al Inc
PO BOX 1173
- - -
Southold, NY 11971
To: Demolition of a 12 x 20 deck as applied for.
At premises located at:
54800 Route 25, Southold
SCTM # 473889
Sec/BlocklLot # 64.-1-16
Pursuant to application dated 9/4/2013 and approved by the Building Inspector.
To expire on 3/18/2015.
Fees:
DEMOLITION $172.00
Total: $172.00
Buildi Inspector
Ti`OWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following, before applying ?
TOWN HALL Board of Health
SOUTHOLD, NY 11971 3 sets of Building Plans
TF,L:765-1802 2 Survey
PERMIT NO. ~ ~ / Check
Septic Form
N.Y.S. D. E.C.
Trustees
Examined , 20 Contact:
Approved , 20~ Mail to: ~1TERhtOLiSL_ ~.1L.
Disapproved a/c ~ D]fh_
Phone: (,?~j 7~5 a~37
~h I, i~!, " iy Building Inspector
SEP - 4 2013 APPLICATION FOR BUILDING PERMIT
Date S)EpT' O~» , 20~
Bum, ~FpT i e
To,~;,;,, ;n~r7o~o INSTRUCTIONS
a. Tltis application MUST be completely filled in by typewriter or in ink and submitted to the Building 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 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 a Certificate of Occupancy is
issued by the Building Inspector.
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 laws, ordinances, building code, housing code, and regulations, and to admit
authorized inspectors on premises and in building for necessary inspections.
S'~-I~T ~rz xa~~~yc. .
(Signature of applicant or name, if a corporation)
~ O Bic 11'73 5ousri~I..a 111! 1147 ~
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Olalya~
Name of owner of premises ~e/,YT~~ALL1pl'~1,,. -~-;t+iC-.
(as on the tax roll or latest deed)
I p 'cant ' rporation, signature of duly authorized officer
V t cE ~~T
fry.- ~-ft.~'¢><'Ytt~aa =b-I'lC~ .
(Name and title o corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on whichp~o osed work will be done:
.~~-800 1JS.~,I.1.1 1~Cn .S~xcr;l~I~
House Number Street / Hamlet
County Tax Map No. 1000 Section bt Block ~ Lot 1
Subdivision Filed Map No. Lot
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ,
a. Existing use and occupancy u~~~
b. Intended use and occupancy SA,TICQ~
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Demolition_~_~~Other Work
(Description)
4. Estimated Cost Fee
(to be paid on filing this application)
5. If `dwelling, number o~ dwelling units Number of dwelling units on each floor
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front Rear Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
9. Size of lot: Front Rear Depth
10. Date of Purchase Name of Former Owner
1 1. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation:
]3. Will lot be re-graded Will excess fill be removed from premises: YES NO
14. Names of Owner of premises Address Phone No.
Name of Architect Address Phone No
Name of Contractor Address Phone No.
15. Is this property within 100 feet of a tidal wetland? *YES NO
• IF YES, SOUTHOLD TOWN TRUSTEES 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)
~S'yS:
COUNTY O
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 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.
Sw rn to before me this
day of 20_~
~ '
Notary Public r ignature of Applicant
CONNIE D. BUNCH
Notay Publlc, State of New York
No.O18U5185050
(~uaiified in Suffolk County tt
Commission Ear ire4 April 14, 2,_ a
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