HomeMy WebLinkAbout39184-Z � TOWN OF SOUTHOLD
4"
BUILDING DEPARTMENT
y' TOWN CLERK'S OFFICE
"a 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#: 39184 Date: 9/15/2014
Permission is hereby granted to:
Mangini, Mark & Nelson, Laurie
290 Sixth Ave Apt 5L
New York, NY 10014
To: demolish an accessory barn as applied for
At premises located at:
12935 Route 25, East Marion
SCTM # 473889
Sec/Block/Lot# 31.-5-8.1
Pursuant to application dated 8/29/2014 and approved by the Building Inspector.
To expire on 3/16/2016.
Fees:
DEMOLITION $250.00
Total: $250.00
Building Inspector
TOWN 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 4 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Survey
SoutholdTown.NorthFork.net PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
9 Flood Permit
Examined G ��,20 Single&Separate
Storm-Water Assessment Form
Contact:
Approved ! 120 Mail to:
Disapproved a/c �a✓�G �d ,j Phone: //. 70 Z'3
Expiration 1/5',20
(1V
Building Inspector
PLICATION FOR BUILDING PERMIT
AUG 2 9 ?0'4
Date '� '�`� , 20 y
INSTRUCTIONS
a. is 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 authorized 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 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. f
In'laLQ-
(Signature of applicant o name,if a corporation)
S'S" dl-c�,d Sl- 6717,2 r-y.
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect,engineer, general contractor, electrician, plumber or builder
Name of owner of premises {q��O-e
(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:
/-9 93J— rV -5-), � tiy, /19.3 9
House Number Street Hamlet tq I
County Tax Map No. 1000 Section Block Lot C) t 1
Subdivision 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
b. Intended use and occupancy
3. Nature of work(check which applicable): New Buildin Addition Alteration
Repair Removal Demolition o6o.4 ia.9ther Work
(Description)
4. Estimated Cost Fee
(To be paid on filing this application)
5. If dwelling, number of 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
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning 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 Owner of premises Address Phone No.
Name of Architect Address Phone No
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. Is 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.
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 )
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.
Sworn t before me thi
!)G1 day of 204)—�
w�P
Notary Public CONNIE D.BUNCH Signatur of Applicant
Notary Public,State ofBNein York
No.01 U6185050
Qualified in Suffolk county 2��
Commission Expires Ap t
U.P.
S.C.T.M. NO. DISTRICT: 1000 SECTION: 31 BLOCK: 5 LOT(S):8,1 LAND N/F
OF
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ASPHALT R=1009.00'
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U.P. APRON
E OF PAVEMENT
ROAD (S .R. 25)
MAINTHE WATER SUPPLY, WELLS; DRYWELLS AND CESSPOOL
LOCA77ONS SHOWN ARE FROM FIELD OBSERVA77ONS
AND OR DATA OBTAINED FROM OTHERS
AREA: 40,963 S.F. or 0.94 ACRES £LEVA77ON DATUM: _________________________
UNA U 774ORIZED AL TERA 71ON OR ADD1770N TO THIS SURVEY IS A WOLA 77ON OF SEC T70N 7209 OF THE NEW YORK STA 7E £DUCA 77ON LAW. COPIES OF THIS SUR VE Y
MAP NOT BEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TI7LE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION
LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUT10N, GUARANTEES ARE NOT TRANSFERABLE.
THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE
NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE 7H£ EREC77ON OF FENCES, ADDITIONAL STRUCTURES OR AND 07HER IMPROVEMENTS. EASEMENTS
AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY
SURVEY OF: DESCRIBED PROPERTY CERTIFIED TO: MAXINE SHRIBER; RICHARD SHRIBER;
MAP OF: FIDELITY NATIONAL TITLE INSURANCE COMPANY,
FILED:
SITUATED AT: EAST MARION
TOWN OF: SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC
SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design
P.O. Box 153 Aquebogue, New York 11931
DATE: JUNE 10, 2014 PHONE (631)298-1588 FAX (631) 298-1588
FILE 14—$6 SCALE: 1 -30 N.Y.S, LISC. NO. 050882 maintaining the records of Robert J. Hennessy & Kenneth M. 1loychuk