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HomeMy WebLinkAbout39475-ZnFaF d� coy TOWN OF SOUTHOLD o���F a� BUILDING DEPARTMENT ' TOWN CLERK'S OFFICE oy . oN 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 #: 39475 Date: 1/7/2015 Permission is hereby granted to: Warlan, Michael & Warlan, Erin 165 E 66th St New York, NY 10065 To: Demolition of house only as applied for. At premises located at: 1145 Jackson St, New Suffolk SCTM # 473889 Sec/Block/Lot # 117.-9-8.1 Pursuant to application dated 12/29/2014 and approved by the Building Inspector. To expire on 7/8/2016. Fees Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.No rth Fork. net BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? PERMIT NO.J�I Building Inspector 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 Phone: QPPROyt �T APPLICATION FOR BUILDING PERMIT �� �.P. It �` --� � Date Z , 20%� DATE: INSTRUCTIONS ...—sic PEE: h�s:apphcation i` 1. e c�{npletely filled in by typewriter or in ink and submitted to the Building Inspector with 4 NOTII� tts of�ppp'D; �wCutatepl 't�p1C$nit cafe. FFee according to schedule. 765-INI 8k bP�ot-Pt n sh¢ivingF6batiWnLff-lot and of buildings on premises, relationship to adjoining premises or public streets or FOLLOWI C . M)NEY�iQNS: e r�Cnq¢vered((llyjtlti��_pplication may not be commenced before issuance of Building Permit. i . FOUNDAii.l i%lon alpi'd 4d%Tt$is'appltcation, the Building Inspector will issue a Building Permit to the applicant. Such a permit F s i_all� Vie- tei�p'Yemtse§ available for inspection throughout the work. a "N e No�g�g t to sal P P Y purpose g P 2• R4ss�u�s� Ce�-ficat �o Occupancy.�tcU t fl or used in whole or in art for an u ose what so ever until the Building Inspector $, INSULP.ICLVery ibnildi g �,t'�sv all•expire if the work authorized has not commenced within 12 months after the date of 4. F}��A nce @C'h5s'nort b��n NTpl ted within 18 months from such date. If no zoning amendments or other regulations affecting the �ro rtyAA ayfp erfenact&t�'rl•the interim, the Building Inspector may authorize, in writing, the extension of the permit for an r rT i r aCdd r or}ths. he�'eaffet, &hiiv peiWi shall be required. ALL � l� App C )�I(�N INJE'iEBY�VIA'11� Ato the Building Department for the issuance of a Building Permit pursuant to the RECR�ufl�r 8111 -o�o O di c ��>ie �T f So�t(told, Suffolk County, New York, and other applicable Laws, Ordinances or �� �g�%„l tt�a .for th�Tconstruc oh�S uI .,additions, or alterations or for removal or demolition as herein described. The DE�pp' �a i I g s l ,c� iiiply., It 11 �jj��d laws, ordinances, building code, housing code, and regulations, and to admit au onzed inspectors on premises and in building for necessary inspections. —(Signa re of applicant or name, if a corporation) ,gyp, x 7 V--� �%rr� G� /Vy //.7 S=< (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises �i `4' --7 (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate !?C;cer //V- Builders � Builders License No. 5 Plumbers License No. Electricians License No. Other Trade's License 1. Location of land on which proposed work will be done: County Tax Map No. 1000 Section . 90 Block 6 � -- 6>0, Lot Q o O 1 ®� Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intend use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy �� e 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolitions< —Other Work (Description) 4. Estimated Cost �ob o Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units__L_Number of dwelling units on each floor If garage, number of cars a 6. If business, commercial or mixed occupancy, specs ature and extent of each type of use. 7. Dimensions of existing structures, if any: Front d Rear 1p© / Depth Height Number of Stories Dimensions of same structure wit lli2tations or additions: Front Rear Depth eight Number of Stories 8. Dimensions of entire new construc " .fro -n -E' Rear Depth Height Number of Stories 9. Size of lot: Front / Rear ,, In Depth g�;� 10. Date of Purchase '96 /_3 Name of Former Owner /ye- 4 -17 . 11. Zone or use district in which premises are situated el -5 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_ NO->< 13. Will lot be re -graded? YES_ NWill excess fill be removed from premises? YES_ NO 14. Names of Owner of premises ke Wr& 1UTAddress Phone No. Name of Architect / Address Phone No �- Name of Contractor j3ba( l�4-,.1 i/R, c 14 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. Ix - 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 / ��/�G�✓��r�/ being duly sworn, (Name of individual signing contract) above named, , (S)He is the r deposes and says that (s)hethe_ y�$,p�iffnUNCH Notary Public, State of New York No. 01 BU6185050 (Contractor, Agent, Corporate Officer, etc.) wuaonju in ounum county Commission Expires April 14,2-n/ 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. S m to before me thi �^ l!adV sa�!C C 0i8�!L'U'Lr �� day of `� 64 uno ol•IoS '. pe!f!1"nC Ogt 581 0 -ON Io IS `08 n Notary Public H 8 -0 31NN0 Signature of Applicant d.� Scott A. �L1S��il F�� �TORI\�C���A\��'IEI� sUPBaivaso�z �� �' ��IEA\1�A\(GJEMt1ENT SOUTHOLD TOWN HALL - P. O. Box 1179 p 53095 Main Road - SOUTHOLD, NEW YORK 11971 f • Town �f Southold ClUPTER 236 - STORIVIWATER lViANAGEMENT (FORK SKEET ( TO BE COMPLETED BY THE APPLICANT) DOES THIS PROJECT ]INVOLVE ANTY OF THE F'ULLLD`b`t,'IING: (CHECK ALL THAT APPLY) i Clea .ing, grubbing, grading or stripping of land which affects more an 5,000 square feet of ground surface. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. 00 feet of horizontal distance. D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. E. e preparation within the on floodplain as depicted on FIRM Map of any watercourse. F. Installation of new or resurfaced impervious surfaces of 1,000 square feet or more, unless prior approval of a Stormwater Management Control Plan was received by the Town and the proposal includes in-kind r.eplacemenl, of impervious surfaces. __..... . If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name, Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project. if you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan and a completed Check List Form to the Building Department with your Building Permit Application. s.C.T.M. 1000 gate: APPLICANT: (Property Owner, Design Professional, Agent, Contractor, Other) /Mirict g� / �m' Sectionlock Lot iLDl {:; D€_ P; l'�"?'1L'iE_i t 1 t i ;E :iii - `i Coninci Informatiorr. , 777..___....... & ......_ Reviewed By:� . _.-.�� �.L ................. ...... .....: Property Address i Location of Construction Wctrk� �Approved for processing Fusdiog hermit.+_J_...._..-_._..._........_..�...f........_........ �tor;t:uatcr vianagettieni Co ,tro{'I_r Not fYc aired. r., 5torri,,wilt<ur ivlat:anent n' Cc t;it oI ?iHn r� Require d. tfor,v,;r:l to Ettgmeet ,i; Drras;rt-,cnr;t f.s:• I_.OR1VI ' `"v1C'P - ,"US :11AY 20 �