HomeMy WebLinkAbout39693-ZTOWN OF SOUTHOLD
coa 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 #: 39693 Date: 4/20/2015
Permission is hereby granted to:
Tuthill III, Ralph & Tuthill, Susan
PO BOX 306
Mattituck, NY 11952
To: Demolition of an existing swimming pool as applied for.
At premises located at:
1045 Wagon Wheel Ln, Cutchogue
SCTM # 473889
Sec/Block/Lot # 108.-3-12.7
Pursuant to application dated 4/14/2015
To expire on 10/19/2016.
Fees:
and approved by the Building Inspector.
DEMOLITION $100.00
Total: $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
PERMIT NO.
Examined 20
2-a i�,
Approved 120
Disapproved a/c
�y II I , J
t
I `m/ I 1
APR 14 2015
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
4 sets of Building Plans
Planning Board approval
APPLICATION FOR BUILDING
INSTRUCTIONS
Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O. Application
Flood Permit
Single & Separate
Storm -Water Assessment F rrn
Contact: SUSAN � ��/ �
Mail t�0 �X -- W
Date L+ I � `-T 20 IS
--i-�—isappli&tian M TST belcompletely 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.
(Signature of applicant or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
U(jJY �R ,
Name of owner of premises "R0�� i - — 5 A tJ ! • 1 l
(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
of land on which DroDOsed work
House Number 1 Street
done:
Hamlet
County Tax Map No. 1000 Section k O $ Block Lot k ok TI
�i 3�i
Subdivision
Filed Map No. Lot
2. State existing use and occupancy of premises anintend d use d occ pancy of proposed
a. Existing use and occupancy S!
b. Intended use and occupancy -5 Wak
3. Nature of work (check which licable): New Building Addition
Repair
Removal Demolition Other Work_
4. Estimated Cost • Q C) Fee
Alteration
(Description)
(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_X,
w
13. Will lot be re -graded? YES NO^ Will excess fill be removed from premises? YES NON� YDS
--lea3,-fig-
14. Names of Owner u)L R
of pr' Address Phone No. 103 -- �0� g - $6 �s Q—
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 X
* 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_X_
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK) TRACEY L. DWYER
SS: NOTARY PUBLIC, STATE OF NEW YORK
COUNTY OF_5qbjk) NO. 01 DW6306900
QUALIFIED IN SUFFOLK COUNTY
U1S W vl"� 1' I being duly sworn, deposes and says that (s)he is tqPW§A40N EXPIRES JUNE 30, 29-1-82
(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 to before me this
f'�+h day of r 20/5
�Y1 I
Notary Public 01Signature of Applicant
4OWN Of SOUTHOLD- PRIO
/00-0 --Ajq-1 13 �'jskrrr PERTY` Rjk;-ORP CARD
OWNER
STREET
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'DIST. SUB. LOT --
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FORMER OWNER
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ACR.
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Se RA ej,
TYPE OF BUILDING
Uri
RES.
SEAS.
VL.
FARM COMM. CB. mics. Mkt. Value
LAND
IMP.
TOTAL
DATE REMARKS
I/00
f;
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FRON TA4.ON WATER (F>
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411. J+NFRONTAGE ON: ROAD
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House Plot
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Total
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LAND OF CV40SE
APPROVED By
Ppzop)L. El) SE -r - OFF
MAP OF PROPERTY
SURVEYED FOR
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SITUATE- AT
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TOWN OF 500TWOLb. N.Y.
BOARD
PLANNING
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OF SOUTHOLD
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Ppzop)L. El) SE -r - OFF
MAP OF PROPERTY
SURVEYED FOR
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SITUATE- AT
CUTC.HOGUE
TOWN OF 500TWOLb. N.Y.
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INSURANCE COMPANY
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0 SURVEYED - JUNE 22, 1972
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MY
SCALE - (00'=1'' GUARANTEED TO TUE U.5, LIFE TITLE
INSURANCE COMPANY
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0 SURVEYED - JUNE 22, 1972
VAN TUYL & SON Torr prraPgsel?_ei_-r�.►
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