HomeMy WebLinkAbout39721-ZS�FFot,r
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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TOWN CLERK'S OFFICE
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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 #: 39721 Date: 4/30/2015
Permission is hereby granted to:
Edgett, Scott
685 Track Ave
Cutchogue, NY 11935
To: Demolition of an existing deck as applied for - Demo only
At premises located at:
685 Track Ave, Cutchogue
SCTM # 473889
Sec/Block/Lot # 137.-1-22
Pursuant to application dated 4/23/2015 and approved by the Building Inspector.
To expire on
Fees:
10/29/2016.
DEMOLITION $263.80
buiiaing inspector
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following, before applying?
TOWN HALL
Aoardof Health
SOUTHOLD, NY 11971 .4, sets, of Building Plans
TEL: (631) 76.5-1802 Planning Board approval
FAX: (631) 765-9502
SouthoIdTown.NortfiVork.n'e't PERMIT NO. Check
41 :=SepticForm
N.Y.S.D.E.C..
Truslees,
C.O. Application
Flood Permit
Examined- 20;-, Single & Separate
St6hn--WaierAssb§sffi6i Form
-Contact:
Approved 20 ; Mail 0
Disapproved a/c
q
P;': 1', 1 Phoh6:
Expiration 20
L;
PLICA'PION FOR BUILDINGTER-MIT-1;
-APR 2 2 2615
Date hook VL_ —,201S
INSTRUCTIONS
BLDG DEN.
1 !41 1 i 3 i MUST be completely filled in,by, typew, yfter, or in ink and submitted to the Building inspector with .4
sets of plans,accurate plot plan to scale. Fee according 16 schedule.
b. Plot plan showing location* of lot and of buildings on premises,. hi d
_Tplations p to adjoining premises or public streets or
areas, and waterways.
c. The work covered by. this application may not be commenced d before issuance of Building Permit.
application i - -I, ; 0,f'fl 11". , ) - I ,j-'� " - ;!, , - Permit. r,
d. Upon approval of this applichtion:, theBuilding Ihi§p-6ct6r Will issue 'a BuildingPerhift to the4oplicant.* Such a permit
shal I be kept on the premises available, for inspection throughout the work.
.wlible",-,
e. No building shall,be occupi&d`6Fu§6d -in or -in p�Wf6i-dfiy`piur'prbrse wh'a't' so ever until ifi"6 'Building Inspector'
issues a Certificate of Occupancy.
f. Every, building p " iVSfidll expire if the work authorized has not commenced within 12 months after the date of
grin
issuance or has not been completed within 18 months from such ddt6.,,If no zoning amendments or other regulations affecting the
property have been enacted inthe,interim, the Building Inspector may authorize, in writing, the extension, of the permitfor, an
addition six months. Thereafter, a new permit shall be required.
APPLICATION IS HEREBY MADE. to, issuance, of.a Building Permit pursuant to the
thqBuil P�paytmentf
114 Joirig� " I I ,
Building Zone Ordinance of the Town of Southold, -Suffolk Coun% New, York, anapplicable"., : I , S,
dother Law Ordinances or
Regulations, for the construction of buildings, additions, or alterations,or for, removal: or demolitionas -herein described. The
usi�g c 9 regulations; applicant agrees to comply with all applicable laws, ordinances, building.',66d6 ho mg e, and regulations; ani'd to admit
ai?4 rqgu
",�d to admit
authorized inspectors on premises and in building for necessary inspectib S.
r V-%% i — x4naturnTapplica-R-rorname, if a corporation) 91
'10
C' -'D N C0'6 jMailin'gjaddrdss of applicant)"
contractor, electrician, plumber or builder
State whether applicant is owner, lessee, Ntb�arcmklll
o
0\2 o
GO
��P�U�p1N0
)r -
Name of owner of premises
f 6
e r0 M i eep.
If applicant is a corporation, signature of duly hu. r "k 10�A S' Op0ES0 FOR
rO C)�Sp0NS�6
(Name and title of corporate officer)��0�10N;J, I
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:
(0%13 _4�aA(�L N j e OV�C,�Lko off' 119157
House Number Street Hamlet
County Tax Map No. 1000 Section - Block Lot
2.
3.
4.
5.
Subdivision Filed Map No. Lot
State existing use and occupancyJof premises and intended use and occupancy of proposed construction:
a. Existing use and!o'ccupancy #'
b. Intended use and -occupancy
Nature of work (check which,'applicable): New Building Addition Alteration_
Repair Removal Demolition_ Other Work
(Description)
Estimated Cost Fee
`. (To be paid_ornfiling this application) '
If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cars
6. If business, commercial orm iked occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front`` Rear Depth 1'i a f
Height Number of Stories
Dimensions of same structure with alterations or -additions:- Front 3q ` Rear
Depth 4 -Height Number of Stories
8. Dimensions of entire new construction:° Front`,`
Depth
Height Number of Stories
9. Size of lot: Front D 0 Rear i . L)"O . ",-; �T e p-. ZDepth 90
10.- Date of Purchase ;Nariie' of Former'
X,:.
11. Zone or iise'district'iri`vvhich premises' are'sitimted''"```
.." ..r � � �.� � r
12. Does proposed construction violate any zoning law,;ordinance' oriregulation?,YES, M' v''
13. Will lot be re -graded? YES NO,
cess,fi .l,.berremoved from premises? YES NO
14. Names of Owner, of,premises.S'cof=rE8x.v"• j Address U5, -„{Q CIct,, ..A)O� Thon'eVNo. 631. 25S-401%
Name of Architect- , J ', '
.: �� �� � ��Address > � r, � � �: Thone,No
Name of Contractor = J> kit. Address PhoYre No.-'
15 a. Is this propertyWithin'406feet of a`ti"dal�weflarid'$'r a freshwater wetland? *YES '' NO• OC `
* IF YES, S'OUTHOL'D`TOWN'TRUSTEES & D.E'C•.'PERIVIITS,NIAY BE'REQUIRED
�� t 1`T ( `i"i
b. Is this pr'operty'within 300; feet of a tidal we'tl'� tarnd? *r YES NOS_'
* 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 dpplicant
(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 bei,
performed in the manner set forth in the application filed therewith.
Sworn to efore me thi
day of 20�
�� h � BUNCH
Notary Public Signature of Applicant
Notary Public, State of New York , �, , ;.
No. 01806165050
OualMled In Suffolk County
Commission Expires April 14,
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