HomeMy WebLinkAbout39828-ZTOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
SoutholdTown.NorthFork.net
Examined ,20
'LL2,
Approved , 20
Disapproved a/c
Expiration 20
BUILDING PERMIT
Do you have or
Board
4 sets •c
Planni.
Survey
PERMIT Check_
Septic,
I
MY.S.
'LICATION CHECKLIST
the following, before applying?
alth
Board approval
.C.
C.O. Application
Flood•Pe�rinit
Single & Separate
Storni-V later Assessment Form
Contact:
Mail to:
Phone:
/ I
Building Inspector
M AY p 2015 APPLICATLON FOR BUILDING PERMIT ,
j I Date;
INSTRUCTIONS
a. This application MUST be'completely filled in by, typewriter or;in ink,and submitted t
sets of plans, accurate plot plan to scale. Fee according to schedule.
-b: Not plan -showing location of-lot_and dbuildings,,on premises, relationship,to adjoinir
areas, and waterways.
c. The work covered by this application may not be commenced before issuance of.Builc
d. Upon approval of this application; the Building Inspector, will issue a Buiiding Permit
shall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used'in whole or iri'part;for ariy purpose what so eves
issues a Certificate of Occupancy.
f. Every building permit shall expire if the work authorized has not commenced within 1
issuance or has not been completed within 18 months from such date. If no zoning amendments e
property have been enacted in the interim, the Building Inspector• may.. authorize; in writing, the e
addition six months. Thereafter, a new permit shall be required.
APPLICATION IS HEREBY MADE to the Building .Department for the issuance of a B
Building Zone Ordinance of the Town of Southold, Suffolk County;, New York, and, other applic
Regulations, for the construction of buildings, additions, or alterations or for removal or,demoliti
applicant agrees to comply with all applicable laws, ordinances, building code, housing code,.ani
authorized inspectors on premises and in building for necessary inspections.
(Signature of app
AU
State whether applicant is owner, lessee agent, chitect, engineer
Name of owner of premises
(As on the tax roll or latest.d ed3
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No.
Plumbers License No. j
Electricians License No. j
Other Trade's License No. r .
1. Location of land on which proposed work will be done:
House Number 'S.treef 30 Hamlet
L1111L YAW
County Tax Map No. 1000 Section ' hABlocic ° a1J uw `1' bRooy
I V 1 SrCvoy:r 1 u .vV-
ytnuo:) Alo,,W2 nl beffl1vuS
M J ! U VIUL MigX3 n01921=100 yi!
'—T---� 71
20
the Building. Inspector with 4
premises or public streets or
ag Permit.
the applicant. Such a permit
xntil the Building Inspector
months after the date of
other regulations affecting the
tension.of the permit for an
ding, Permit pursuant, to the
Laws, Ordinances or
as herein described. The
,gulations, and to admit
icant or name, if a corporation)
address, of applicant)
Arician, plumber or builder
of
E- 1� -q X171 �J
Subdivision ����1 ��— Filed Map No. ! 3 Lot 3
2. State existing use and' occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use arid,occupancy q o --P
b. Intended use and occupancy
Idition 4.-3. Nature'of work (check which applicable): New BuildingAAlteration
Repair Remo'v'al' Demolition Other Work
(Description)
4. Estimated Cost Fee
(To be paid on fling 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:42 rout �'� '� - Rear S
Depth �-,r� ' HeightNumber of Stories
r
r
8. Dimensions of entire new construction: F'r'ont' 3 "Rear `f r Depth*W`
Height /l" Number of Stories
9. Size of lot: Front / e(I - 9—Rear i 3 ,�;-� Depth zfk �
10. Date of Purchase Name of Former Owner,' �%0--�/�r1 !7
11. Zone or use district in which prerimises-are situated
12. Does proposed construction. violate any, zoning law,, ordinance or regulation?, YES_ NO
13. Will lot be re -graded? YES :, N9__ Will excess fill be removed from, premises? YES NO
14. Names of Owner of premises `%�� . `-,�hA�:O,,Address / A?:; M4'�`'nAIW.4h�No3 Dz -IV
Name of Architect . , . "Address,.. Phone No
Name of'Contractor ddress w . )cj+e; 6 P, Phone"No. `1'7 % —0'57 ?�
15 a. Is this property within ' 100 feet ofja'tidal`4etland or a fr`esfiwater' wetland? *YES - NO
* IF YES '-SOUTHOtD TOWN'TRUSTEES-& D.E.C. PERMITS MAYBE QUIRED.
b. Is this property within 300 feet"of a tidal'wetland? l 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 s rvey.
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 9W
C% being duly;sworri, deposes and -says -that (s)he is the applicant
(Name of individual signing contract) above named, ; t
(S)He is the
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 ! •, ,
day of Q. 20 ' J
�,u 'tL-2
REiEVE
tary PublicNOTARY PUBLIC -STATE OF NEIN YORK 1, ignature of Applicant
No.01RE6059270 -
Qualified In Suffolk County
My Commission Expires July 23, 2017
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SURVEY OF
LOT 3
MAP OF
WILD OATS
FILE No. 9331 FILED MARCH 9, 1993
SI T UA TED A T
PECONIC '
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000-86-04-6.3
SCALE 1 "=40'
JULY 30, 2001
SEPTEMBER 25, 2001 REVISED PROPOSED HOUSE
NOVEMBER 19, 2001 FOUNDATION LOCATION
OCTOBER 22, 2002 FINAL SURVEY
FEBRUARY 21, 2015 ADD PROPOSED POOL
APRIL 27, 2015 ADD PROPOSED DECK & HOT TUB
AREA = 39,998 sq. ft.
0.918 ac.
PREPARED IN ACCORD MINIMUM
STANDARDS OF
SURVEYS BUSHED
BY THE LI. - D A TED
FOR SUC SA+E TE D
TIME OCA
(� 7 Lic. N
UNAUTHORIZED ALTERATION OR ADDITION
TO THIS SURVEY IS A VIOLATION OF
SECTION 7209 OF THE NEW YORK STATE
EDUCATION LAW.
COPIES OF THIS SURVEY MAP NOT BEARING
THE LAND SURVEYOR'S INKED SEAL OR
EMBOSSED SEAL SHALL NOT BE CONSIDERED
TO BE A VAUD TRUE COPY.
CERTIFICATIONS INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY
IS PREPARED, AND ON HIS BEHALF TO THE
TITLE COMPANY, GOVERNMENTAL AGENCY AND
LENDING INSTITUTION LISTED HEREON, AND
TO THE ASSIGNEES OF THE LENDING INSTI-
TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE
THE EXISTENCE OF RIGHT OF WAYS
AND/OR EASEMENTS OF RECORD, IF
ANY, NOT SHOWN ARE NOT GUARANTEED.
Nathan IWUGbrwin III
Land Surveyor
Successor To: Stanley J. Isaksen, Jr. L.S. -
Joseph A. Ingegno L.S.
Title Surveys — Subdivisions — Site Plans — Construction Layou
PHONE (631)727-2090 Fax (63.1)727-1727
OFFICES LOCATED AT MAILING ADDRESS
1586 Main Rood P.O. Box 16
Jamesport, New York 11947 Jamesport, New York 11947
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