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HomeMy WebLinkAbout39990-ZTOWN OF D SOUTHOL BUILDING DEPARTMEN U� 'P HOL RTM D TOWN HALL EN] SOUTHOLD,NY 11971 i TEL: (631) 765-1802 FAX: (631) 765-9502 r Si1 LI ? -if_,qLUT_ sm Expirat 20 W Board of Health 4 sets of Building Plans W 0 M Survey Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Storm -Water Assessment Form r-*-* - ttltw ........ ....... ...... S,0 )hone: 20j Diiiapplicdfl�'Jii,,,J e com le illed in by typewriter or in ink and submitted to the Building Inspector with 4 ,f3b _p_jely f rT_ sets of p• �i�a e. Fee according to schedule. nr� 'a c ns, b 1:11 ot 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 � or has not been comppleted 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 applic- ble laws, ordinances, building code, housing code, and regulations, and to admit 3uthr)ri7(-.r1 inz antnr, on nrerniqe, N . . o for T ------ * - Tltinm ZASE AHMEL Ile Notary Public - State of New York k? (Signature of applicant or name, if a corporation) NO. 1IAH6213A245 Qualified in Queens County W. 1�tl)4 1:��T - #I Vo(p NY N4 �Qots My Commission Expires Nov 2, 2017 7i� - llr___:]�` .11, , (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder MEFc- Name of owner of premises CW -1 LJF0 Ge7 I N C - (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer BE= FICuilders License No. V"lumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: lEFAr1 House Number Street Hamlet County Tax Map No. 1000 Section -7 Block t -Lot Subdivision_ Filed Map No. Lot State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy FG7 S � 1) el%k CG7 W / CA, r -A G e - b. Intended use and occupancy i?_ C__ S IL De" cc V4 I GPr_411Qi57 3. Nature of work (check which applicable): New Building Addition Alteration ✓ Repair , V' Removal Demolition- Other Work (Description) 4. Estimated Cost!��011 , G0Q Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units I -Number of dwelling units on each floor If garage, number of cars - 3 0 rIlm.., Dimensions of exis In structures, if any: Front 591 --7 It Rear 9 '- 7 6 /4 Depth, 40 1 -(G 0 Height 2-2'--73 -Or" Number of Stories :2 Dimensions of same structure with alterations or additions: Front 5'49 ( - -7 � /4 Rear Depth -40' - 10 Height -22'- -7 3/1q It -Number of Stories— S 8. Dimensions of entire new construction: Front —Rear Depth Height Number of Stories 1 (/9. Size of lot: Front Rear 4)-:S' Depth Ss) 11. Zone or use district in which premises are situated R - I ze 12. Does proposed construction violate any zoning law, ordinance or regulation? YES--"AO- 13. Will lot be re -graded? YES— NO %-/ Will excess fill be removed from premises? YES.— NO 1. 4. Names of Owner of premises F�C't Ua2�g I NC Address Phone No, Name of Architect Z@�Cg D - K itJL& tA Address�� w -'VM 5V 4 K)0(a Plione No al'zl: 095 '2 9E)B Name of Contractor Address `-"I k f'fl 101�3 PhoneNo, 15 a. Is this property within 100 feet of atidal wetland or a freshwater wetland? *YES—NO • IF YES, SOUTHOLD TOWN TRUSTEES & D.E.Q. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? • IF YES, D.E.C. PERMITS MAY BE REQUIRED. ...... ...... NAWNTIN 'I Dill 1111 1 ffil& I W. I 18. Are there any covenants and restrictions with respect to this property? * YES NO V" * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF being duly swom, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, RMEM I Agent, Corporate Officer, etc.) Of Said owner or owners, and is duly autnorizea to perlorm. or nave periormel= saialror& an 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. Io] ZABE AHED Notary Public - State of Now York NO..OIAH6213245 Qualified in Queens County my Commission Exp-Ires Nov 2. ?017 Signature of Applicant