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Home My WebLink About40804-Z TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN ALL Board of Health SOUTHOLD,NY 11971. 4 sets of Building Plans TEL: (631)765-1802 Planning Board approN a I FAX: (631)765-9502 survey Southolh[Town.NorthFork.net PERMIT NO. QQ Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined 20 Single&SeP'ara't'e"' Storm-Water Assessment Form Contact; Approved_ —20 Mail to: ----------------- Disapproved a/c Phone,,._ Expiration 20 Building Inspector APPLICATION FOR BUILDING PERMIT /Date )wA,e 2,q 2016 INSTRUCTIONS a.This application MUST be completely fitted 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, 01— (Sigrradai of applicant orUime,if a corporation) (Mailing address of applicant) Swie whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder /Xame of owner of premises hic-i I d (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. ................. [,,,"L,ocatioiioft,,indora NNIiichl)rol.)oseclwoi-kwuI be done: S2 House Number Street HamletT ounty Tax Map No. 1000 Section Block Lot Subdivision—,,,,.. ... Filed Map No, Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy , b. Intended use and occupancy.m.m. 3. Nature of work eck which applicable):New Building _Addition w r, Alteration Repair Removal Demolition Other Work (Description) 4. Estimated Cost Fee (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 13.Will lot be re-graded?YES N® Will excess fill be removed from premises?YES NO_____ 14.Names of Owner of premises Address Phone No. 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 *IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE R1 7D. 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 *IF YES,PROVIDE A COPY. STATE;OF NEW YORK) I sS• COt.JNTY OF,.... y 2 _ n being duly swom,deposes and says that(s)he is the applicant (Name of indMdual signing contract)above named, (S)He is the (Ccnt'rta.c°caa,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 the rew.tll" tRA EY L.DVVYER NOTARY PUBLIC,STATE OF NEW YORK NO.01 D W6906900 S ori to before me this QUALIFIED IN SUFFOLK COUNTY day o LApj, 20. 1 b/' COMMISSION EXPIRES JUNE 30,2(21� Notary P'aai ignataire of Applicant TIM GRAY MASONRY CONSTRUCTION, LLC. P.O. Box 412 Southold, NY 11971 Phone (631) 765-5221 Fax (631) 765-8156 graymasonry@aol.com June 28, 2016 Southold Building Department, We have been hired by the Mallins at 4525 Wunnewetta Road, Cutchogue N.Y. to repair the damage done to the top of their stone chimney by a lightning strike on June 20, 2016. The strike blew out some of the stone and flues in the top several feet of the chimney. The rest of the chimney is undamaged. We have taken down all the loose and damaged parts to eliminate any danger of anything falling and plan to start rebuilding the chimney to the exact shape, size and height as before. We would like to start rebuilding at the end of this week. Thank you for all your help. Sincerely, rrTimothy S. Gray. 1 DX`! � .�.., ,.....e., .. , 1, iiO fir; -, a#11`ED c " s, I N' �; " 1 j^" A ., p.; ;. NAiJR..AT1 ') � A. A 1PlAL G C)I —TRIJ�:.";Ti" 13� �,mL�S..f. AP.A AONATA1a��.1�() � H REQ Hi IENI Ind ,:°°> OF k'W7 ,",OF I°Q!AW 10')�I K STATE"' 1"�O I A��/JJlVI »11 1l „