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Home My WebLink About41100-Z guFFntk�o TOWN OF SOUTHOLD BUILDING DEPARTMENT y ,a. 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#: 41100 Date: 10/20/2016 Permission is hereby granted to: Lewis, Herbert 14 Horatio St Apt 12G New York, NY 100141660 To: demolish existing house, deck, and shed as applied for. At premises located at: 4525 Breakwater Rd., Mattituck SCTM # 473889 Sec/Block/Lot# 99.-2-17 Pursuant to application dated 9/28/2016 and approved by the Building Inspector. To expire on 4/21/2018. Fees: DEMOLITION $454.00 Total: $454.00 Building Inspector TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD, NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: 631 765-9502 FAX: (631) Survey SoutholdTown.NorthFork.net PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application I Examined l 20 Flood Permit D �� Single&Separate D Storm-Water Assessment Form SEP 2 7 2016 Contact: Approved ,20 Mail to: PP BU LDING DEPT' a 7 Q L �2..,.� }�c.�• lar Disapproved a/c • J�� `SOWN OF SO Phone: S)CP" 9,9S— 7 5/ I l 4Y G Expiration ,20 VV Bui tng I ctor APPLICATION FOR BUILDING PERMIT Date , 20 /6 INSTRUCTIONS a. This application MUST be completely 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. nature of applica or nam ,if a corporation) a� aj M;�- e�� (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises (As on the tax roll or latest deed) If a lican 's a c tion, signature of duly authorized officer (Name and t' corporate officer) elders License No. / �} Plumbers License No. Electricians License No. Other Trade's License No. 1. Location Z15�on which proposed work will be done: House Number Street Hamlet County Tax Map No. 1000 Section 19 Block-, j2Q_ Lot L7 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 3. Nature of work(check which applicable��=!�-=�Other Addition Alteration Repair Removal Work sc Oe—k 5 - (Description) 4. Estimated Cost ' ` N , i " '"" }(� o " aid on filing this application) 5. If dwelling, number of dwelling units umber of dwelling un sfo i each floor If garage, number of cars .+,y, r� ;�;s j U 6. If business, commercial or mixed occupancy, specify nature,and extent of each type of use. r+r,� ��ily`[�J.� 7. Dimensions of existing structures, if any: Front �''' `v9°� 3c��' ' 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 NO Will excess fill be removed from premises? YES NO-A/-/- 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 "QUIRED. 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 o survey. 18. Are there any covenants and restrictions with respect to this property? * YES NO * IF YES, PROVIDE A COPY. STATE OF NEW YORK) S: COUNTY OF SW401 �,jC?A? ��FJ being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the (Contractor,Agent, orporate 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 ri TRACEY L. DWYER Notary Public NOTARY PUBLIC,STATE OF NEW YO Sig ure of App ' t NO.01 DW6306900 - QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,2 Q� Josephupper s P I at i O-r,`a l • Senior Supervisor Customer Fulfillment Department .1 October 12, 2016 Herb Lewis 4525 Breakwater Road Mattituck,NY 11952 E-Mail: HLEWIS&NYC.RR.COM ;JOHNF2Bc OPTONLINE.NET National Grid WO# T101892760 Service Address: .4525 Breakwater Road Mattituck, NY 11959 To Whom It May Concern: This letter is to advise you that National-Grid investigated your request and confirmed that the subject property does not have an active gas service line. New York State law requires,anyone planning underground excavation work to notify local utilities by making one call to-a toll-free number to,get your underground lines identified for you prior to doing any digging. This phone call needs to be made at least 2,-days but not more than 10 days prior to starting work, not including the date of the call. The number to call is either the nationally sponsored"811", or the local number for NYC/LI area, 1-800-272-4480.This confirmation letter of no active gas service line to the subject property does not relieve the excavator of making this "811"call. If you have any further questions, kindly contact me at 631-348-6218. spectfully, Joseph Kearns R [E(gRO'V Senior Supervisor [E D Customer Fulfillment Gas NY OCT 2 0 2016 BUILDING DEPT. TOWN OF SOUTHOLD 1650 Islip Ave,Brentwood.NY 11795 T:631-348-6218 F:516.545-2333 Joseph.keams@nationalgrid.com www.nationalgrid.com PSEG Long Island Building & Renovation Services 15 Park Drive Melville,NY 11747 LONG 0 PSEG ISLAND IIr•mala,1hii gs wrnk jar on. September 21, 2016 Mr. John Ferguson 27 Quail Run Hampton Bays, NY 11946 Re: Electric Demolition Request _ 4525 BREAKWATER ROAD,MATTITUCK, NEW YORK PSEG Notification#900000033653 Dear Mr. Ferguson: This is to advise you that the PSEG-LI electric facilities at the above referenced location have been disconnected and removed off the building structure that is located on the property. Please note that there may still be PSEG LI facilities located within the property boundaries and that NYS law (NYCRR Part 753) requires all contractors to call for a utility locate (NY 811) prior to performing any ground excavation or regrade activity. The call to the 811 Call Center must be done at least 2 business days prior to the start of the work and confirmation of utility marks having been identified must be received from all the facility owners prior to any site work. You must also contact National Grid at 516-545-4973 to procure a letter of demolition associated with natural gas service, whether or not your home or business uses natural gas. If you have any questions regarding the above, please contact Building 8s Renovation Services at 1-844-341-6378 or via email at BRSLI@PSEG.com. Very truly yours, Carolyn Mackin Manager Building & Renovation Services PSEG-LI CM/am B:W MON. 0.4S WOOD N U.P. t*1 U. Co r2 0 ONARY ST P 6LK. SHED U� QJ Q co COcs N STO yt } CON . v°. IYjp� tt3 r� �� tT M.H.Q - -70.5' IA zo,s'• t7 a p C,T't to U P ELLuj Z I MASOMARY48. BLK. SHED O (fj M U.P. Q0 PTSCD `"�� '""�'-""^^.^•-..•.._._.� ---- -----.. -_._ ASPHALT YEL DRIVEWAY -- - APRON FC C13t __ _------ 0 8:N4 W MON. MON. 0 4'N MON. 0.2 S 2.2 S S83' 4(l Q�' FE 337.17 0.2 W 4' CHAINLINK, FENCE MAPOF CAPTAIN K1DD ESTATES i 672 , w . W THE WATER SUPPLY, WELLS, DRYWELLS AND-CESSPOOL Q LOCATIONS 3NOWN ARE• FROM FIELD OBSERvATlONS p AND OR DATA OBTAINED FROM OTHERS Ps ELEVATFOH OATUAL IS A VIOLATION OF SECTION 7209 OF THE NCW PORK STATE EDUCATION LAW. COPIES OF, THIS SURVEY L SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES'INDICATED HEREON SHALL RUN ?ED AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INS7I711770N INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE. PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE ) GUIDE THE ERE077ON OF FENCES, ADDITIONAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS WED ARE Nor GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY CERTIFIED TO; HERBERT" LEWIS; AS ' �j OLD REPUBLIC NATIONAL TITLE INSURANCE x OA D r,nAAPAn1Y-