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Home My WebLink About43004-Z .SAS° TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE o� . ®� 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#: 43004 Date: 9/6/2018 Permission is hereby granted to: Raacke Robert N Irry Trust PO BOX 816 Mattituck, NY 11952 To: demolish existing swimming pool as applied for. At premises located at: 3855 Westphalia Rd., Mattituck SCTM # 473889 Sec/Block/Lot# 113.-13-19.4 Pursuant to application dated 8/28/2018 and approved by the Building Inspector. To expire on 3/7/2020. Fees: DEMOLITION $100.00 Total: $100.00 ildin spector 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 Survey Southoldtownny.gov PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees ® LL�� V � C.O.Application F Flood Permit Examined 20 Single&Separate AUG 2 8 2018 • Truss Identification Form 3UfLDnkTG DEPT. Storm-Water Assessment Form Contact: Approved 20 Disapproved a/c 49 Phone: '' Z�w Koo Expiration ,20/ YYI0. }o 2)Ox 5I(o tnspector M o-ffi +LAC� � �G 59, APPLICATION,FOR BUILDING PERMIT Date , 20 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. (Signature of applicant or name,if a corporation) pb �gVP Mailing address of applicant) �� State whether applicant is owner, lessee, agent, architect, engineer, general contr ct r, electrician, plm er r builder Naive of owner of premises ReCDS R",Z_cRi� (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. 1. Location of land on which proposed work will be d e: az d M w+� x ck. House Number _ Street Hamlet County Tax Map No. 1000 Section 1 ' 25 Block',,.,-.', ri 2i • ' Lot I�- 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 (D3. ature of work(check which applicable): Y B ilding - -., ,Addition Alteration Repair Removal D84 of �%° ; " <y�' Work TO a WC(Y Rll O J (Description) Estimated Cost Fee ( o be paid on filing this application) If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars ,., 'If business, commercial,or-mixed occupancy, specify nature and extent of each type of use. 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 IP/ Size of lot: Front Rear Depth 10. Date of Purchase Name of Fonner Owner /11. Zone or use district in which premises are situated 11 l. Does proposed construction violate any zoning law, ordinance or regulation? YES NO Will lot be re-graded? YES NO Will excess fill be removed from premises?YES NO -14. Names of Owner of premises Address Phone No. Address Phone No r Address Phone No. 5 Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE REQUIRED. b. s 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) SS: COUNTY OF&� 'j�a being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)He is the of pac E (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 be performed in the manner set forth in the application filed therewith. Sworn to before me this day of—AU 0j64 20J9) TRACEY L. DWYER )( NOTARY ELIC,STATE OFIqEWYOW Notary Publi NO.01 DW6306900 Signature of Applicant QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,21a,�. COMPLY WITH ALL CODES OF NEW YORK STAVE & TOWN CODES APPR VED AS NOTED AS REQUIRED AND CONDITIONS OF A DATE- B.P.# SO t r RflD - 4 FEE: By. NOTIFY BUILDING DEPA NT AT . =y RETAIN STORM WATER RUNOFF 765-1802 s AM TO 4 PM FOR THE • PURSUANT TO CHAPTER 236 FOLLOWING INSPECTIONS: OF THE TOWN CODE. 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH -FRAMING & PLUMBING w _ .. �,..--a- - .-.a•---�^°.�.. •�-�-. •� 4. FINAL - CONSTRUCTION MUSrq.d.' 51^" ' BE COMPLETE FOR C.O. ' f • Y y `B ALL CONSTRUCTION SHALL MEET THE ` y\ REQUIREMENTS OF THE CODES OF NEW 1 ® _ ,-- , . ...._..� - YORK STATE. NQ .,.. .T �P QN..Sl8LE.FQ E DESIGN00• CONSTRUCTION ERROR§. l(e at �a4 r 1. -L�cyy)0 � 1� 40 1Y/TL � 1 V-4 + .