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Home My WebLink About29536-Z FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 29536 Z Date JULY 1, 2003 Permission is hereby granted to: EDWARD SANDBERG MATTITUCK,NY 11952 for DEMOLITION OF THREE EXISTING ACCESSORY BUILDINGS AND A PORTION OF AN EXISTING DWELLING WITHOUT UTILITIES AS APPLIED FOR at premises located at 20105 MAIN RD MATTITUCK County Tax Map No. 473889 Section 108 Block 0003 Lot No. 005 . 003 pursuant to application dated JULY 1, 2003 and approved by the Building Inspector to expire on JANUARY 1, 2005 . Fee $ 81 . 35 th ri ed rture ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN FALL Board of Health SOUTHOLD, NY 11971 3 sets of Building Plans TEL: (631) 765-1802 . Planning Board approval FAX: (631) 765-9502 �� .3 Survey www. northfork.net/Southold/ PERMIT NO. Check Septic Form N.Y.S.D.E.C. r Trustees Examined ( ,20 Contact: Approved ,20___$ Mail to: Disapproved a/c Phone: Expiration f 20 Building Inspector APPLICATION FOR BUILDING PERMIT II Zo� ` ' • r.� Date / 0 , 20 INSTRUCTIONS a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 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. (Signatur of applicant or name,if a corporation) APPROVED AS NOTED 1-14� o DATE: /�/�� B.P.6 C9 S j (Mailing address of applicant) State wl p tfcant isBWn nt, architect, engineer, general contractor, electrician, plumber or builder NOTIFY BUILDING DEPARTMENT AT 765.1802 8 AM TO 4 PM:;FOR THE FOLLOWING INSPECTION$Name-do e � FO ON -- - -- — As:on 2 ROUGH - FRAMING &PLUMBIN ( the tax' 'roll or latest deed) If W§LjAyWration, signature`o7duly authorized officer d FINAL rn I (N4te k1*E4aRr0.(orAte officer) ALL CONSTRUCTION SHALL MEET THE, BuildersHEAU1 (�TS OF THE CODES OF NEW PlumberXQRKAJ6,T1q,0 NO ES 0 Electricig§%Rge . Other Trade's License No. L. Location of land on which proposed rk will be done: House Number Street Hamlet County Tax Map No. 1000 Section z��2 Block es Lot Subdivision Filed Map No. Lot (Name) 2. State existing use and occupancy of premises and in ended use a d occupa cy of roposed construction: a. Existing use and occupancy IZ b. Intended use and occupancy ,SJ Ze_ 14 X kd 3. Nature of work(check which applicable): New Building Addition Alteration Repair Removal emolition Other Work c e G o -- o (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 A— ✓u o /e re-11- yJ4 74- 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 �11163 Name of Former Owner '�5V 4 h 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 l'Z1ar1, 73 ~l/1 14. Names of Owner of premises - 1 w S Address�7`"� ' 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 REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO-!K_ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide.survey; to scale, with accurate foundation plan and distances to prope ; l, e�st ` 4s' �� 17. If elevation at any point on property is at 10 feet or below, must provide_topQgraphi.cal data�onsa e. STATE OF NEW YORK) SS: 3�I'. w+�-'. ' 9 COUNTY OF ) �3✓t(�ii' '. !?� k:si'e^F',1_:sC� / x Q _ �T a I k t'—-s being duly sworn, deposes and says that�(Jhe is�thgj ppiiGU (Name of individual signing contract) above named, (S)He is the (Contractor,Agent, Corporate Officer, etc.) 12G of said owner or owners, and is duly authorized to perform or have performed the said wbrk:ai d'to make aridifiI this application; that all statements contained in this application are true to the best of his knowledge':andlbElief;-)dhd that'the'work'will'b'e performed in the manner set forth in the application filed therewith. Sworn to before me this day of f U'&'t 2000 Notary Yublic Si ature of Applicant LI NDA.J.COOPER Notary Public State of New York No.48'22563,Suffolk County Term i s p:rGs Decaaiber 31, N �10 0, Wo N/O/F GREENBR/AR HOM M �11 200 0 '�m ES. INC. 133,9.7,• . A N 6 i ° •,t SUR BEY OF PROPER 1"Y ;A T Mi4..T TI TUCK TOW. N OF.SOU THOLD y011 /8, o SUFFOLK COUNTY, N. Y 1000- 108 - 03 - 53 Z Scale: 1" - 40' In chi repce i May 30, 2003 31 M im •, ., V 'V /v ' • ,.. - � (+� � n1 I - off. �� .�_--' —A `� _ .. •� _ moo - ,I I � i' C� � . 1 - - —1` . r N. 85°25'S0' {� W. - - - 250.00' MA IN AD Ys I v AREA. = �13038:A cres RTE 25�. Y S..METI�e .CERTIFIED TOi e . � ? �� NQEL''P` GAIN€S OO.. _ '�• o A'N.Y'�L TERA,TION:OR'ADDIT/ON.,TO THIS SURVEY IS.A' VIOLATION. -Gi GA/NES OF_:SECTION, OF::THE•NEW-.-••YORK'STA'TE 'EDUCA:TION ' 'W. '` -LOANS C.4 ._�.. COUN:TRYWIDE.:•1-IOME . ,"INC.~ EXCEPT PER-°SECT/0N VO9 -.SUBDIVISION.Z. ALL CER.T/F/CA.T/ONSLAND, HEREON ARE VALID FOR THIS'MAP AND COPIES THEREOF'ONL Y.IF. . . C604fONWEAL'I-TH TITLE INSURANCE , . -SAID'MAP OR COPIES BEAR•.THE`IMPRESSED SEAL, OF'THE:SURVEYOR ` �' / :S LIC. NO.., 496/8 WHOSE.'SIGNATURE'APPEARS:.''HEREON.: ' M; Q 9 ADDITIONALLY .TO COMPL Y WITH SAID'LAW TERM ' AL TERED:BY P.C. MUST BE USED, BY ANY AND ALL. SURVEYORS UTILIZING A COPY (63l), - FAX (63/) 765, -. /797 OF ANOTHER SURVEYOR'S•MAP TERMS SUCH'-INSPECTED. ',AND `� P. .O. BOX :909 "BROUGHT TO - DATE '`ARE NOT/N:COMPLIANCE WITH THE LAW. 1230. TRAVELER STREET „ r SOUTHOLD, N.Y . I197/ r= . 03 174