HomeMy WebLinkAbout37100-Z ' TOWN OF SOUTHOLD
��o�SUFFot,r�o BUILDING DEPARTMENT
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z TOWN CLERK'S OFFICE
o • SOUTHOLD, NY
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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 #: 37100 Date: 3/29/2012
Permission is hereby granted to:
IMELDA CORCORAN FARRELL
95 DEAN DRIVE
CUTCHOGUE, NY 11935
To: demolish an isp & 684 Sq. ft. of decking as applied for
At premises located at:
9520 NEW SUFFOLK AVENUE CUTCHOGUE
SCTM # 473889
Sec/Block/Lot# 116.-5-4
Pursuant to application dated 3/23/2012 and approved by the Building Inspector.
To expire on 9/28/2013.
Fees:
DEMOLITION $164.80
Total: $164.80
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 Survey
SoutholdTown.NorthFork.net PERMIT NO. 3 Z6 Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application ,
Flood Permit
Examined ,20/)-- Single&Separate,
Storm-Water Assessment Form
Contact:
Approved 20_L�- Mail to:
Disapproved a/c
Phone: Iq
Expiration 't W 20 1,3`. 3 7 Q
D Q �f 2 Building Inspector
L�MAR 2 1 2012 LICATION FOR BUILDING PERMIT
Dater 2-1 , 20 12•
BLDG.DEPT.' _ _ INSTRUCTIONS
TOWN OF SOUTHOLD
a. This application M letely.filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of plans, accurate plorpldn 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 Ordindnce 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.
(Dr ev Ian 4•Yre_ll
(Signature of applicant or nam , if a corporation)
�9szo A)ew.SKI Ilk
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4/93
(Mailing address app icant
State whether applicant is owner, lessee, agent, architect, engineer, general.contractor, electrician, plumber or builder
,6 a/'/o.E (--
Name of owner of premises
(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 rb done.
A546 '75-16 Al Ya" aQ D E.
House Number Street y Hamlet
County Tax Map No. 1000 Section Block ,J� 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 ��la
b. Intended use and occupancy eae,4�X41ZAla
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost fQ Q.(] Fee
(To be paid on filing this ap)lication)
5. If dwelling, number of dwelling units / - Number of dwelling units on each floor f
If garage, number of cars �¢,
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. /V
7. Dimensions of existing structures, if any: Front Rear Depth
Height' Number of Stories rdd; ? ea�ih .
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 6 i J Depth 1,041///Z*7�
10. Date of Purchase Name of Former Owner T-4,0"e Di"i��v�Gtld GlJ�1 E'-r`
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO V
13. Will lot be re-graded? YES NO_V//Will excess fill be reijiove from premises? YES NO tV/
14. Names of Owner of premises AAddress 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 lV
* 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
* IF YES,D.E.C. PERMITS MAY BE REQUIRED.
16. Provide survey,to scale, with,aecurate foundation plan and distances to property lines.
1-7. 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 )
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named, CONNIE D.BUNCH
Notary Public,State of New York
(S)He is the No.01BU6185050
Qualified IF,Suftlk Gee
(Contractor, Agent, Corporate Officer, etc.) Corn nisslon Expires April 14,2Ol
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 y e thj ^ r
I da of( u'1 20
Notary Public ms Signature of Appli ant
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SUFFOLK COUNTY, NEW YORK i
4 TV 11 I �`01 00, S.C. TAX No. 1000-116-05-04 !
SCALE 1"=20'
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Land Surveyor
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PHONE(515)727-2I190 F..1516)722-5C93
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