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Home My WebLink About37183-Z oSUF c,r� TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE 'goy . o� fi 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#: 37183 Date: 5/1/2012 Permission is hereby granted to: Dejesus, Beatrice 21870 Route 25 PO BOX 1088 Cutchogue, NY 11935 To: demolish existing shed (200 sq. ft.) as applied for At premises located at: 21870 Route 25, Cutchogue SCTM #473889 Sec/Block/Lot# 109.-1-3 Pursuant to application dated 5/1/2012 and approved by the Building Inspector. To expire on 10/31/2013. Fees: DEMOLITION $167.50 Total: $167.50 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. Check Septic Form N.Y.S.D.E.C. Trustees C.O. Application Flood Permit Examined ,2017— Single&Separate Storm-Water Assessment Form Contact: Approved 20 Mail to: Disapproved a/c II__ l G� Phone�/�` -73� 6"-Te / Expiration ,20 DE C E U E Building Inspector APO 2 2012 PPLICATION FOR BUILDING PERMIT Date , 20 BLDG.DEPT. INSTRUCTIONS TOWN OF SOUTHOLD 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) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises FEll-7_41 6- 0 ykE3_,�eS (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. Lo�tH11 ^and on which �prjc will be don e/®7-C` House Number Street ► GJ/l Y Hamlet County Tax Map No. 1000 Section / I 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 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work 4 (Description) 4. Estimated Cost ,Z,QO G 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. Dimensiotls o existing tructures, if any: Front c' 1, Rear Gr C - Depth 1 Height !� t� Number of Stor s 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 a7I�'67o f�Jll�`J .�. 14. Names of Owner of premise //C S Address&l7C/fd6ele,Id✓�Phone No.4-;k7l d-d 2ej' 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 * 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 ) being duly sworn, deposes and(j +LiLb(�tfi6Ahe applicant (Name of individual signing contract) above named, Notary Public,State of New York No.01 BU6185050 Qualified in Suffolk County (S)He is the (Contractor, Agent, Corporate Officer, etc.) Commission Expires April#�� 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 thi a�-* day of 20/ � UA CA j A' '4.e 12.4 "'ol Notary Public Sign ire of App icant TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET -21170 VILLAGE DIST.1 SUB. LOT Ald, FORMER OWNER N ,��r' . ACR. ; S„ W TYPE OF BUILDING aC t c 4� V � �ES- �+ SEAS. VL. , FARM COMM.. CB. MICS. Mkt. Value LAND IMP. 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