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Home My WebLink About37771-Z TOWN OF SOUTHOLD 4�gi1FFOt,��o BUILDING DEPARTMENT TOWN CLERK'S OFFICE oy • N- A 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#: 37771 Date: 1/23/2013 Permission is hereby granted to: Lipovac, Denis & Lipovac, Suzana 32-58 37th St Astoria, NY 11103 To: Demolition of existing deck as applied for. At premises located at: 5220 Stillwater Ave, Cutchogue SCTM # 473889 Sec/Block/Lot# 137.-2-14 Pursuant to application dated 1/18/2013 and approved by the Building Inspector. To expire on 7/25/2014. Fees: DEMOLITION $251.20 Total: $251.20 Building Inspect r TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TO"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 Flood Permit Examined 3 20 ,� �11 F C E [� Storm-Water Assessment Form_____ ' u Contact: Approved t 2- ,20 �3 JAN 2013 Mail to: Disapproved a/c BLDG.DEPT. Phone:_ Expiration / 2 ,20 (�( _ TOWN OF SDUTHOL (Ck J 'B g Inspector APPLICATION FOR BUILDING PERMIT Date �� , 20 1 3 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,a d regulations,and to admit authorized inspectors on premises and in building for necessary inspections. l (Signature of applicant or name,if a corporation) �Z-5'g `57 7�T A->-roiZ#.,, /J`/ lu o3 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder pw�tE2 Name of owner of premises 1)0 i 5 cos i tJhL (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 done: 5zuO 54 I1wa oe- e- G'w`C-4 n�c House Number Street Hamlet C County Tax Map No. 1000 Section ( 3 /--7 Block co2 Lot Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use a d occupancy of proposed construction: a. Existing use and occupancy e'j -�-i b. Intended use and occupancy Z25 i a, 71101 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition V' Other Work (Description) 4. Estimated Cost 40/000 Fee I (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. 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 19 Name of Former Owner _Gr\j d G(5.0- 11. Zone or use district in which premises are situated / 12..Does proposed construction violate any zoning law, ordinance or regulation?YES NO L- 13. Will lot be re-graded? YES NO V Will excess fill be removed from premises?YES NO 03 14. Names of Owner ofpremises_Jb,,Nt-rIS-z", )�,,_Address3z-s83'7sr m_AZ Phone No. '7(e-U-6 - yo/z 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 t' * 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__�.Zl * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OFQ,-o )ff T.eNi > ! -1 P-0V being duly sworn,deposes and says that(s)he is the applicant (Name of individual signi g contract)above named, (S)He is the 01-3 Nz_r (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 p N 20 ,_.•�'"''�~ THOMAS R. 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