HomeMy WebLinkAbout44395-Z 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
Flood PIarmit
r,�xarrnncd— 1110 Contact:Storm-Water Assessment Form-
20,
Appi-oved Mail tcy Bennett Enterprises LLC
Disapproved a/c PO Box 386,Wading River,NY 11792
fPhone:631-445-5907
Expirawn
4,1
Laltni'ling it'spector
OCT 1 6 2019 APPLICATION FOR BUILDING PERMIT
Date
...... 20L--L--
INSTRUCTIONS
a.This«appslieation 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 water-ways.
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
-- I- -
addition six months.Thereafter,a new permit shall be required.
APPLICATION IS HEREBY MADE to the Building Department for ffic"fisuance of a Building 111 lit', r 11
Building Zone Ordinance of the Town of Southold,Suffolk County N 'i' an
and other I aper r inal s
Regulations,for the construction of buildings,additions,or alic
"is for removal or ,moij, n as he "descr h
e
applicant agrees to comply with all applicable laws,ordinances, ode;41a siI d reaiow ,sit
authorized inspectors on premises and in building for necessary inspections
(SigilatUTC ofapplicant ortiame,ifa corpoTation)
Polar Tree Farm,9West 57th Street,New York,NY 10019
(Mailing address of applicant)
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
Owner
Name of owner of premisesPolar Tree Farm LLC
(As on the tax roll or latest deed)
If applicant is a corporation,signature of duly authorized officer
Stefan Soloviev,Managing Member
(Name anand-tit—leof 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:
30105 Route 25 Cutchogue
House Number Street Hamlet
County Tax Map No. 1000 Section102 2 Lot 16
J(_
Subdivision,n/a -—— -—Filed Map No._J�
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy single Family Dwelling,Retail/Storage Building,Christmas Tree Farm
b. Intended use and occupancy ,
ame
3. Nature of work check which applicable):New BuildingAddition A terafi a t r(�
Repair Removal _Demolition Other Work
_ ... m.�
4. Estimated Cost �� _ Fee (Description)
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
n
9. Size of lot:Front,�' °"��� � °��� �� ar Depth ?.(7
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 x
13.Will lot be re-graded?YES ,NOX mm Will excess fill be ivinoved fi-oni premise ?YES NOX�
14.Names of Owner of urc iri¢sc. " 4.. ibJiti.rus,_ e i...ia 'ltolte No. �2 C>7
Name of Architect ' Address— —lone No,
Name of Contractor Address rhone No.
15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES—NO X
* 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.X....."„_
* 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 bek-)w,must proOdc topographical data on survey,.
18.Are there any covenants and restrictions with respect if,)this property?* YES—, NO
* IF YES,PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF Suffolk l
Stefan Soloviev being duly swom,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the Managing Member (Contractor,Agent,Corporate Officer,$Wrr
of said owner or owners,and is duly authorized to perform or t)6ia performed the said as iiitttaaatlwamtd f tlrr's"�pl`rcatiei ..,
that all statements contained in this application are true to 11 best of his knwAjgdpll l� iwrf"and that tlia r�osk will be l
performed in the manner set forth in the application filed tli Frith ... ,.. "
smt o l to before me this
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.....� i� o ro" �1�:
iw Pbhcgil5kireofApplica7nC
Nota u 9 ira 5r{t�!”
,
m. .. No.eft 124CoMM )a01�.taic� AP
Scott A. Russelld .
SUPERVISOR MANAGEMENT
SOUTHOLD TOWN HALL-P.O.Bim 1179 Southold
53095 Main Road-SOUTHOLD,NM YORK 11971
CHAPTER TE
(TO BE COMPLETED BY THE APPLICANT )
,
a. a , ..
DOES THIS PROJECT OL O�
..... . _
(CHECK ALL THAT APPLY)
. ....
"ties No
A. Clearing, grubbing, grading or stripping of land which affects more
than 5,000 square feet of ground surface.
B. Excavation or filling involving more than 200 cubic yards of material
within any parcel or any contiguous area.
C. Site preparation on slopes which exceed 10 feet vertical rise to
100 feet of horizontal distance.
ffD. Site preparation within 100 feet of wetlands, beach, bluff or coastal
erosion hazard area.
013/E, Site preparation within the one-hundred-year f loodplain as depicted
it
on FIRM Map of any watercourse.
E413"F, Installation of new or resurfaced impervious surfaces of 1,000 square
feet or more, unless prior approval of a Stormwater Management
Control Plan was received by the Town and the proposal includes
P f
_ t
in-kind replacement o impervious surfaces
If you answered NO to all of the questions above,STOP! Complete the Applicant section below with your Name,
Signature, ContactInformation, Date & County T Nap Number! Chapter 236 does not apply to your pro'
If you.answered. _ .. ... .., ._ ... w...
to one or more of a above,please submit Two copies of a to waterManagement Control l
and a rem;pleted Cltcti' last term to(.lte�Butilfling NparWieAt wli&w y� pualhfid Pe it p licatl6h:
. -.:_� nom... . S.C.T.M. #: 1000 11aCe:
APPLICANT-. (Property Owner,Design Professionat Agent,Contractor,Other) DLstrtct � W
Stefan Soloviev 102 2 �w
162
NAME
Section Block
FOR BUILDING DEPARTMENT
USE ONLY
Contact Information
917-929-
�1
Reviewed By:
Date:
'I
�irc��,rert301d05 MamRoad CutCho
Location
f tion Wnr°k mmm �
gue NY Approved for processing Building Permit.
i Stot mwater Management Control Plan of Require.. �
(Forwt
ardEngineering Enneering Departm ner Management Control t for Ren is view .)
_.....__
FORM SMCP-TOS MAY 2014
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. For new building or new use:
1. Final survey of property with accurate location of all buildings,property lines, streets,and unusual natural or
topographic features.
2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1%lead.
5. Commercial building,industrial building,multiple residences and similar buildings and installations,a certificate
of Code Compliance from architect or engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings(prior to April 9, 1957)non-conforming uses,or buildings and"pre-existing" land uses:
1. Accurate survey of property showing all property lines,streets,building and unusual natural or topographic
features.
2. A properly completed application and consent to inspect signed by the applicant.If a Certificate of Occupancy is
denied,the Building Inspector shall state the reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00,
Swimming pool $50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building- $100.00
3. Copy of Certificate of Occupancy- $.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential $15.00,Commercial$15.00
Date._.._mm
I 'I
New Construction: Old or Pre-existing Building: _ (check one)
Location of Property: 30105 Main Road Cutcho ue, NY
House No. Street Hamlet
Owner or Owners of Property: Polar Tree Farm LLC Stefan Soloviev
Y p ��
2 Lotw.16a.�2 &1§,3 Suffolk Count Tax Ma No 1000 Section 102 Block _.__..�.
Subdivision W_.._ Filed Map. Lot:
Permit No ....... ��.......Date of Permit. µµµ .. Applicant:
Health Dept. Approval: mmm Underwriters Approval:
Planning Board Approval: .......__ _.....,_
Request for: Temporary Certificate Final Certificate: X (check one)
Fee Submitted: $ ..._.
Applicant Signature
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Mini Barn Classic,Cape,Cottage, Quaker,Dutch Barn
I'� a 8'wide–48" 8'wide–all doors 54" 12'wide x 12'and under–54"
10'wide–60" 10'wide x 12'and under-54" 14'thru 18'–60"
Cape (quaker 12'wide—72" 14'and up—60" 20"and up—72"
6'WIDE(overall width 71") 57"'
1
8'WIDE(overall width 92")
_ J J
10'WIDE(overall width 117.5")
F—25" I 34.25" - I 34.25"4—25"
12'WIDE(overall width 138") MN I
f— 34.5" I 34.25" I 34.25"t 34.5"— 1
14'WIDE(overall width 161")
Dutch Barn Mini Barn 1—23.25"+23.25"-1 34"—� 34"— - 23.25"—f—23.25" --I
Design and Specifications subject to change without nonce Not responsible for typographical error's or omissions
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