The URL can be used to link to this page

Home My WebLink About36769-ZTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE 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 #: 36769 Permission is hereby granted to: Moody, Hiram F. Jr. QPRT & Goulard Sarah R QPRT 2127 Rabbit Road, Wickenburg, AZ 85390 Date: 10/20/2011 To: Alterations to a Single Family Dwelling; Renovation of a 2nd Floor Bath, as applied for. At premises located at: 128 Reservoir Road (Winthrop Drive), Fishers Island SCTM # 473889 Sec/Block/Lot # 9.-8-3.2 Pursuant to application dated To expire on 4/2012013. Fees: 10/13/2011 and approved bythe Building Inspector. SINGLE FAMILY DWELLING - ADDITION OR ALTERATION CO - ALTERATION TO DWELLING Total: $214.00 $50.00 $264.00 Building Inspector Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF occUP~NCY This' application must be filled in by typewriter or ink and submitted to the Building Department with the follo~ving: For new building or new use: 1. Fina~ survey ~f pr~perty with accurat~ l~ati~n ~f al~ bui~dings~ pr~perty ~ines~ streets~ and unusual natura~ ~r topographic features. 2. Final Approval from Health Dept. of wate~ supply and sewerage-disposal (S-9 form). 3.. Approval of electrical installation from Board 0fFire Underwriters. 4. 8w. om statement from plumber certifying that the solder used in system contains less than 2/I0 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 requi~ments. B. For existing buildings (prior to April 9, 1957) fion-confoyming ns~s, or buildings and "pre-existing" land nses~ 1. Accurate survey of property showing all property lines, street, building and unusual natural or topographic features_ 2. A properly ~mpleted 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. Certifica{e of Occupancy - New dwelling $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00, ~ Swimmifig pool $50.00, Aceessory building $50.00, Additions to aecessury 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 New Construction: Y Location of Property: ? ~ ~ House No. · Own6r or Ownera o; Property: ,/'~, MOd)/~3 . 8uffolk County Tax Map No 1000 Section Subdivision P~mitNo. 3/w q6~ Health Dept. Approval: Date. /tO - Z¢ - /( Old or Pre-existing Building: (cheek one) Planning Board Approval: Da~ofPermit. Street Block ~ Filed Map. o~0.7//Applicant:. Undetwrite~ Approval: Final· Ceaificate: '~ Request for: Temporary Certificate Foe Submitted: $ (check one) Apphcaut Stgnatm · ',,'.LV ~S~:rlONa]~'ORTD,~r~ co~Nrs ~o~o~ (~ ROUGH ~G & PL~G ~S~A~ON PER N. Y. STATE E~GY CODE ~D~ON~ COUNTS ~.~, ,,, ,, 'TOW~ OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown. NorthFork.net Examined PERMIT NO. Building Inspector BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying'? Board of Health 4 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Storm-Water Assessment Form Contac'i: Mail to: >hon :~)~ -- 0¢T12 2011 BLBG. DEPT. IOW~I OF SOUTHOLD APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date J~7 ~- ,20 I I 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 promises 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, Suftblk 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 lbr 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 ~'-l~t"oW,. .~:::>c~-.t ~- (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 ,3o-m p 1. Location of land on which proposed work will be done: House Number Street Hamlet County Tax Map No. 1000 Section'a:] Subdivision Block <~ Filed Map No. 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 Repair Removal Estimated Cost '~! ~O~ If dwelling, number of dwelling units If garage, number of cars Addition Demolition Other Work Fee Alteration (Description) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height Number of Stories Rear .Depth Dimensions of same structure with alterations or additions: Front Depth Height Number of Stories 8. Dimensions of entire new construction: Front Height Number of Stories Rear Depth Rear 9. Sizeoflot: 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 14. Names of Owner of premises Name of Architect Name of Contractor Address Phone No. Address Phone No 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 y/a,,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 ) e~ ~, ~gl,.~ ~) being dui3, sworn, deposes and says that (s)he is tile applicant (Name of individual signing contract) above named, O x (S)Heisthe'""~'~i~x~q~' g] /~}'0, /0~_..~ ~(jO~)~.-4e~ qContractor, 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 tree to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application flied therewith. Sworn to before me this-~ .~"ff~--, day of gP~'~-t~- 20 / / Notary Public -- - / Signature of Applicant ON LEAD CONTENT BEFORE CERTIFICATE OF OCCUPANCY SOLDER USED IN WA TER SUPPLY SYSTEM CANNOT EXCEED 2/10 OF 1% LEAD. PLUMBING ~1.~ WNn'E & WATER UNES NEED TESTING BEFORE cOVERING ,JOTED STRAPPING ELECTrICaL ~. ~NSULAT~ON 4 FINAL- CONSTRUCTI~ ~UST BE COMPLELE ALL CONSTRUCTK)N ~[cL ~NL[~IT 1T~ ELECTRICAL INSPECTION REQUIRED ~-eo ,00 Tom's Plumbing and Heating Box 534 Fishers Island, NY 06390 COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED AND OONDITIONS OF SOUTHOLD TOWN ZBA SOUTHOLD TOWN PLANNING BOARD TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net Examined ,20 Approved ,20 Disapproved Expiration ,20 BUILD1NG PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Board approval__ Survey PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees Flo9d Permit Storm-Water Assessment Form Contac'~: Mail to: BLDG. 10WN OF SOU[H0[D Building Inspector APPLICATION FOR BUILDING PERMIT (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 Nameofownerofpremises H ~f'oll'~. ~Q~C~'~ (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 N . . 2 6$o-mp Location of land on which proposed work will be done: House Number Street Hamlet Tax Map No. 1000 Section<~ County Subdivision Block <~ Filed Map No. ~Lot - · ~o~n's Plumbing and Heating Box 534 Fishers Island, NY 06390 Town of Southold Building Department P. O. Box 1179 Southhold, NY 11971