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Home My WebLink About38538-Z _ TOWN OF SOUTHOLD (Li~ / BUILDING PERMIT APPLICATION CHECKLIST t BUILDING DEPARTMENT s Do you have or need the following, before applying? TOWN HALL ~S ~ 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 CUt~~~L'~' >n+ITH ALL CODES OF N.Y.S.D.E.C. NEW YURK STATE & TOWN CODES Trustees AS REQUIRED A FG.O.Application Flood Permit Examined q I2T , 2013 ~}{gE6{glyy-~Bp Single & Separate 3 Storm-Water Assessment Form S~~~f ontact: Approved ~ I Z ~ , 20 ~ 3 - ~ Mail to; J Disapproved a/c Phone: ~r~ Expiration , 20~_ j ~1 ~ h ~ ~ ~,1~ r? Building Inspector SEP 1 7 2013 ,j D pPLICATION FOR BUILDING PERMIT Date September 16, 2013 , ~'~,oc oEPr INSTRUCTIONS To~~aar; erounic~o a. This app watton mpletely 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 agees 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. OCCUPANCY OR Roland M. Grant USE IS UNLAWFUL (Signature of applicant or name, if a corporation) WITHOUT CERTIFICATE PO Box 126, Peconic, N.Y. 11958 (Mailing address of applicant) OF OCCUPANCY State whether applicant is owner, lessee, agent, azchitect, engineer, general contractor, electrician, plumber or builder owner APPROVED AS NOTED DATE: . # Name of owner of premises Roland M. Grant ?G~.,~o2CYj~ av~,_,,,t~l~~ (As on the tax roll or lately) BUILDING DEPARTMENT AT If applicant is a corporation, signature of duly authorized officer 765-1802 8 AM TO a PM FOR THE FOLLOWING INSPECTIONS: (Name and title of corporate officer) 1. FOUNDATION -TWO REQUIRED Builders License No. FOR POURED CONCRETE Plumbers License No. 2. ROUGH -FRAMING 8 PLUMBING 3. INSULATION Electricians License No. 4. FINAL -CONSTRUCTION MUST Other Trade's License No. BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE 1. Location of land on which proposed work will be done: REQUIREMENTS OF THE CODES OF NEW 800 Norton's Lane, Southold, New York 1197VORK STATE. NOT RESPONSIBLE FOR House Number Street H ' County Tax Map No. 1000 Section 1000 Block 63-01 Lot 09 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 Garage b. Intended use and occupancy Garage ~ ~ ~ - ~ r/+/~ 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work X (Description) 4. Estimated Cost 5, 000.00 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 4 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. N/A 7. Dimensions of existing structures, if any: FranY 26' ' 7" Rear 26' ' 7" Depth 37' ' 0 Height ~(ob~fo Pu9fco,~'Rio.F Number of Stories 1 Dimensions of same structure with alterations or additions: Front N/A Rear N/A Depth - Height - Number of Stories - 8. Dimensions of entire new construction: Front N/A Reaz - Depth - Height - Number of Stories - 9. Size of lot: Front 282.76 Reaz 261 .23 Dept 148.64 Margaret Leonard-loper & Barbaara lO.DateofPurciYaSe 09/12/2013 Name. of Former Owner Leonard Family Trust 11. Zone or use district in which premises are situated LI 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_ NO R 13. Will lot be re-graded? YES_ NO x Will excess fill be removed from premises? YES_ NO x 14. Names of Owner of premises Roland M. Gran}~ddress800 Norton's LaghoneNo. 516-446-0127 Name of Architect N / A Address Phone No Name of Contractor N/A Address Phone 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 pro~exty )fines., , . 17. If elevation at any point on property is at 10 feet or below, must pri~vide topographical ziata on survey. . 18. Are there any covenants and restrictions with respect to this,properly'7 ~ ~SGE>5,,;~,w, NO x * IF YES, PROVIDE A COPY.. r- STATE OF NEW YORK) SS: COUNTY OF_~ Roland M. Grant being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, CONNIE D. BUNCH Notary No. 01BU5 85050 York (S)He is the Owner (Contractor, Agent, Corporate Officer, etc.) Comrrsisaion Exillres April 14, 2 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 j ~ day of 20~ ~ .c ~ ~r Notary Public ignature of Applicant