HomeMy WebLinkAbout39859-ZTOWN 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 a/c
,2C 1
PERMIT NO. Jry
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.SDE.0
Trustees
C.O. Application
Flood Permit
Single & Separate
Storm -Water Assessment Form
Contact:
Mail
Phone:
Expiration 20
Building Ins'PeCE01
"A
p,
APPLICATION FOR BUILDING PERMIT
Date 20
INSTRUCTIONS
6 , -Tbis-applicAtion MUST -be completely Filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of ptans,`acCUmie'pl0t plan to Sc,41e4 Feee0cording to schedule.
b. �'Qppia' e
- flan showing locition' of lot mid of on premises, relationship to adjoining premises or public streets or
areas, and, Wafq��,a'ys'-
c. The �r,W,,,o,rkcover e,d[by,tJi'i's,, ng,
this", may not he commenced before issuance ofBuildi a Permit.
d: Upona licatki
_ pprovhl� of this App 4�,"zfie`'Buildirig Inspector will issue a Building Permit to the applicant. Such a permit
ori
ilea, , _
shall be keptPr&mi,e i . , 1, 8 9
�s,# able n throughout the work.
e. N6:building , `whole or in part for any purpose what so ever until the Building Inspector
shall be cup'i�e"T,,civ th�cd "
Z",
issues a Ce�iate of"(3cctmancv." f , "I!, �, " "I"
f. Ey,�4,�buildlbgcohfii`f s -hill expire if the work,,authorized has not commenced within 12 months after the date of
issuance or liO�n'lot been completed within 18 months from such date. 1f 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.
A111"Ll CATION IS HEREBY MADE to the ,Building Department for the iSsptance of a Building permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk CottrityiNew York, and cattier 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 applila ws, ordinances, building code, housing code, and regulations, and to admit
authorized inspectors on pre bu f �k necessary inspections.
(Signature of applicant or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, 1� ent, architect, engineer, general contractor, electrician, plumber or builder
ftg'a., � / 60 1 LM ep 0
Name of owner of premises
�rlmsAnA t Tt (I 14er-41"
ct (As on the tax roll or latest deed) . .....
If applicant is a corporation, signature of duly authorized officer
1
(Name and title of corporate officer) QJ
Builders License No.
Plumbers License No. _;77
Electricians License NO. . . .... ...
Other Trade's License No.
Location of land on which prop(
X080 �"
House Number Street
County Tax Map No. 1000
;d work will b done:�
67- sa)
Hamlet
061 lAnk"',
Subdivision Filed Map No. -Lot
2. State existing use and occupancy of premises and int dd d
a. Existing use and d6cupancy W 1;��Iebo
7,r
2p
b. Intended use and occupwicy
proposed construction:
3. Nature of w r (check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost Z, Fee
(To be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor
Ifgarage, 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 construciioinFront 'Rear Depth
Height Number of Stories
9. Size of lot: Front Rear :: -;, � ; � � -, � ��Depth
10. Date of Purchase Name of Former"OWndt'
11. Zone or use district in Which premises did' I situ I ated,
vi ®late anyni
zon _,.aw, orm
ance or regu ation? NO
1.2. Does proposed construction,
13. Will lot be re -graded? YES, NO 'dill ,excessti fill, beremoved premises? YES NO
, 0#erM1+tkj
14. Names of Owner of e lises Pr0,ZT0'4,1,,` "'Address bcv7'4b"yPh
[f�, ,one No.
Name of Architect 5CA ef7.Addiess-6*19-1- 'PhoneNo d8
Name of Contractor 419411;t5f(4 Address Phone No.
J
15 a. Is this property within 106 feet of a tidAl wedand or a fres'hwater,�vetland? YES NO
IF YES, SOUTHOLD TOWN TRUSTEES k'D.E.C. PEANUTS' MAY BERtQ'UfRE57
b. Is this property within 300'feei` f`a'tidal lvetlana? *'YES NO
*IF YES D E C PERMITS MAYBE REC)UIRE D
16. Provide survey, to scale, with accurate foundation plan and distances to prRperty 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
YES, PROVIDE A COPY,
STATE OF NEW YORK)
SS:
COUNTY OF
being duly sworn, deposes and says that (s)he is the applicant
(Name oVindlhddual signing confrldt)�_�abovena7md, r
(S)He is the V4f
, AgenQCorpofale 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 O*e"t his knowledge and belief; and that the work will be
performed in the manner set forth in the application filed t�"ierewitb.
Sworn to before me this
day of
20IS'
CONNIE 0. BUI CH
C
Notary Public Notary Pulft, $tate W i ature of Ap licank,l
NO. 01 BUST 0
Ou~ In &tftk
cornmfteilon E;Vme 1114"Z!:Ll��
SECB
PROFESSIONAL ENGINEER
1725 HOBART ROAD/ PO Box 616 SOUTHOLD, NEW YORK 11971
TEL: 631.765.2954 • FAX: 631.614.3516 • e-mail: joseph@fischetti.com
Date: 26 May 2015
Reference: 1060 Traveler Street
Building Inspector
Town of Southold
Main Road, Southold, NY 11971
Dear Sir,
The initial construction at the above referenced building was to clean out the inside of debris
and repair the holes in the roof and make structure watertight. Without that work I could not
enter to make drawings of the existing building for the owner.
During the cleanup, an area on the east side of the building consisting of a one story shed roof
was unsound. The main girder supporting the :2nd floor was damaged and many of the shed
rafters were found to be rotten.
With this Building Permit we wish to complete the repairs to the roof rafters and replace the
damaged girder "in kind"
If we find any additional repairs we will inform your office prior to making those repairs. After
completion we will submit drawings of the location of all repairs.
If you have any questions on this chatter please contact me..
truly yours,
os6ph Fischetti, PE
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