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Home My WebLink About40008-ZTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net Examined_„ 120 r Approved 20 Disapproved a/c Expiration--....._ 20 ti �l,r 41� n k y sets o5, attula0. b.,i;l loot plan', .,., areas and ateray. "saflie�yvork" ,' Opon"app'. shall be kip + D t, 'I e.1Jo ittt`ldis BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health PERMIT NO. " ALIG 5ilu KK; Bung In, aer A 'PLICATION FOR BUILDING INSTRUCTIONS 4 sets of Building Plans, Planning Board approval Check Septic Form N.Y.S.D.E.C. C.O. Application Flood Permit Single & Separate Storm -Water Assessment Form Contact: Gw91 I", Phone: 3 0/ i X16 I f... Wl' CERTER, A III DatemANC �„ — 20/y 4US_T,be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 last to scate<.F: according to schedule. ,=louatton of lot and of buildings on premises, relationship to adjoining premises or public streets or i by this' application dray not be commenced before issuance of Building Permit. this applicaotiohlthi building Inspector will issue a Building Permit to the applicant. Such a permit a available for *'6� ion throughout the work. k oc'tig9i g �t'i whole or in past for any purpose what so ever until the Building Inspector issues a Ce:f$ioa f i kyr la t)9c{dngert�t sh'1"e �psrc if the work authorized has_not commenced within 12 months after the date of issuance orit npp.beezt completed within 18 months from such date. If no zoning amendments or other regulations affecting the property havo"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 t6 comply -with alb apprltcable:la'WA,b'r6r noes, building code, housing code, and regulations, and to admit aulhororea ins re.to'o on,prdnaai s'atttl nlarlil)iltl Graf rl s y inspections. AS ......,... "" ' Y (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 fees O (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) tl Builders License No. l t (fjt Plumbers License No. Electricians License No.t��" "- Other Trade's License No, �') (( p p el work will be done: 1. Location of land on which ro os, v House Number Street Hamlet County Tax Map No. 1000 Section Block Lot �' 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 S`! C" : I b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work_ 6/Or ?r. ®..__...._ (Description) 4. Estimated Cost Fee r. I? be paid on filing this application) 5. If dwelling, number of dwelling units Number Mwelling 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 Height Number of Stories Rear Depth 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 I I I. ' Number of Stories 9. Size of lot: Front Rear I I Depth 10. Date of Purchase Name of Formbr Owner 11. Zone or use district in which premises are situated`' 12. Does proposed constfuctionyjplate iny,zo I ning-law, ordipanqe or f r 13. Will lot be re -graded? YES NO Will excess fill be rpmoyed frotn,premises? YES 14. Names ofOwnerof premises , .. Address Phone No. Name of Architect AddressPhone No Name of Contractor Address Phone No.' 15 a. Is this property within 100 feet of a tidal wetland or i --freshwater wetland? *YES NO * IF YES, SOUTI=TOLD TOWN TRUSTEES & D.E.C. PERMITS BE REQUIRED: b. Is this property within 300 feet'of a tidal 0/etland': * YES NO IF YES, D.E.C. PERMIT'S MAY EF REQL7R.ED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. h[1 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. /i 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 _ j ) Po,,,,5l a % 5 being duly swom, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the td�2j2 (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 th day of ��_ 20� Notary Public TRACEY L DWYE Signature of Applicant NOTARY PUBLIC, STATE OF NEW YORK NO.01OW6M900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30, 2____ Scott A- Russell SUPERVISOR —0 SO OLD TOWN HALL - P_ 0- Box 3379 53095 Main Road - SOUTHOLD, NEW YORK 13971 6 1�x' 9 SEEM DOFS TMS pRojECT INVOLVE ANY OF THE FOLLOWING: I'No (OiECK ALL THAT APPLY) Yes . A. Clearing, rubbing, 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 ora contiguous area. C. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. D_ Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area - E. Site preparation within the one -hundred -year floodplain as depicted on F1Pd\-4, Map of any watercourse..., F_- J-D-stallati of h W_ Or resurfaced impervi-o-us surfaces of 1 -000 -square feet or more, unless prior approval of a for to MaDageme Control Plan was received by the Town and the proposal includes in-kind replacement of impervious surfaces. If you answered NO to all of the questions above, STOP! Complete the Applicant section below with youf-�'�ama, Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project. n answered YES to one or more of the above, please submit Two copies of a Stormwater o Management Ctrol Pla. and a completed Check list Form to the Building Department with your Building Permit Application - APPLICANT: (Property Owner. Design Professional. Agent, Contractor. Other) 'I, 12. ... . . . . .......... . . . ......... . . . ......... S.C.TIM 1000 Section -Block Lot DINM' DEP,� fri Reviewed'By� Date. - — -------- J)��)�ovcd fog Buddillog "�-rrml of orw'md lo F_jv�'m(�vring D(Purlm(�w fof Rcvwcw �i,. Y ClCyy � Jti � f✓7 tz �J 2 yJ Qj 4 �N t� 0 0 C�2 q -t5 . NL. 4N N fj � e oaif I` ;LJJ.�k ?"�`� '44 LU cc LL 4,00, V } } y Ili IT.w moil. •° t ¢ ,r O F-~�¢. o ut a0�-3:1 F Uj Ei CL oc Uj U W Off.✓ w dm 0 Tu� W �. Q LU I wl � 1 r# f N " u : i C p.11oiu u, Datic, a Outd4xii, , fi:i I:: Tula. j, Sl::+,i::us h P1xflo:ii i� iiRoI rui:n Yr spB ii 'b 'b W MU 7 N Evolutioui Spas"',A11ure 6o,Jet, 6 Person Spa eaturIutrip s, Nuptooffi Audio System, Miugriirdo� J l) IPMiiIV S of 11 uotlll0, Wall ortaU and Moll W Ccrnllmii::^ IlSroduuw u Za i ed (iixft of 2 Shaii e itVnlr IlIii oduct: Itein 49M'52 $62999.99 ShlIppint t HandUngiili-luded qin&uITY u product detaill have been supplied by the Manufacturer, and are hosted by a third party. Evollution Spas'All �alutio OfflRejuvenate and cle.-stress inEvin Slle6 -jet spa. Fwostainiess F4 0G ✓0 pumps and 60eautiful steel swirl jets relieve stress and musde fatigue fora complete massage from neck to toes. Comfortable, v, ergonomically designed seating features a full body 4116 lounger and two captain's chairs with rolillover neck , and shoulder jets., Il the elegant ambience of our custom -molded LED backlit waterfall while you luxuriate in soothing hydrotherapeutic waters.. Our beautiful Provincial cabinet offers the look of a natural , ir f, wood spa with no sanding or staining. Seating Features Relax in Allure's full-body lounger, or sit back in one of the 2 captain's chairs and enjoy as soothing neck and shoulder jets massage away stress. Stainless Steel/Black Swirl jets are perfectly placed throughout Aliure's .shell, including massage -action and rifle -action jets, ll complete hydrotherapy to neck, back, legs, and feet. ® Seating- 6 adults including cookJown seat • Total lets. 60 Stainless Steell/l Swirl Jets: 37 back jets; 8 leg jets; 8 neck/shoulder jets; 4 hip jets; 3 foot jets. $3,,999 99 $3,499,99 b (J r.Py, Iq product detaill have been supplied by the Manufacturer, and are hosted by a third party. Evollution Spas'All �alutio OfflRejuvenate and cle.-stress inEvin Slle6 -jet spa. Fwostainiess F4 0G ✓0 pumps and 60eautiful steel swirl jets relieve stress and musde fatigue fora complete massage from neck to toes. Comfortable, v, ergonomically designed seating features a full body 4116 lounger and two captain's chairs with rolillover neck , and shoulder jets., Il the elegant ambience of our custom -molded LED backlit waterfall while you luxuriate in soothing hydrotherapeutic waters.. Our beautiful Provincial cabinet offers the look of a natural , ir f, wood spa with no sanding or staining. Seating Features Relax in Allure's full-body lounger, or sit back in one of the 2 captain's chairs and enjoy as soothing neck and shoulder jets massage away stress. Stainless Steel/Black Swirl jets are perfectly placed throughout Aliure's .shell, including massage -action and rifle -action jets, ll complete hydrotherapy to neck, back, legs, and feet. ® Seating- 6 adults including cookJown seat • Total lets. 60 Stainless Steell/l Swirl Jets: 37 back jets; 8 leg jets; 8 neck/shoulder jets; 4 hip jets; 3 foot jets. $3,,999 99 $3,499,99 Provincial Wood -look Resin Cabinet Cabinet a The classic wood -look Mahogany Provincial spa cabinet is sure to enhance your patio and your home, making you the envy of your neighbors! The Sterling Silver (white with gray marbling) acrylic shell shines.;. by day or by night! & Our Provincial cabinet is insulated using reflective surface backed foam fitted tightly to the spa frame, which provides heat retention, yet is easily removed for access to components. Every Evolution— acrylic spa features our stainless steel, true all -season heater for energy-efficient, year-round use of your spa! Lighting, Sound and Water Features Ambient lighting sets the moGd for a party, or a relaxing, romantic eveningl 16 programmable points of exterior cabinet lighUng set your patio aglow and LED points of light in the waterfall bring a sensory experience to spa users. A large underwater light, lighted control knobs, and a backlit control panel make navigating a breeze! The Allure spa includes a marine -grade MP3/Bluetooth sound system that stands up to water, sun, the environment, and has high- power sound performance to provide clean, clear sound in the outdoors, 2 marine -grade speakers grace the spa shell and 2 in the cabinet exterlor allow music to flow throughout your patio area, • EJ9:htJng. Programmable digital multicolor LED points of Ilght in cabinet exterior, waterfall, LED lighted control knobs, and urge LED underwater light • Water Feature: Programmable backlit molded LED righted waterfall with on/off contrail • sound system- Self-ampiffied MP3 Dock ohth Bluetooth capability, subwoofer, 2 tGpSlde speakers, and 2 panel speakers. (MP3 player not included.) Specifications • Made in the USA • Dimensions. 8S' x 85" x 36' • 2 Pumps: 5BHP (4CHP) 2 -speed pump + 4BHP (3CHP) high-speed pump • Water capacity: 400 USG • Weight Dry / Filled: 650 lb. / 3,482 lbs • Electrical Requirements- 240V / 50A GFC1 breaker required (not included) (Electrical connections must be made by qualified, licensed personnel. Improper installations present hazards, which can result in personal injury or property damage. Contact licensed electrician.)