HomeMy WebLinkAbout40402-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_,.
SouthioldTown.NorthFork.net PE IT NO. Check
Septic Form_
N.Y.S.D.E.C.___
Trustees
C.O.Applicauon
Flood Permit
Examined 20 Single&Separate .................
Storm-Water Assessment Form
Contact:
Approvcd (Z— 20 Mail to:
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DEC, 214' 2",'115 APPLICATION FOR BUILDd1 1� ,RMIT
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INSTRUCTIONS Date—..-
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 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 arty 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 riot 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 IIEREBY 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 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.
(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
(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 No.
1. Location of land on which proposed w,)rk will befdone
L r<.i 7
House Numbe'r Streit Hamlet.
County Tax Map No. 1000 Section Block Y, Lot
Subdivision Filed Map No. Lot
2. Statexisting use and
occupancy of P remtses and irate ded aancYofpsed construction:
oc
a. Exitinguse and occupancy
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b. Intended use and occupancyk
3. Nature of work(check which applicable):New Building Addition Alteration
Repair __Removal Demolition Other Work
(Description)
4. Estimated Cost 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
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 ,ear Depth.
Height Number of Stories
9. Size of lot: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 Address Rhone No.
Name of Architect Address Phone No
Name of Contractor 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 on 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 )
being duly swom,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the
(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.
Svi rn to before rr�c t is WE D.BUNCH
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DATE REVISIONS
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12.22.15 REVISED FOR APPROVAL Al
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IIIIIIII MI 1 45 WEST 21 st STREET
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40 NEW YORK, NY 10010
TEL 254-1175
FAX(212) 254-1755
31'-0"
JOB NUMBER: 1308
S.
DRAWN: NCFO
CHECKED: WR
PRINT DATE: 12.22.14 Sg 015 �'
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DATE REVISIONS
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BENCH 45 WEST 21 st STREET
50 4th FLOOR
1 j 30 NEW YORK, NY 10010
6'-81/2" TEL 212 254-1175
UNDERFLOOR 3'-1" 23'-10" ( )
RADIANT HEATER 16'-2" FAX (212) 254-1755
j 13..4"
WOOD POSTS AS PER MARINE GRADE 31'0"
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JOB NUMBER: 1308
STRUCTURAL ENGINEER'S STAINLESS �,�.�
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DRAWN: NC
CHECKED: WR
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PRINT DATE: 12.22.14 ` 16' �
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