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HomeMy WebLinkAbout40437-Z TOWN OF SOUTHOLD ' BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL . Board of klealth SOUTHOLD,NY 11971 , ' _ 4 Sets.of Building Plans TEL: (631)765-1802 Planning Board approval FAX: (631)765-9502 / ps, .--2 - ,—7 Survey SoutholdTown.NorthFork.net PERMIT NO.(---{‘,„,.) 2... -----C- Check Septic Form N.Y.S.D.B.C. , , Trustees . , C.O.Application Flood Permit Examined ' ,20 Single&Separate ift , , " „L. j,,, .7, Storm-Water Assessment Form______... . . , Contact: , Approved ,20 Mad to: J, C.I-- L-FIV•'-)N.I t--- ,-------- Disapproved a/c \ [ --, Phone: , Expiration 1 a ,20 1 ' ,..., Bui A g'nReq...tor , ___ AP,rLICATION FOR'BUILDINC;P q iDatel* ,20 9 1 ,,,,T,5 ,_,, INSTRUCTIONS a.This application MUST be completely filled in by"ty,Peiter or irtinl(and.submitted to the Building inspector with 4 .,ets of plans.accurate plot plan to scale.Fee according to schedule. b.Plot plan showing location...anal and of buildings op premises,relationship to adjoining premises or public streets or ai east and waterways. c. fire work covered by this application may not be commenced before issuance of Building Permit. d,i„lpon approval of this application,the Buitding Inspector will issue a Building Permit to the applicant.Such a permit shalI he kept on the premises available for inspection throughout thie work. e No"upilding shall be occupied tifi'used in Whole or in paii for any purpose what so ever until the Building lospecadt ssucs a Certificate of Occupancy. , ,Every building permit shall expire if the work authorliedl'asricit coMineneed within 12 months after the date of t, issuance or has not been completed within 18 months from suchidat,;If no zqning amendments or other regulations affeciing property have been enacted in the interim,the Building Inspeettinn-ay authorize,in writing,the extension of the permit for 2,71 addition slx months.Thereafter,a new permit shall be required, .APPLICATION IS HEREBY'MADE.ttythie,Building)D,epartrrient for the issuance of a Building Permit pursuant to the Building Zone Ordnance of the Town of Southold,Suffo,Ik CountANewYlork,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,Ordinancees,building codehousing code,and regulations,and to admit, a',.AI-torized 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,age . architec engineer,general contractor,electrician,plumber or builder Name of owner of premises ATt---PNI ' ,-,,- Li. 9. 4 (Asb 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 work will be done: House Number Street ,' Hamlet County Tax Map No. 1000 Section 10 ,,, , 4" Block ii, 4,4/.3„, Lot_14, 1 Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and 'ntendt}g ed use and occancy of proposed construction: a. Existing use and occupancy S I N(,(, �r1 Al i' b. Intended use and occupancy —C 4 3, Nature of work(check which applicable):New Building Addition Alteration Repair Removal. Demolition Other Work 6leA 4r2 } o ) 4. Estimated Cost Fee = i',) oon) 5,>4.4 r I Pa KGi-1 (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. SF kaL 7, Dimensions o 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. Dight nsions of e�ntin lJ k' are ruction: umbeor ntof Stories i: Rdar Depth 9. Size of lot:Front ( Rear it t„1.,,„.s: Depth 10.Date of Purchase Name of Former.Owner i i. Zone or use district in which premises are situated" °F4-O 12 Does proposed construction violate anyrzoning"llaw,'ordinan'Ge orregulation?YES NO K , ,, ,,,ill lot be re-graded?YES__ NO\(Wil➢excess fill be removed from premises?YES NO 14."aures of Owner of premises,L1 eI4A IQ f h,rg., .Address ,, Phone No, �' 26-z, i 4-1 8 Name of Architect Sc. I-1I'W.r .1 Z Adda'.ess Phone No 3 4 —‘-le cff Name of Contractor Address, - ` .'+::• Phone No.. 15 a. Is this property within 100.feet of a.tidal wetland or.tfr2sh}NaterWetland?*,YES°XC NO * IF YES,SOUTHOLD TOWN TRUSTEES&:D:FEC,PF,RI 1 L1 '`l'+IAlrs'aa'J REQUIRED, b.Is this property within 300 feet of a tidal wetldndQ *°AYES""+pc: NO * IF YES, D,E,C,PERMITS MAYBE 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 tlf44. - _ C betnglcIu y svo{n,deposes and say ithat(s)he is the applicant (Name of individual signing contract)above named,, (S)He is the A1 ( (Contractor,Agent, ^ orporaP 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. __day Sworn to before me this�� �� 20� T-�1( of �. � , , nr .NIE D.BUNCH / / ,_1' t C f° CON C � _ v rite of New York Commission ed In Suffolk A C1o14,ty,u Notary Public No.01BU6185050 Si.; %tur, of Applicant i d STORMWATER A. Russell � SUPERVISOR MANAGEMENT SOUTHOLD TOWN HALL-P.O.Box 1179 53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of Southold - .+,�"r ., CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) DOES THIS PROJECT INVOLVE ANY OF THE FOLLOWING: Yes No (CHECK ALL THAT APPLY) ❑ L4 A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. • f21,. B. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. ❑ C. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. O rA D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. O r E. Site preparation within the one-hundred-year floodplain as depicted on FIRM Map of any watercourse. ❑ rid F. Installation of new or resurfaced impervious surfaces of 1,000 square feet or more, unless prior approval of a Stormwater Management 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 your Name, Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project. * If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan and a completed Check List Form to the Building Department with your Building Permit Application. S.C.T.M. #. 1000 late' APPLICANT: (Property Owner,C� go Professional,Agent.Contractor,Other) Donk,t NAME: 1, to _ 4"" 104 73 a w ... Section 3( w_ ... Lot x:<:r:` FOR BUILDING DEPARTMENT LSE t)N1.`-' Contact Information A/ Reviewed By: Date: Property Address / Location of Construction Work: l� ,5� .� �t �\)t�('na�� (or processing Building rmit.edti 'Management Control Plan Not Required. 6° Stormwater Management Control Plan is Required. (Forward to Engineering Department for Review.) FORM a SMCP-TOS MAY 2014 Town Hall Annex � , Telephone(631-1802 54375 Main Road 4 t4 t % Fax(631)734-9502 P_O. Box 1179 1 Southold, NY 11971-0959 4,, BUILDING DEPARTMENT NOTICE OF UTILIZATION OF TRUSS TYPE CONSTRUCTION,PRE-ENGINEERED WOOD CONSTRUCTION AND/OR TIMBER CONSTRUCTION OADate: I Owner:. Location of Property: N i Please take notice that the (check appl cable line): ,, New residential structure Addition to existing residential structure Rehabilitation to:an existing: residential structure m lo e constructed orperformed subjectproperty reference above will Utilize at the 5..41,(11A1/4j&h cls: applicable line): C Truss type construction(TT) Pre-engineered wood construction (PW) Timber construction (TC) in the following location(s) (check applicable line): Floor framing, including girders and beams (F) V A , ' Roof framing(R)' Floor and roof frami s,(FR) 4/ ,,,,,, (,,,, ; Signature: ,..„,„to . Name (person submitting this forn-i): a rt._ Capacity(check applicable line): Owner Owner representative TrussResRegl5.docx Effective 1/1/2015 -/ N----- 1F:.- ..4L'S,r°" • y,1.16, :0., k '-S" i",i=�''�C •-'-- ELO®rr�15•o.�sANb'..slGtwr'C T''z vSa �1`_____,,,,,,,...:4 vLc ix . / ss'x@C1'uE OTa'''1,s.F95°,s L.2F xsG—LF2 I,Ts'.',�„v x69 1"J` �_OtlTL p,3'166.,,°O``E,V 115'u 4.2 31 NATURar AREA TO �s re .I-76-66-F-4,..' ' ° Ear ',LIE:,AND DENnDEDA I EA OF BE RF {OS"r. 4.2 NDV'JA itl i OF NAYBAI ESI>BE ,� P'U x y ds REMAI' A$NON- .w x T^�r a DE rLEArh sA a� 1 w c aw „. .M1ERIC,.N BEACH GRASS 12 OC DISTUB,NCE BUFFER '.6;' ,x1 # 5 ni^ �XI5 STING EDGE OF "� ✓ SG sb .4E - 10NA URAL VEGE 7 6 y ,y" 9 t"' , 000000,,000:0•_,.:,,„ litO ,5 V C05'Y 4G141 x Ci M..•'¢+t'+U'ME5P .6"3',6/6":.",,a,'61."'''e. 0F, C 605. �� "C6 VP a.a aoL�'E. Faro °q', �.� cam' w �¢? ol7ry '� ! r"1' D y ,:. PRoeOSEC) _ �^. PCC,T4 L,,,VEG A q2.''..,,..,10t4 y �}� 6-2T:\ P 6F 0 �p(LY I PODF.'D AND DENUDED AREA OF BERM 0, y EL.ii.9' PR© C75E 5 'X LANDWARD OF HAYBALEST{J BE P%OR. 10'WI // iE PID WITH APROXIMATELY 50 CUBIC %0 -. YARD (TOTAL)OF CLEAN SAND AND CAPE ` `* yC '. II} 3 9 En!CA�u BEACH GRASS la"OC ,'`� �` EX.5.7 5.0 'J 5.9 1111 �r ; % 5.3 EX 56 6.4 x EX.5.0 x7 ; 80/0 ED SEGS,4CY..E,- Z10AL'�TLP�n5 NATURA AREA TO ''',‘„,',.',..,..s.,„.' °° c REMAIN AS NON- :: DISTUBAN' E BUFFER s.4 a EX. 6 m c \. 1, �! """" b .Y PROPOSED ~` .+. EL.11.0' \ "'�}O ''h'Gf'C75cb 2'NON-TURF BUFFER '''''',‘• ,w N.7.8 8.''' .W. ::,....,8, 1 "'I ONSISTI 1 I.OF NATURAL STONE `^.A 6606U6L0 �, t0 a rS1 1117 4 PF FLY WITH PLANTING 52 y ?fl,n.m `"._.✓ `+ ,L rJ . ., D (SEE DET I) / 13'Bt,' NJ w +PCI r R C TYPIC w PROPOSED 50 CH EY 6,s .... - N r ,F fF EJC.CLEARING 705 '^'�•„'` RF.L' 'T R AN `6 LANpWARD LSINifi K a r NON-D.7661 2 26 BUFFER r.,; :N I(! 92.7” ` PROPOSED D LI COAS FAL BARRIERS, .• EL.1I.E p� NLI216..1990 IN DFSICNATFD �-7 Y/2 STY' O STRUCTURES ON OR AFIL! FXis'LIH SEDA W s a,py t E4 y•. t(i i I IC)N OR SU64TA4yr Y fi ;URAh,CL 1VCJT AVAIFoa1 �' PO PRC ' , SOUSE � PROTECTEDAir, RDe SrsLD w'�7 .''.? 'P06050 q E Ek„�4,�" ILL TI MLW• 16190 � 4 4r POACH :, V PROP . l3'•NC1Ps!'#'t1RP'917"F'PE 1p.'n''n' .. r� CONsisTiAl iFNATURAL STONE ._66,^ 3p y 9. (,kOPO jD OOACH 5E c,,,..; � 4• dMTE:RS@E4 �..WITH PLANTINGS Y � -P &B .• �' SEE DETAILS} 0!, r 1. '• ''' l'- -,,,,..,,,,,,,,,\,,,,, .,.. � � � � � 7,„,,„ 2 STY ►'""'_. EUV EL. 7 - I . ` 'n I 12.5' ... , t�-�� m O GAR Q - AS DELINEATED BY O h �" t t a� `� TIDAL WETLANDS a•LIN DAR1"'Z' 9.5INEW,EL .O P, r, mil, ✓ Cn EN-CONSULTANTS,L C. S 71.5 P,E o 5 RWI04JS PCIA.}A�O''VE ,rL '"n ' JULY 22,2009 K D61BV yy',A"ea y� n, mom» , (COLOR 70 Ivo'Et•,,,, „.„3. INC; Orr ..F ! _ 36.' " ,' ,.. x . '"ti 6,'1 ME"UU GE. 7 Y 125 71 P { Lo I {" P057 2 Is n w -L'.AMP q . 1 .'" ^"'rt->-11`,o�y.•.h, EL x v,hI A x o= P?"Ioo 17 m .. . . e.1 1r� cur IG\ - L,„,..S . 0.3E. GLIT' BULKHEAD ION. "•. •� .. .. f31, S'Ul KA- SWALE - .5'1 A� 202.00' (. — 95.63 1 11°24'3C GE /f 6 ! ' a, h GRASS AREA:16520 SQ.FT.x 0.35 5782 ``b 1 5782 x 2 INCES RAIN PER HR,=11564 •,, z 11564+12=964 CU.FT. PROVIDE 24 VF 8'dia.DRYWELL wJ CA" BASINS AL V DRIVEWAY AREA:6510 So.FT Y n 7=assa