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Home My WebLink About40456-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 ................._.......................m ------- ........ SoutholdTown.NorthFork.net PERMIT N . Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined 20 Single& parate Storm-Water Assessment Form._ Contact: Approved 20& Mail t,',71Eale Disapproved a/c.... Phone:_,L!(_- Expiraflo – 20 Buil Inspector FEB 1 2016 APPILICATION FOR BUILDING PERMIT Dat e 2 ............ ............ INSTRUCTIONS 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 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 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 work will be done: House Number Street Hamlet County Tax Map No. 1000 Section— .Block 0 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 Qf✓S Co e dun E}( b. Intended use and occupancy_ (° _�f-)Al 3. Nature of work(check which applicable):New Budding Addition Alteration t/ Repair Removal ___Demolition __Other Work ( '"1 M, LL (Dmscription) 4. Estimated Costr _Fee (To be paid on filing his 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. i ITi 7. Dimensions of existing structures,if any:Front sz Rear 15 _ Depth Height tL_ 12-161 Number of Stories .21 k 2i C Dimensions of same structure with alterations or additions: Front Rear Depth ' Height:-. Z3 Number of Stories___2 8. Dimensions of entire new construction:Front Rear Depth Height Number of Stories 9. Size of lot:Front_ Rear Depth 10.Date of Purchase L - Name of Formerr-,Owner - 4,,� 4 ,i 11.Zone or use district in which premises are situated h 12.Docs proposed construction violate any zo (ng law,ordinance or regulation?YES NO 13.Will lot be re-graded?YES NO Will excess fill be removed from premises?YES NOYT tbUO3 14.Names of Owner of prem ises -fAddress l 9_u Ti t Phone No. 4- Name Name of Architect . ILA1,14 4, Address " i t Phone No 1 Name of Contractor Address Phone No. 15 a.Is this property within feet of a tidal wetland or a freshwater wetland? YES NO * IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BEQIJQRED, 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 a..,t jbeing duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the + " f t�( (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 ' p....�. day of 20 gPubrlTRAG NotarEY l_.D` 'ER YOAK tt *hlatu'., Applicant NOTA'pt SSC,STATE OF NeJ No,01 rtW630S .moi ri i Scott A. Russell ` S`7C'OR1M[WA\X]E]K • w a ' , SUPERVISOR b TWANAGIENHENT SOUTHOLD TOWN HALL-P.O.Box 1179 " ` " r�g 53095 Main Road-SOUTHOLD,NEW YORK 11971 µ Town Of,So u th o l d P CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( T® BE COMPLETED BY THE APPLICANT ) BOE '7[`il-iIS PROJECT' INVOLVE ANY' OIC" 11114, FOLLOWING. Yes N( (CHECK ALL THAT APPLY) . Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. E]RrB. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontaldistance. &(D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. WE. Site preparation within the one-hundred-year floodplain as depicted on - a o any watercourse. F. Installation of new or resurf aced 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, ate & County Tap Number! Chapter 236 does not apply to your project. If �.... P g' please P your Building Permit Application. eTement Control ....� and a comple ed Check List Form to of e line eeaart sent Department Two copies of g Plan AlPL1t F:PVr'; (Pr"a'perty r ro:H i�uf't aaPrcd.9iorb�I,F etiu'C.u� uulrcrtcr7:c.u,CDV esl S.C.T.M. #: 1000 Date District NAME Section Block Lot Q."oroTai.¢I'u'ufonrvualuon R,evllewu~d By: Property / Location of Construction Wa..r...k...:.. �. �. _ Date: .. f.pp:uuoved for prsrmsing l3tidding lAemffl... _ W .... �trorrnwwaater MziinageinenU.Control Ran Not Recltudurci. taiiiwtonagnientDepartment 1 lnsRa Q !n ea ur..i ew) rORM � SMCP .......iTOS MAY 2014 Form No.6 TOWN OF SOUTHOLD DEPARTMENTBUILDING TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY is application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new buildingor new use: 1, Final survey of property with accurate location of all buildings,property lines, streets,and unusual natural or topographic features. 2. Final Approval frorrr Health Dept. of"wate"supply and sewerage-disposal(S-9 form) 3. Approval of electrical installation f�rotn Board ofFire Underwriters, . 4Sworn statementfrom plumber certifying that the solder used in system contains less than 2/10 of l% lead.. 5. f oraunercial building, industrial building, multiple residences and similar buildings and installations,a�ce�r6,,ificate of`Code .ompliance from architect or engineer responsible for the building. ti. Submit Planning board Approval of completed site plan requirements,. B. For existing buildings(prior to April 9 non-conforming ones,ori buildings and "pre-existing"land uses: L Accurate survey of property sl-rowing all property limes,streets,, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If Certificate of Occupancy is decried,the Building inspector shall state the reasons therefor in writing to the applicant, Ca Fees 1. Certificate of Dccripar,rcy-New dwelling 550.00, Additions to dwelling$50.00, Alterations to dwelling $50.00, Swimming pool $50.00,Accesson, building$50,00,Additions to accessory building$50.00,Businesses $50,00, 2. Certificate of Occupancy on pre-existing Building_ $100.00 ,. Copy Of Certificate of Occupancy 5.,25 4, 1.➢plated Certificate of Occupancy - $50.00 5. Temporary Certificate of .lccupancy- Residential $1.5.00,commercial$15.00 tw t l ., f New Construction: �� _ .. g )p ga .�.(check one) ... or Pre-existing s 1 � .. House No. —m Street 1 l Location ofProperty: ...�.�._...�,.._.— ..., Street ��...._..�........�..�,.._.—.. � Q-�-�..........—... Hamlet Owner or Owners of Trope Suffolk County Tax Map No 1000, Section Block ..�..�Lot Subdivision Filed Map-— . . ._�.. _ —.. Lot ., . Permit 1sT:, Applicant- ) �... 5 _ ate of Permit. m.. t �m Health Dept,Approval: Underwriters Approvals Planning Board Approval: , Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ pplicant Sr nature d rn o \ \ ". , � � \ � � >* . / - /- 22» %. . < : � \ ' »\\y\ \ \\ } \\ \\� « \ ! . . fit \ �\ PRIVATE ROAOUNN LANE. % o _ _ E NOUCrlddtl UMdJd AMR Ytl?,f /IU t> ¢ — z c� > a ------------- ® .... -----LAJ w � INV SNYId 11V MVI 1NOIN1,dQ7 N213m � j N3CNfi 031O310Nd3NV SNONVh3l3 ONtl SNVid JCOl3 TV 113AN8 3 L A13N5f1'1 Y3 Q3ON3OIl SI SNVId 3S3N1 PiCtlj 3NfNCIiN1S IND AINO QIION O1 ll191N 3N1 YN lHWN3l13C hl3 o�z o 000 - EED ��...... - A� z ar www � � o �.o ---------------- -------------------- Q ...---------------- .mmmmmm a_w ELE= � C. oc CL o � z ns m OF"W u Q 110 LZJ 0 4 ✓ U J ) VIM II � I dll� CC CD C) LLJ CDH ui Iw ..z H u a Z�w 0 0 o F.— < CC n.c7 Q wow. 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