HomeMy WebLinkAbout40504-Z SoutholdTown-NorthEork.net PERMI'I' NO. U,-.IU I Check
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N.Y.S.D.E.C........................................................
Trustees
C.O.Application
Flood Permit
Examined 2(10�i Single& Separate
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-Water Assessment Form
FEB 1 2016 Storm
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APPLICATION FOR BUILDING PERMIT
Date 20
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 Pen-nit 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 peitshall be required.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Pennit 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 isowner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
Name of owner of premises CA— 4::
(As on the tax roll or latest deed)
If applic.ant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
3. Nature of work(check which applicable): New Building Addition Alteration
—
Repair air e oval Demolition Other Work FAV L I-�c J
(Description)
4. Estimated Cost Fee
( o be paid on filing this application)
5. If dwelling, number of dwelling units Nut ber lif divelllitTjits 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 Rear 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
13. Will of be re-graded? YES NO Willexcess fill bere owed from remises.? YESNO,
14. Names of Owner of premises Address Phone 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 propertyis 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 )
S :
COUNTY OF SUR I
_........_......... t .l being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signi ontract) above named,
(S)He is the
wawa
� (Cc�3rtracto 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
oerformed in the manner set forth in the annlication filed therewith_
SCOTT A. RUSSELL "' °" JAMES A. RICHTER, R.A.
SUPERVISOR MICHAEL M. COLLINS, P.E.
TOWN HALL - 53095 MAIN ROADS TOWN OF SOUTHOLD,NEW YORK 11971
Tel. (631)-765—1560 �fl Fax (631)-765—9015
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OFFICE OF THE ENGINEER
TOWN OF SOUTHOLD
MEM N um, UM
To: Michael Verity
Principal Building Inspector
From: James A. Richter
Subject: Shade Shelter for Dog Run on Peconic Lane
SCTM#: 1000-75-JA 5.2
Date: March 2, 2015
As per a request from your office, please consider the following certification related to the
proposed Shade Shelter.
The drawings numbered A-1 through A-4 have been designed to meet the minimum
requirements of the New York State Building Codes.
If you need any additional information or require a more specific certification please contact
my office.
Thank you.
Q 'G
Form No-6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter ori and submitted to the Building Department with the following:
A. For new building or new use:
I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or
topographic features-
2- Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of I% lead.
5. Commercial building, industrial building,multiple residences and similar buildings and installations, a certificate
of Code Compliance from architect or engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements-
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses:
1. Accurate survey of property showing all property lines, streets,building and unusual natural or topographic
features.
2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is
denied, the Building Inspector shall state the reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00,
Swimming pool$50.00, Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00.
2. Certificate of Occupancy on Pre-existing Building- $100.00
3. Copy of Certificate of Occupancy-$.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential $15.00, Commercial$15.00
Date. .-0 t 6
I
New Construction: Old or Pre-existing Building: 1 ck one)
(c] e
A,4 Location of Property: q-7 D ....- . .__._. -
House No. Street Hamlet
Owner or Owners of Property: Z
Suffolk County Tax Map No 1000, Section mm tBlock Lot
Subdivision Filed Map. —Lot:
Permit No. p�-4......Date of Permit. Applicant:—,
Health Dept. Approval: .11,111,111,1111, Under-writers Approval:
Planning Board Approval-
Request for: Temt)orary Certificate Final Certificate- (check one)
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6 x 6 x36"45°ANGLE BRACE BOLTED ALL JOIST&FRAMING CONNECTIONS SHALL
TO POST 8 GIRDER WITH 1/2"O
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