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HomeMy WebLinkAbout40531-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 ....... SoutholdTown.NorthFork.net PERMIT NO. Check Septic Form N.Y.S.D.E.C. .... Trustees C.O.Applicatian ....— Flood Permit Examined_ .. _ 20 Single&Separate Storm-Water Assessment Form Contact: A" 4ilao ed (,, C— .. 1.1.k .20�u Disapproved a)cMail to X �-.�"�' �I * Phone: s Expiration—.- 201-'7 Buil mm I otos APPLICATION FOR BUILDING PERMIT Date Hayti) 11 201(a 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 RN 4 Ei ken F,,-)p rAQ (As on the tax roll or latest deed) If applicant is a c\or-poration,signature of duly authorized officer ?'dame andtitle `"corporate officer) Builders License No.— q(09 I j Plumbers License No, Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be'dbne:" House Number Street Hamlet County Tax Map No. 1000 Section � Block Lot dd� 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 Se c .t c b. Intended use and occupancy 3. Nature of work(check which applicable):Now Building Addition Alteration� Repair Removal _Demolition Other Work-JieLL� MnQ! \j reg- ��• r ) (D I D 4. Estimated Cost J? i � e ,"r _..._. i� be paid on filing this application) 11 5. If dwelling,number of dwelling units G, i Number of dwelling�umt_s on each floor If garage, number of cars RAY . 6. If business,commercial or mixed occupancy,s1 I��� ixtent of each type of use. A 7. Dimensions of existing structures,if any:Front �E ,ar _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 DSize 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 N0,9 Will excess fill be removed from premises?YES NO® A I d Er;I eNa, 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 M.AYEQUIRED. b.Is this property within 300 feet of a tidal wetland?* �`E5 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) S: COUNTY O (1being duly sworn,deposes and says that(s)he is the applicant (Name of individual si �go contract)above named, (S)He is the (Contractor, gent,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. Swar ii to before me this TRACEY L.DWY GR I� day of 0166 20 NOTARY PUBLIC, TATE OF N YORK NO,01 DW6306900 QUALIFIED IN SUFFOLK COUNTY _ 1 lallSSiON EXRIRESJURE 30 Ste, q 7'�otary Publi• Sint Gp!�,IY,.�u.t�.i�r, �1f�91!y�Ir1I'J�y�r,r,ir�/i!f„r/iiy-�l�a„,,,',/�/,r//f//,/,/rrir/%/�,%r/r,/,%,,�,,rru.,,,,////,�/fri/li�/„///rr�1rC,��rrr/.,/1/o/�r/•/,,%,i//%,�e,/r�ra/r//�//r�srJr//,'',�„/i�,!,I%.1/�/���r r/%//,r/rr//,9//%,/�/����/,���/ir%o�„///�,//////rm,�,�/r//r/r�///r/�ry�r�y,�/,r„///,//,Ir�����/�f;�u�r'/l�,9.r�/rl�i/r1�//p/,;'/�r��J/�1i,''���J�//��;`,1�,;,J�/1>.�✓�z�l:1IIr,�G.;i°�.t,r�,i,%,l',''(q��r;r;��✓,�,vIr�,,,�id�'�or�ri„/��e!�//�//./r�,�„Y��,�l,/1%�,i✓:6//�,�%��N�.r,'r��/+l/u,li. ,�Jl%yr1lr,1',49��31 111 1 'I I iY w it Name: ' rANGL.E 6” RADIUS ,ar din al'Syatas'a z,Inc. Route 61 South,Schuylkill Haven,PA 17972• 570-3W4733• fax-570-385-1318o Cust ee i sr Irasl ste sinc.c® —..�. 16' ......_ 84 6 4” 8' d 87 46 USE -A” FRAME BRACE AT -6,� E V"...-- __.._._ak _B" .. 6” PANEL JOINTS AS SHOWN W 4-0 Z 4 H ` Z $ f ` 8° 32, U 8 P ` W _w .. 32” 0 SAFETY $ ROPE O w r — > 15'-6." b f $, 8„ rJ f 4" 8' 4,. S-4" el PANELS TO BE REMOVED WHEN USING STEP OPTION NON—DIVING POOL STEEL STEP OPTION 1 PLASTIC STEP OPTION#2 4' 4' 8' 8" 5 1/4" 5 1/4" 4' 4` 16' STEEL STEP SPSX316OXXXXXX �rj 8' PLASTIC STEP leck Area: . Area : 448.0 SO. FT. ml_ Ions: 19,200 Perimeter: 96'-0°" 2115/13 512.0 a 2F' R rr„” lea 1/6"= V Sheet: 1 OF 2 � a =r0lidenflal pToperty cl Cardfmal cyst ,aim ,I r or daypfiesb*n w ;r , , 0hl , spunm d aluauc 0" crleapc* _ 301irms amn°uS ammlomw am Wob IRA an �� — — Scott A. Russell ST0]KMWA\T]E][. SUPERVISOR AWANA\GIEMLENT SOUTHOLD TOWN HALL-P.O.Box 1179 1 T 53095 Main Road-SOUTHOLD,NEW YORK 11971 , Town n Of Southold CHAffER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) _ .. .. _ DOES THIS PROJECT INVOLVE ANY OF THE FOL. 1 ^ LOWING: (C'8 CCC K ALL "TC 4A F AC'Y LY') Yes No nq A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. 1 ❑ 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. D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. ❑ E. Site preparation within the one-hundred-year f loodplain as depicted on FIRM Map of any watercourse. 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 APPLICANT. (Property Owner,t)est n Professional,Agent,Contractor,Other) District NAME: m. © �_ J A„��" SectionBob 003 ; a , o G"�' i LSU l l II", l�k � ,: USE ONI r' _ ll,ul i l 4 a i Contact gt�'"arfrat4 Kr,lrvgpgmx"u yv4w. Reviewed By: Date: Pro erty Address/ Location of Construction Work: It —Approved for processing Building Permit. Stormwater Management Control Plan Not Required. tet" Stormwater 6 Management Control Plan . re m e�`M an is RequiredLi . _. .. _' �� (F® Incct to Department for Rcv tcw " FORM * SMCP-TOS MAY 2014 00, W k o €oei CL LU Q �pQ ? VCJ{ w w g 4 � W pul o (!1 vl ® @00 0 ' ��,� ,p1 lull,t Fo f njt�4Je ` 60 ` qqg Ci S;91- F YY Li w xw � � w z wvnxa Wsw i ro G4 w�� W le�i� •^� o m m oLL o`�p w °' �'� o�vwv�� €�o! �Cb $g p titt gS. ��.........., w slag' wo m�$