HomeMy WebLinkAbout40532-Z TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Ilealih
SOUTHOLD,NY 11971 4 sets of Building Plans
TEL:(631)765-1802 Planning Board approval
FAX:(631)765-9502 �3 r] Survey.. ...........................�
SoutholdTown.NorthFork.net PERMIT NO. o` Check
Septic Form
N.Y,S,D.E.C.
I.rwNees
C O Application
Flood Permit
Examined :"li Single&Separate
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Storm-Water Assessment Form
r..n. 7VAR Contact:
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LV Phone:631- yTS - 1002.
ptspector
APPLICATION FOR BUILDING PERMIT
I)ute
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.
„,.... .. ...
6S 011 uuuc of al Ii ant or name,if a corporation)
Mallin rirfdra1�a plrcant)
State whether applicant is owner, lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
Name of owner of premises..,,P Cml C.... Lralo�/h
(-As on the tax roll or latest deed)
If applicant is a corporation,signature of duly authorized officer
1-11,111,11111,_ ......._ .........
(Name and title of corporate officer)
Builders License No,
Plumbers License No.
Electricians License No.
Other Trade's License No,,
I Location of land on which I'rccsl osedaotlk will be done:
House Number Street Hamlet
County Tax Map No. 1000 Section 35 Block Lot o2
Subdivision Filed Map No.
2. State existing use and occupancy ofpremises and intended use and occupancy ufproposed construction:
o. Existing use and occupancy
^ \E4~~
b Intended use and occupancy ` �
3. Nature ofwork(check which opy|icuh|x):New Buildhq.t Additiono i
Repair—-,'',
4. Estimated Fee
(To be paid on filing this application)
5. )rdwelling,number nfdwelling units umternfdwelling units oneach Omx
If garage, number ofcars
6. [fbusiness,commercial mmixed occupancy,specify nature and extent ufeach type ufuse.
7. Dimensions ofexisting structures,ifany: FmnL ____Rnu
Height Number ofStorie
'
DimenoionaofuamontructuvewdhnUamtionaoraddiUono: Fm,t *nor_________
Depth—- —NumbernfStories
8. Dimensions o[entire new construction:Front Rear Depth
Height 'Number ofStories
9. Size oflot: Front Rear Depth
18.Date or Purchase ame of Former Owner
11.Zone or use district in which premises are situated
)2.Does proposed construction violate any zoning law,ordinance orregulation?YES NO___
13.Will lot bnro'gradod?YES NO __VVi\}excess fill hcremoved from premises?YE@___ND___
14.Names ofO [ iAddress.&q5 Phone No. C37
Name of Architect --Plione No
Name of[oiaoo re,"15t I p i mu
|5u. [xthis property within |OOfeet ofatidal wetland nrufreshwater wetland?*YES__ NO____
* 1FYES,80UTH0L0TOVYNTRUSTEES d�D.B.C. PBR&4(7S��AYBDRBVO|KBD.
h.Is this property within 30Bfeet of atidal wetland?* YES -----__N0___.
* lPYkS.D.E.C.pBRk4lTQ&8/\YREKCOO|RBD.
16.Provide survey,to scale,with accurate foundation plan and distances to property lines.
l7. )[elevation uoany point onproperty isat |Ofeet orbelow,must provide topographical data nnsurvey,
18.Aotheroumyoo,enuotuuudrostriodouowithrcupocttothixproperty?*Y20____N0____
* lFYES.pKOVlD8AC09Y.
STATE OPNEW YORK)
,
C0OMTYUR-�-61'��/e)
_ being duly owom`deposes and says that(o)heiothe applicant
(Name of in(h lwd signing contract)above named,
(S)xCiutile
(Contractor,Agent,Corporate Officer,etc.)
"fsaid owner mowners,and i,duly authorized mperforin whave performed the said work and mmake and file this npp!{catiow
that all statements contained in this application are true to the best oflus knowledge and belief,and that the work will h*
performed inthe manner set forth inthe application filed therewith.
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