HomeMy WebLinkAbout40599-Z TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Boardo[Eeahh
SOUTHOLD,NY 11971 4 sets of Building Pkins
TEL: (631)765-1802
Planning Board approval----
FAX:(631)765-9502 S-1-y-I/
SoutholdTown.NorthFork.net, PERMIT NO. Check
Septic Form
N.Y.S.D.E.E
"trustees
C.Okppticat
. ion
Examined Nt 'Tr6od'P=rgrtl .........
Single&Swparate
Storm-Water Assessment Form
•
Contact:
Approved 2'01
Mail
Disapproved a��,
Expiration 20
Ing
—APPLICATION FOR BUILDING PERMIT
Date ?*---.- 201.40
INSTRUCTIONS
a.This application MUST be completely fired in by typewriter or in ink and submitted1to the Bitilding Inspector with 4
sets of plans,accurate plot plan to scale.Fee according to schedule.
b.Plot plan showing location of lot and of baildings.4i 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 approAl of this application,the Building Inspector will issue a Buildhig Permit to the applicant.Such a permit
shall be kept on the premises available for inspection throughout the work.
c.No buil ding shall be occupied or used in whole or in part for any purpose,what so ever until the Building Inspector
issues zt Certificate-,of Occupancy'
f.Every,bailding permit shall expire ifthe work authorized has not commenced withIn 12 months after the date of
issuance or has not been completed wifhin18 Mont lis,"from"such date.If no,zoning arhendrnserats iat o0nerregolations afferdng the
property have been enacted in the interim,the Building Inspector rnay authorize,in writing-'the,exte,rEsion 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
aP,JC[20V[Rs9D d in building for necessary inspections.
A R 8 2016
d Signature of applicant�-)r name,if a corporation)
M 2
BUMDING DM. (Ivl i ling addXs of applicant)
State1WRyfflMPFIRWer,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
Naive of owner of premises
(As on th4tax roi or latest deed)
If applicant is a corporation,signature of duty authorized officer
(Name and title of corporate officer)
Builders License No. wqre
Plumbers License No,
Electricians License No.
7
Other Trade's License No............
1. Location of land on which proposed work will be done:
House Number e"l Set
J
County Tax Map No. 1000 Section ........Block 2: t7
Subdivision Filed Map No. Lot
2.
a. Eistin use andoccupancy intended State existing use an occupancy premises andtended use nd occupancy oproposed construction:
b. Intended use and occupancy
3. Nature of work(check which applicable):New Building Addition ✓ Alteration
Repair Removal. Demolition Other Wor o �
(Description)
4. Estimated Cost .... Fee
(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.
i
7. Dimensions of existing structures,if any:Front 6� Rear Depth
Height Number of Stone'
� 11 � , 1t
Depth_
Dimensions of same t acture with alterationsoradditions: Frontb�r of Rear -^
p _ g mStorwe
4-L
8. Dimensions of ent •e new construction:Front Rear �Deptlt
Height Number of Stones I 1 111
9. Size of lot:Front 11 Rear r f Depth -' I
10.Date of Purchase *e a _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_A/
13.Will lot be re-graded?YES NO–�elwill excess fill be removed from prer_pjiscs?YES NO
14.Names of Owner of premises � � *00 Address :Phone No.
Name of Architect a,am �„ ddres, a. Phone No
Name of Contractor Address q!:!" t Phone No.
k �a
15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YEr NO
*IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BEEQ'UIRED.
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 in✓
es.
j
17.If elevation at any point on property is at,10 feet or below,must provide topogi aph
. . s'ca1 dati'ii(sii survcy',j,:<
18.Are there any covenants and restrictions`with respect to this property?*YES NOo,
*IF YES,PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY 06
being duly sworn,deposes and says that(s)he is the applicant
(Name of inaiivi(ual si as tg cora,tra t)above named,
(S)He is theg -1
Contr ct r,Agent, orate Officer,etc.
w
of said owner or owners,and is duly authorized to perforin 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 df his knowledge and belief;and that the work will be
performed in the manner set forth in the application filed therewith.
Sworn to 1 fore me this.-, 1
day of" <_
atm
CAP S ,ar aw'YaA- yagnature ofApplrcant
` Pmr. tis tJIt7� 3
Qtgoo im Suffolk Count/
r., �oraaa~ilaarraaitaira�itS/t�4�
S� FOIKJMMAIFIEIK
Scott • Russell
rr'
SUPERVISOR
k
'Nr] N
7
souToLn rowN ALL-P.o.s®x 1179 ` - W Southold
53095 Main Road-SOU OLD,NEW YORK 11971r „
CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET
( TO BE COMPLETED Y THE APPLICANT )
DOES THIS PROJECT INVOLVE OF THE FoLLO G-
(CHECK ALL THAT APPLY)
A. Clearing, grubbing, grading or stripping which affects more
than 5,000 square feet of groundsurface.
B. Excavation or filling involving ore than cubic yards of material
within any parcel or any contiguous area.
CSite preparation on slopes which exceed 10 feet vertical rise t
100 feet of horizontaldistance.
D. Site preparationwithin 100 feet of wetlands, beach, bluffor coastal
erosion azar area.
El[D�E. Site preparationwithin one-hundred-year f loodplain as depicted
/. __a 111 ap-o -any .a- eFco- e..
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,
Number! copies o 236 does not lay to your project.
P Two f a for ater n
C�.. above, lease submit Chapter IT^— P
nageent Control Plan
Signature, Contact Information, ate & County
...�If you answered to
P
and a completed Check List Form oto of a Building Department yo Building Permit Application.
S.C.T. . #: 1000 Date
APPLlCAN"r: (Property owner,Design Profe:>sionai,Agent.Contractor,Other) i)r;T�a+.,r
NAME: ..
.,. ,. .._ TAI,
�taon F)kTac� (_rC
COrit,]CL ICYfOeCTlariorl:
,.. .rd" —
Pevwwed By:
Date: I
Prop
e �ddres> Ap[)f ved f"w procet,a,rn.g Building Permit,
$ — _
7` l✓c��at)c�)t cr#` Cor) y at Required.
..... ... ...�..""". _ � � r.sr��tient Control Plan CJ....
.�tCrra�im��p�t�r'l�l�uu���
...�« � Stormwater Management Control Plan is Required,
El Torward to Engineering Department for Review.)
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GENERAL NOTES CONSTRUCTION LEGEND ELECTRICAL LEGEND WINDOW SCHEDULE DRAWING LIST ) q° ✓ ' �33 U) bn
1 Q ALL WINDOWS TO BE ANDERSEN 400 SERIES, U.O.N.. ARGON FILLED, DIRT
1 ` SHEDDING GLASS, SIMULATED DIVIDED LIGHTS/WHITE PREPAINT. INT. JAMBS,
- t&TRUE SCENE SCREENS - 0
1 cm - 'it JPPI IF-I) BY FGJR=17-CON I R ROUGH ROUGH 3L JILDING ELEVATIOMS P1 AN
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, - 1 _ - FX I ANDERSEN REFER. NO. OPENING OPENING QUANTITYMISC. NOTES
_ WIDTH HEIGHT - ST. FIRST/SECOND FLOOR PLANS
I EX EXISTING TO REMAIN.CHECK HARDWARE IS FUNCTIONING. W__Fs IST. ELEVATIONS PLAN
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EX EXISTING TO BE REUSED FROM REAR OF EX. EXTENSION. u 715
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DOOR SCHEDULE
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DOOR -h� WIDTH: HEIGHT: DOOR MAT'L. OPERATION: LOCATION:
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_ JB Jt FIRST FLOOR: ? W
F EXISTING TO REMAIN. UIJ 1 1-13 N
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�B EXISTING TO REMAIN AND BE RE-FINISHED. Q G;
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NOTE:
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NOTIFY THE AR Hj=E(
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SECOND FLOOR PLANE I R ST FLOOR PLAN -- _____ -- - - N N
UHANIVI NU HUA 1-1
SCALE 1 /411
1 1-011 SCALE 1/4 11 1 1-011 SCALE:
OFFICE SET DWG. NAME:
9.22. 15
THESE DRAWINGS AS INSTRUMENTS OF SERVICE,
ARE THE SOLE PROPERTY OF THE ARCHITECT.NO
REVISIONS,CHANGES,AND/OR MODIFICATIONS
SHALL BE ALLOWED W/O WRITTEN AUTHORIZATION DWG. NO.:
BY THE ARCHITECT. ANY REPRODUCTION IN PART
OR WHOLE IS STRICTLY PROHIBITED BY LAW.
GENERAL NOTES FOUNDATION NOTES :
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1. ALL WORK PERFORMED SHALL BE IN COMPLIANCE WITH ALL FEDERAL, >
STATE & LOCAL BUILDING CODES AND ORDINANCES. 1. BASED ON SOIL BEARING CAPACITY, TWO TON PER SO. INCH SUBJECT
TO INSPECTION AND VERIFICATION. ------
2. BEFORE COMMENCEMENT OF WORK, THE GENERAL CONTRACTOR 2. ALL FOOTINGS TO BE CARRIED DOWN TO UNDISTURBED SOIL. NO FTG. __ V.I.F.
SHALL FURNISH OWNER AND ARCHITECT WITH COPIES OF ALL REQUIRED SHALL BE SET HIGHER OR LOWER THAN A 30 DEGREE ANGLE FROM .rTrIa
INSURANCE AND WORKER'S COMPENSATION CERTIFICATES AND NAMES ANY OTHER FTG. STEP FOOTINGS ARE TO HAVE A 30 DEGREE MAXIMUM. MEC!77FMj� I r.--:".I
3. ANCHOR BOLTS TO BE AT LEAST 1/2" IN DIAMETER AND 10" IN LENGTH =:5=1 I TREAE
OF ALL SUBCONTRACTORS INVOLVED IN THE CONSTRUCTION. u
WITH A MAXIMUM SPACING OF 3'-0" ON CENTER.
3. 1 HLz CON I HAU I UH6 SHALL 13�_- HLSFUNSIBLE �-(.)H ALL DIMEN�iIONS A 4. ALL CONC, TO BE 1:2:3 MIX; 2500 LB. CAPACITY U.O.N. OR SPECIFIED.
CONDITIONS ON THE JOB. THE ARCHITECT MUST BE NOTIFIED OF ANY 5. IF CONC. BLOCK FOUNDATIONS ARE USED, THE BLOCK SHALL BE I Oil
4,
VARIATIONS FROM THE DIMENSIONS SHOWN. ASTM-145 WITH FULL MORTAR JOINTS. CORNERS ARE TO HAVE CORES z
FILLED SOLID WITH REINFORCEMENT. CORES WITH ANCHOR BOLTS
4. THE CONTRACTOR SHALL SUPPLY ALL LABOR AND MATERIAL SHOWN -11-4
ARE TO BE FILLED TWO COURSES DOWN. SEE NOTE 3 ABOVE. 0
ON THE DRAWINGS UNLESS OTHERWISE NOTED. 6. PROVIDE 0.025"ALUMINUM TERMITE SHIELDS OVER FIBROUS P_ >� 00
L\BoV C4
5. THE CONTRACTOR SHALL BE RESPONSIBLE FOR ADEQUATELY BRACING INSULATION AT ALL PERIMETER SILLS. L FIN (-3HAL2E___R0I 1 4" A(,()-
:30SI 10 I()EEU= �j ) C)
AND PROTECTING ALL WORK DURING CONSTRUCTION AGAINST DAMAGE, 7. ALL WOOD IN CONTACT WITH CONC. OR MASONRY TO BE WOLMANIZED f I YP 4 I-C7
OR PRESSURE TREATED. 00
BREAKAGE, COLLAPSE, DISTORTION, AND MISALIGNMENT ACCORDING TO u cv
c�
TO ALL APPLICABLE CODES. I I a U
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6. THE GEN'L. CONTRACTOR SHALL PAY FOR ALL PERMITS, FEES, & COSTS I I
t�
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RELATED 1-0 THE WORK OF THIS CONTRACT. GEN'L. CONTRACTOR SHALL 6
INITIATE ALL REQUIRED INSPECTIONS OF ALL WORK COMPLETED UNDER
THIS CONTRACT UNLESS OTHERWISE NOTED. V.I.F.
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7. THE SUB-CONTRACTORS SHALL AT ALL TIMES KEEP THE PREMISES U C'�
CLEAN AND ARE RESPONSIBLE FOR REMOVAL OF ALL RUBBISH CREATED _ 0 00
BY THEIR INDIVIDUAL TRADES UNLESS OTHERWISE NOTED. = c�
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8. ANY "EXTRAS" FOR ANY AND ALL FIELD CONDITIONS/SUBSTANTIAL
CHANGES SHALL BE DOCUMENTED WITH THE COST OF APPROVED BY <
OWNER AND OR HIS AGENT BEFORE STARTING ADDITIONAL WORK. 110HIMIN
9. DOUBLE FLOOR JOISTS ARE TO BE INSTALLED UNDER ALL WALL CROSSES NISSEN\
❑ N
PARTITIONS RUNNING PARALLEL TO THE FRAMING. PROVIDE DOUBLE HDR. � I
RN.
&
JOISTS AT ALL OPENINGS. REFER TO CONSTRUCTION DWG'S. FOR SIZES, VA.F.
10. ALL FRAMING LUMBER TO BE DOUGLAS FIR #2 CONST. GRADE OR EQ. UP
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11. ALL EXTERIOR STRAPPING TO BE ABOVE OR BENEATH EXT. SHEATHING.
. . . . . . . . INSRU
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CONTRACTORS NOTES :
AFTER DEMOLITION, THE CONTRACTOR MUST INSPECT THE EXISTING
STRUCTURE AND NOTIFY THE ARCHITECTS OF THE FOLLOWING FIELD
CONDITIONS AND EXISTING DAMAGE OF THE EXISTING STRUCTURE;
1. ORIENTATION OF EXISTING FLOOR AND ROOF JOIST THAT DIFFER
FROM THE CONSTRUCTION FRAMING PLANS.
MODIFICATION OF THE FRAMING PLAN MAY BE REQUIRED.
2. ROTTED OR CRACKED EXISTING FLOOR JOIST, CEILING JOIST,
WOOD STUDS OR SHEATHING. A DETERMINATION WILL BE
MADE AS TO THEIR REPLACEMENT. 0
3. EXISTING STRUCTURAL COLUMNS THAT DIFFER FROM THE PLANS.
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4. DISCARD ALL ASBESTOS PER NEW YORK STATE REGULATIONS. LL >
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FIRST FL . FOOTING PLAN- H
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THIS DRAWING IS FOR REFERENCE ONLY OFFICE SET DWG- NAME:
THIS DRAWING IS FOR REFERENCE
ONLY& IS NOT INTENDED TO BE SCALED. ONLY .22.
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THESE DRAWINGS AS INSTRUMENTS OF SERVICE,
ARE THE:SOLE PROPERTY OF THE ARCHITECT.NO
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SHALL BE ALLOWED W/O WRITTEN AUTHORIZATION
BY THE ARCHITECT, ANY REPRODUCTION 11',I PART
OR WHOLE IS STRICTLY PROHIBITED BY LAW.
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SCALE:
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OFFICE SET
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9.22. 15
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ARE THE SOLE PROPERTY OF THE ARCHITECT. NO
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SHALL BE ALLOWED W/O WRITTEN AUTHORIZATION
BY THE ARCHITECT. ANY REPRODUCTION IN PART
OR WHOLE IS STRICTLY PROHIBITED BY LAW.
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OFFICE SET DWG. NAME:
9.22. 15
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THESE DRAWINGS AS INSTRUMENTS OF SERVICE,
ARE THE SOLE PROPERTY OF THE ARCHITECT, NO
RE-VISIONS,CHANGES,AND/OR MODIFICATIONS DWG. NO.:
SHALL BE ALLOWED W/O WRITTEN AUTHORIZATION
BY THE ARCHITECT. ANY REPRODUCTION IN PART
OR WHOLE IS STRICTLY PROHIBITED BY LAW. I A-