HomeMy WebLinkAbout40632-Z TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board ofHealth
__
SOUTHOLD,NY 11971 4 sets of Building Pians,
TEL:
lans-
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.Application_
Flood Pennit
Examined— wtt Single&Separate
Storm-Water Assessment Form
Contact:
Approved 20
Mail
Disapproved ajc---,,,
—----- Phone: 4- -ot-55!57-16i(0 tifit
Expiration 240,
Expiration
r
r--N, Rau I VS g BUildit
APR, i � 2016 APPLICATION FOR BUILDING PERMIT
,IUILI)ING DVT- INSTRUCTIONS 20_"
aTd#MK)ffi0UT09W. be completely filled in by type%%�riter or in ink and submitted to the Building Inspector with 4
sets of PIWIS.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 d, molition as herein described.The
applicant agrees to comply with all applicable laws,ordinances,building code,housing ck de,and fC U'dons,and to admit
authorized inspectors on premises and in building for necessary inspections. I
Al
Signature 0 plicam or name,ifa corporation)
s (mailing address of applicant)
OL/J-F-I of e, _4-, ' I/ q-7
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or(milder
Name of owner of premises LA&,, t ,J i.,Sc
(As on the tax roll or latest deed)
If applicant is a corporation,signature of duty authorized officer
............. —--------
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
.................
Electricians License No.--A-C)5�5, fis,t5,
Other Trade's License No,
1. Location of land on whtp,,,,,pc,,ed work wt be done:
q 3,7o
House Number Hamlet
J
County Tax Map No. 1000 Section01ock" Lot Z
............ . ......
-7
iled Map No. -200 3 Lot—
SubdivisionWo—,,),�
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy Q e",,L.?'^ 4�'.' I
b. Intended use and anc
oecu y 0, --4
p 4-\,/ ---
'j
3. Nature of work(check which applicable):New Building_ Addition Alteration. ........
Repair Removal Demolition -Other Work—-.. '!�
4N
-e Lec i,, DesThr,fion)
4. Estimated Cost 0 CPO 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.
7. Dimensions of existing structures,if any:Front -.-.--Rear
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 ✓ a
9. Size of lot:Front 1-1 ., Rear -L-L-7 Depth
10.Date of Purchase —Name of Former Owner Dc." CA.1
11.Zone or use district in which premises are situated
12.Does proposed construction violate any zoning law,ordinance or regulation?YES NO_
'�( excess fill be removed from premises?YES p -
13.Will lot be re-graded?YES_NOWill. NO
14.Names of Owner of premises ..77
-L-1n,e e,4 zr'L�- Address q� 1 6,4-Phone No.116 5 T14 z OSr
Name of Architect-7o—e-5 oeewkej ft; ...........—Address r ate, t7Phone No 631 735r:5'
Name of ContractAll e.'-L, Qa .is Address Phone No. 63 1
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 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) -f-p-
COUNTY OF
,e being c4dy sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the
(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 20 1 �- 17 1:
..__day of -1bAEGMMM I
WTARY PUBM STATE OF NEW Y
NO.01 PR*904W
......... --QWFW IN SUFFOLK
1qT U-V b�ic W COMMISSION EXPIRES AM 14, 1!.5"r,�'iic- ---
New York State Department of Environmental Conservation
Division of Environmental Permits, Region One
Building 40 -SUNY, Stony Brook, New York 11790-2356
Phone: (631)444-0365 FAX: (631)444-0360
Erin Crotty
Letter of Non-Jurisdiction .. Fres hwate'r Wetlands Act Commissioner
Ronald Smith August 12, 2002
6320 Main Bayview Road
Southold, NY 11971
Re: Smith property
South side of North Bayview, 390' southwest of Seawood, Southold
SCTM# 1000-79-8-12.2
Application #1-4738-03062/00001
Dear Mr Smith :
Based on the information you have submitted, the New York State Department of
Environmental Conservation has determined that:
Your parcel in Southold NY, as shown on the survey by David H. Fox dated June 28,
2002 is more than 100 feet from regulated freshwater wetlands.
Therefore, no permit is required under the Freshwater Wetlands Act (Article 24 of the
Environmental Conservation Law).
Be advised, that all construction, clearing, excavation, filling, and/or other ground
disturbance must remain more than 100 feet from the freshwater wetland boundary. In
addition, any additional work, or modification to the project as described, may require
authorization by this Department. Please contact this office if such are contemplated.
Please be further advised that this letter does not relieve you of the responsibilit of
obtaining any necessary permits or approvals from other agencies,
Sicerely,
Perm' ri° is atr
cc: BOH
file
STORIMMA
Z_I)cott A. Russell
( r
SUPERVISOR
] NIF
SOU OLD TOWN HALL-P.O.Box 1179 aM c k
53095 Main Road-SOUTHOLD,NEW YORK 11971 �� "� � _ '' �`
Town of Southold
CHAPTER 236 - STORAIWATER MANAGE M-EN'T WORK SHEET
( TO BE COMPLETED BY THE APPLICANT )
or,S THIS PROD C17 INVOLVE VE NY OF THE F o l., O N i i t .
(CHECK ALL THAT APPLY)
A. Clearing, grubbing, grading r stripping iaffects more
than 5,000 square feet of groundsurface.
Excavation r filling involving re than is yards of material
withinrc or any contiguous .
C. Site preparationslopes 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 floodplain as depicted
RTA -Map.of- .. . t r - . rs -.- ---------
. Installation of newr resurfaced impervious surfaces 1,000 square
feet r more, unless prior approvalt r
Control s received by the Town and the proposalincludes
in-kind lace t of impervious surfaces.
If you answered NO to all of the questions above, l Complete the Applicant section below witb your Name,
Signature,
ro
� n�.t.urem ict Information, ate County"f er! Chapter 3 do not apply toyour project-
If
mmmmmm
you answered YES to one or more o
e abwe,pleasesu o copies of a Stormwater Itlanspeent Control Plan
and a completed Check list Form to the Building 'Department grit your Building Permit Application.
�- 1000 x ..-...
APPUC = $.Property ner-,Design Pr®t" i�arwnt,Aggem,Coraractor,Other) •�� "�' �°
Mirmt
79
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Reviewed By.
Propertyt��t �lC.
Onstruction W_-o_rk:
Approved for processing Budding e
rn ,a.t_.
Storatwater a �cment Control Vaui No
t Required,
S€orrrowa er Manaernent
CorrtroN Ran. is Required
fforwarO to k:cawguieermg Department trsr ii.me,,O
i
TOTAL PLOT AREA: 166 596 SQ. IT. t / 3.824 ACRES
ROAD
NORTH BA(VIEW - - _
572'59'11"E �it„
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7 1 EA5EMENT AREA
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SUFFOLK COUNTY TAX MAP DIST: 1000 SECT: 79 BLK: B LOT: 12.2 --....
-- ..._..........—
MAP NO: 1115113 DATE: MARCH 13, 2001 Wallace T Bryan
LOT(S): 2 Licensed Land Surveyor
MAP OF: SUBDIVISION PLAT FOR NORTH BAYVIEW ASSOCIATES MAINTAINING THE RECORDS OF
BURTON, BEHRENDT&SMITH
LOCATION: SOUTHOLD
TOWN OF 50UTHOLD, COUNTY OF SUFFOLK, STATE OF NEW YORK
559 Middle Road (� ;
SURVEYED: MARCH 18, 2016 BdY.11074 New York 11705
't f
(631)472-1770
CERTIFIED TO: VINCENT & EILEEN CARUSO
Far 472-1771
SCALE: 1"=60' FILE NO: 16-129
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TOTAL PLOT-AREA:_166.596 SO. FT. b / 3.824 ACRES
t4op,TH gpYV1EwRoAD
Iz--1 11S�l 273.63'
——————— — 2.1.91
577-5200
I SPACE EASEMENT AREA
BPEN
2.4238"C"S
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ACRES
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SUFFOLK COUNTY TAX MAP DIST: 1000 SECT: 79 BLK: 8 LOT: 12.2
MAP NO: 1 05113 DATE: MARCH 13, 21101 Wafface T Bryan
LOT(S): 2 Licensed Land Surveyor
MAP OF. MAINTAINING THE RECORDS OF
SUBDIVISION PLAT FOR NORTH 8AYVIEW ASSOCIATES BURTON, BEHRENDT& SMITH
LOCATION: SOUTHOLD
TOWN OF SOUTHOLD. COUNTY OF SUFFOLK, STATE OF NEW YORK 559 Middk Road..... ........
Ba)port,New York 11705
SURVEYED: MARCH 18, 2016
(631)472-1770
CERTIFIED TO: VINCENT & EILEEN CARUSO
Fax 472-1771
SCALE: 1"=60' FILE NO: 16-129
——-----— --------