HomeMy WebLinkAbout40640-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 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
Flood Permit
Examined 20 b Storm-WaterAssessment Form
Contact:
Approredl •_f} V
Disapproved a/c
Ex iratio20
D _
4Lu,, , r
All APPLICATION FOR BUILDING PERMIT
Date l i.........._ — 20_1 b
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 IS 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.
" -70'
! .............
(Signature ofapplicantorname,ita :orporati n)
(Mailing address of applicant) 11-7&3'
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
Name of owner of premises t T lr t .._----- .... .....
(As on the tax roll or latest deed)
If applicant is a corporation +g tux4--tl4l-y- uthorized officer
Name and title of corporate rp ate officer)
Builders License No. c;L'7
........................
Plumbers License No.
Electricians License No. `-f O,SS- -7 A-t C-
Other Trade's License No..
1. Location of land on which proposed work will be done:
lyer,-fits .......� .. `acs 7 e}�...... .........
House Number Street Hamlet
County Tax Map No. 1000 Section Block Lot
Subdivision _� v, . _/.�� Filed Map
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy
b. Intended use and
3. Nature of work(check which applicable):New Building......... Addition Alteration
RepairRemoval Demolition Other Work _g c-
(Description)
4. Estimated Cost --, 0 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 3 Rear 6-41,, ',�����'�';!,,",,r 7�*;D"61)tb�
Height Number of Stories
Dimensions of same structure with alterations or additions: Front woe Z-t--�,ROa 11
Depth Height Number of StoriT"
— "
8. Dimensions of entire new construction:Front- Reary— T
Height Number of Stories
9. Size of lot:Front—LC � 1,� Rear 39
�3.
10.Date of Purchase <)--O Name of Former Owner s"k" flie's I
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_NO Will excess fill be removed from premises?YES—NO
14.Names of Owner of premises A ct Re,rjLjhAddress c,o.y��qLtPhonc No.63E-' .:2...-aY 0/
Name of Architect Address ........m,—Phone
Name of Contractor 5P�r�,,L u lc-- Poo K,,t.Phone No. I-6 9 G
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)
SS:
COUNTY OF
-D
sworn,duly swo ,deposes and says that(s)he is the applicant
, <-A�
(Name of andi vidWit 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.
DAWN DWYER
Sworn to before me this Notary Public,State of NewYork
Sr day of April 20 C)ualft-"OW6282704
Qualified
in Suffolk County
Qualified
C"'J"IV,E�xpulnss May 28
a May 28,�201
Nota�y)Public Signature of Applicant
UT
Scott A. Russell
U 0. ,w„�r...._,
SUPERVISOR
MANA
SO OLD TOWN HALL-P.O.Box 1179Town of Southold
53095 Main Road-SOU OLD,NEW YORK 11971 ab >�
CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET
( TO BE COMPLETED BY THE APPLICANT )
DOES THIS PROJECT INVOL F ANY OF THE Ie OUO ISG:
(CHECK ALL THAT APPLY)
Yes No
Clearing, grubbing, grading or stripping land which affects more
than 5,000 square feet of groundsurface.
E][31S. Excavationor f illing involving more than 200 cubic yards of material
within any parcel or any contiguous area.
,.
Site preparation on slopes which exceed 10 feet vertical rise to
100 feet of horizontal distance.
Site preparation within 100 feet of wetlands, beach, bluff or coastal
erosion azar area.
Site aration within te one-hundred-year floodplai s depicted
0 n FIRM- Map-oI an watercourse-m__ _ ---
F. Installation of _ ° - y -
f 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.
i at a Contact Information, Date & County Tax STOP! Complete
_. ,
If you answered N to all of a questions above,
Com Tete a Applicant section below your Name
p p 1236 does not apply to your project.
If you answered S to one or more please Number! Chapter
copies the above, lease submit f a Stormwater Management Control Plan
and a completed Check List Form to the Building Department with -your Building Permit Application.
APPk.YCA. - t
� ......�
S.C.T.M. B1000
Date"
(Property
roP r, 7eesr®rro ESICra 51ontractor,otkwrl nc
—s 10
§e'_
W
Contact Wormation
r
Reviewed By:
Date:
_.. _ ...__ _ ........ _ _ _ . .. .....
..... �-s l Location of or�st(-uctkokt Work: ..�, .
Pro ert A.ddre.� "
A�proved for
processing... _ � t..
................. 0 Strn�water Management Control Phan °o
t Required.
d..
.. ._,
", a _ .. Storrnwater Management Control Plan. is Required.
.
. 1 �.-�......_ El
(Forward to Engineering Department for R.eview.)
FORM 4 ,SMCP -TOS MAY 2014
YSEG Long Island
175 E.Old Country Road
Hicksville,NY 11801
0rSEGIS]
.
We make things woik for you.
APO 13 2016
April 8, 2016
Mr. Adam Panetta TOWNOFSOUMOID
85 Yennecott Dr.
Southold, NY 11971
Notification# 900000027015
Dear Mr. Panetta,
On Wednesday, April 6th , I visited your home to take measurements for the
proposed installation of your new pool.
You may proceed with the installation of the pool as the installation meets
our required clearances to our facilities.
Any questions, please feel free to contact me at 631-284-5301.
S"inc, :ly,
s. Rhonda Rim
Customer Planning Rep.
Distribution Design
Riverhead
Copy to customer file reference#T_
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MEOW m HE F MADE T6MON of FOs.RE0e4Wvus.Pons.POM
PLwmjc Awp&Amomom m mmu)p s oR ANY o1Nw commanom SURVEYED FOR ADAM PANETTA
waunM=x7MM OR ADDMON To THS SURVEY 6 A A VDAM OF SECRON LOT NUMBER 54
rme of Tw NEM Yow grAE ETON Lm MAP OF YENNECOTT PARK
GVPPAKVM Mta TED RM 0wV To THE PetSUM FOR WHOM THE SITUATED AT SOUTHOLD
SURVET tS ,Am ON MtlS SF AF TO T'AM ME COMFW,ONERNEM&
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MOT TWOMFOME Rs TOWN OF SOUTHOLD, SUFFOLK COUNTY, N.Y.
OR Sl6SeoUENT OWNFRs
SCALE I" = 40' DATE 1-27-2014
com OF THG aney NAP NOT Wwalo TFE ttw SIINYEYOR°S N®SEAL OR
7EMMM SEN.SWL NOT 9E oo 70 BE A'W TME CM FILED MAP No. 5187 DATE 10-9-1968
CERTIFIED ONLY TO: TAX MAP No.(REF ONLY) 1000-55-3-10 DISK 2014
PANETiA
BANK HAROLD F.TRANCHON JR. P.C.RT TITLE INSURANCE COMPANY LAND SURVEYOR
BRUCE A. PAYNE ASSOCIATES, INC. TITLE NO. 26134BS P.O. BOX 616
r 1866 WADING RIVER—MANOR RD.WADING RIVER,
NEW YORK, 11792
N. .LIC.No.048992 631-929-4695
HAROLD F. TRANCHON JR. PENN.LIC.No_2115—E
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Engineering, P.C. Drain bels,for:Panetta Residence Spect-Tacular Pools,
273 Hawkins Avenue S thold,c Y 1197 3661 Flersebl Road V ,r
Southold, °!11971
Ronkonkoma,NY 11779 Building R
Tele:(631)67 1atemcard,N.Y.11763
Labcrew@optonline.net 3-��2016
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BC E 279 NG1NEERJ as P� . Zp-eiP-1G,. SPECHT-TACVLAR POOLS INC.
•.;.� Hawkins Ave
Ronkkoma,W 11 79 3661 HORSEBLOCK ROAD
ToneI:(6311616-4"1 The Panefta Re5i4ence BVILDINGR
676-4882 85 Yenrre R Drives Southold,NY 11471 MEDFORD,NEWYORK11763
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