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HomeMy WebLinkAbout40700-Z TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Ila ald�h SOUTHOLD,NY 11971 4 sets of Building Plans—__— TEL: lans .,_ —TEL•(631)765-1802 Planning Board approval FAX:(631)765-9502Survey V,11 SoutholdTown.NorthFork.net PERMIT NO. �O'" JZ chec ' Septic Form V C.O. Trustees anon Flood Permit F:;�anrined, �. 2('- Single&Separad� MAY 1 1 2016 Storm-Water Assessment Form ✓ Contact: pprr wail, 20m�. Mail tal: BU"ING DEM /r3 � p n'y '7 Disapproved -TOWN adur a ,& rms r t t v"/ ��SG E xpirzs8totti 20-� Pltttnw^. 1' cj " `G. . Building Inspector APPLICATION FOR BUILDING PERMIT Date.._ 20-L,& 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.Btaa1'¢ling Inspector may authorize.in writing,the extension of the permit for an addition six months.Thereafter,a new permit shal I 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 P''evulations,for the construction of buildings,additions,(.ar ahcrxttions or for removal or demolition as herein described.The aapphewit agrees to comply with all applicable laws,ordin-ances.building code.housing code,and regulations,and to admit authorized inspectors on premises and in building for necessary inspections. lSignature of ap-p icJJant or name,if a corporation) 5 61n1 nddress of PP c r � 6,1 M State whether applicant is owner,lessee,agent,architect.engineer.general contractor,electrician,plumber or builder of- . c 7. .... ....... Name owner of premises " ` ...... (As on the t a� 'roll or latest deed) If applicant is a corporation,signature of duly authorized officer Builders License title corporate ^ p Plumbers License No. Electricians License No.—....— Other ett., ....Other Trade's License No,, ,,,,,,_ __. 1 Location of land on ac a aTMpr()POSC4 work pa k will be done: House Number ta��. Hamlet / 0 County Tax Map No. 1000 Subdivision-,­­- Map No....................�Lot m 2. State existing use and occupancy of'prernises and� enOed construction: occupancy of proposed constructio a. Existing use and occupancy P. xer",:"d" 41-f .. . .......................... L4 1- b. Intended use and occupancy ::�:4 1�­/?c�� 'l .1 & S 3, Nature of work(check which applicable):New Building, Alteration— Repair--Rernoval­ —Deroolifion Work­­ j (Description) 4. Estimated Cost Fee..... (I'r,, be paid on filing this application) 5. If dwellina,number of dwelling units Number of divellim,units on each floor_.__. If garage, number of cars f7` 6, If business,commercial or mixed occupancy,specifynature and extent of each type of use. 7. Dimensions of existing structures,if any:Front Rear_Depth Height...— Number of Stories — Dimensions of same structure with alterations or additions: Front Rear Depth__... Height umber of Stories_ 8. Dimensions of entire new construction:Front Rear Depth_ W,,.., Height -Number of Stolies­ 9. Size of lot:Front Rear_ Depth 10.Date ofPurchww...... Name of Former Owner I I-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 V NO Will excess fill be removed from premises?YES vl'NO- 14.Names of Owner of 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?*YF X10 is •IF YES,SOIJTHOI�D TOWN TRUSTEES&D.E.C.PERmrrs MAY B"' EQULRED, b.Is this property within 300 feet ol'afidad wetland?* YES •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 OF&VII) Capplicant. J�V 111r' being duly sworn,deposes and says that(s)he is the (Name of individual signing contract)abaQ named. T L. DWYER NOTARY PUBLIC,STATE OF NEW YORK (S)He is the. C, (Contractor,Agent,Corporate Officer,etc.) QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 3%2D12) 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 i day of J4 aNo °n aryPublic Sig-aw -of Applicant F . :631 734 565! Tee 1. 2 _ iI-.e4R4 02 I i 6 bbl 4 47 oe Iv „f 4$ e - ., p b;ma „y. FIT 's Scott A. Russell ° wr � �• w�� lit�"���:y�- ��a SUPERVISOR -NASG]EIS` I ENT SOUTHOLD TOWN HALL-P_O.sox 1179 ., ° r" Southold �~ rTown of 53095 Maul Road-SOUTOLD,NEW YORK 1197110, b .. CHAPTER 236 STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED APPLICANT ) _ DOES THIS PROJECT I.NyOl.,yE ANY ....... I�I"11:II ..F01I.,0 I C . (CHECK ALL THAT APPLY) Yes No . Clearing, grubbing, r i r stripping is affects more than 5,000 square feet of ground Surface. 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. Elm E. Site preparation within the one-~hunre -year floodplain as depicted y rcouse rrm . .._ _ - .... - nsta.11at ion Map of an �. wate- on �lm�� F. of new or resurfaced impervious surfaces of 1,000 square feet or more, unless prior approval of a Stor water Management Control flan was received by the Town and the proposal includes in-kind replacement of impervious surfaces. If you answered Contact t all of questions County as Complete e Applicant section below i your Name, STOP! ate — does not apply to your project. Information, lease submitrTwo copiesChapter of a..... � If you ere S to one or ... . Signature, tt p torater Management Control Plan and a completed CheckList Formmore theBuildingabove, w h your Building Permit Application. ,. X _ AF F'LI(rtiCdT= M9�d a,t rrr Owner,Desigo Professional,Agent,Contractor,Other)) S.C_T.M # Div00 sate rict p di �.�. �. -..... — �eaatC¢n block Lot ... _... -•� ..� ,xs� Nl D_ PRTNS�NrUSI_- 1NL• !sg� C , BUILD, Contact InPor � � L .iei r '.:r '�✓ Reviewed By: ....�-� Dir ..' r� Ct�Adfd�ress.!.�Locat_iKn of C..onst„r_uctio..n Work: Approved for (c ess[ng Building Prmit Storimater ManagementControl Flail Not Required.f � _g ent Control an is R t Li (Forwardttto Engineering iDepartm Pit for Review.)FORM ” SMCP-TOS MAY 2014 o O=�O N y ozm. pyo vi � Yl 6- �m 6-PS?InO 3f" D 000 A...I MAX OD -� O V Z= m m J x �{ VtiIIIC Jp 1; 0 .p O z O z O N O = II o ti O< m O D _ Ox ym 00 � 1I o %L n mN b M C y� �D � m b �Ow = Q < w v > Z m O m _ b m Z m Z w m Z < Q cpm — mL� m - Z �i- n Tm+ o -n m b m� D O ti o y C �OC�Q n�1z�m O� ti El 5>a -0 Q El �`c^� �D a O o cz0< c )� �� m ZFbp �' O C7 m m o N� A ��_ �w o N z rno In zp � D � Dm Do�� =n >0 A Z f O �DD °� - D �b °� _-.�i �... � �m�o zz �3z � <�z az � © i Z v o < z <m Z =m m m D m o D ca� � 500 VILLAGE LANE �� �' o ( M^ 2 ; ORIENT NEW YORK m Z IN-GROUND POOL fl b3 p I ' O ^, (?O INGROUND POOL PLAN AND SECTION P z M > 0- n- nm g nn C)7 > Cm n> :�t> o o b m ob p q 0DZ c! 8, 2' 0-0z on 1z' nz > -,o on cn > >> M, y0 NO Dm > Oo >o 0, ��t - m oma t :fl z > F c > > n z z 0 z E5 z o n 0- z > z n ) m 6 %'- 6� -0 M �E 02 'o 2 IM > n > yo o > z U� IM > z 313 zC-n7p eE On (D Z�> i�- -0 7 A3 2On z�z R - U-- 0> > > 2 >Z mOOwDacy x C) -M 6 0. 0 z p 0 --I, 0� -> b��- �q ,, > (7) f2 0 m > > > Q 4-- >°:E --q z M () -- z m I - �- 8, �>,�T� CIO r 0 0 0- Z -, > > -0 > 7 1 > n 0 In > C) Q 0 o 0 mo 4z Z �o G) 0 1 Q < > I. > > > o > �E z 0 n z -M O > > 0 C) > 0 > n n O Z 0 0 z M > mm n > z F) 0 0 > z n rn n > m 4" 81, T fa N17- 0 ----------................. > 500 VILLAGE LANE NEW YOK N M> C) IN-GR(:IUND POOL NOTES AND DETAILS ---—--------