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Home My WebLink About40752-Z TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board ofliealth IT SOUTHOLD,NY 11971 4 sets of Building Plans TEL: (631)765-1802 Planning Board approval FAX: (631)765-9502Survey SoutholdTown.NorthFork.net PERMIT NO. "" Check w___,_ Form Septic For N.Y.S.D.E.C. Trustees C.O.4 pplication Flood Permit Examined20 Single&Separatc Storm-Water Assessment Form Contact: Approved 20J� Mail to: Disapproved a-/c _... Phone° „� •^ a Expiration j ,20 Mc9 lldidlg 9nspe r MAY 6 101 APPLICATION FOR BUILDING PERMIT 20 D INSTRUCTIONS IrOWN 01SOMHOLD a.Tlr,is 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. (Signature of applicant or name,if a corporation) --RD 55C (Mailing address of applicant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder rlp NrGad Name of owner of premises ' 'D5, (As on the tax roll or latest deed) If�isn igna�hu�lre of duly authorized officer If �”corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: �LO.v � .�''�l'✓1.13 C=.�'� t� House Number Street Hamlet County Tax Map No. 1000 Section ;a -Block 3 Lot 6uoaivision ..--Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy_2 X77 y r b. Intended use and occupancy,7, 3. Nature of work(check which applicable):New BLiiIding � A a1 Alteration p —. . ..—. ., e air Removal Demolition �t,lter Wor ..... 4. Estimated Cost (Description) w .��''�;c7,ce, Fee _ garage, (To be paid on filing this application) ation) 5. If dwelling,number of dwelling units Number of dwellingbunits on each floor If ara e, 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 „2Rear ,Z�. �fgel,t[x y Height ` Number of Stories Dimensions of same structure with alterations or additions: Front i °dear, Depth Height Number of Stories r 8. Dimensions of entire new construction:Front Rear Height Number of Stories ., 9. Size of lot:Front Z Z Z,3 RearDepth..�._ �,�--- - Dez=' t. St 10.Date of Purchase Name of Former Owner 11.Zone or use district in which premises are situatedi 12.Does proposed construction violate any zoning law,ordinance or regulation?YES NO X 13.Will lot be re-graded?YES A NO Will excess fill be removed from premises?YES NO-Y 14.Names of Owner of premises g7m>5f&„a.r Address Lzz:c, r Phone No. ,�-yy . Name of Architect Addressphone No Name of Contractor C°ti �, usrirlressr . ,e-Phone No. �3y-?GGS 15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES NO *IF YES, SOUTHOLD TO'%N TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED. b. Is this property vdthin 300 feet of a tidal wetland?* YES NO *IF YES,D.E.C. PERMITS MAY BE R..EQUIRED. � _,- 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 arty covenants and restrictions with respect to this property?* YES NOV *IF YES,PRO-VII)E A COPY. STATE OF NEW YORK) SS: COUNTY OF _..... 941-7L4( being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)FIe 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 T m da of 20 J CAROL HYDELL *'�Ap;pp)' 4-, ry Cr MS5.®EXPR®q 03E atp Nota L�?p COM c ) ' Scott A. Russell ,r g SUPERVISORIWA T �' SOUTHOLD TOWN HALL s P_0.Box 1179 Town ®f Southold53095 Main Road s SOUTHOLD,NEW YORK 11971 lay CHAPTER 236 ® STORM ATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) DOE) '.FHIs PRf?JY CJ' 111,4VO1.eVE ANY" 01" °Foff I(F'0LL()WVNG-. — A. Tearing, grub ing, grading or stripping of land which 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. E. Site preparation within the one® un re -year f loodplain as depicted on FIRM Mapof any watercourse. El F. Installation of new or resurf aced 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, — to .project. .m' above, please submit Two copies of y Management pr®j _.. if you answered YES to one or ore of the Signature, Contact Information, ate � County Tax a Number! Chapter�' �� does not apply and a completed Check List Formto the Building Department with your Building Permit Application. a Storpr�water Dana ement Control Plan 0➢II V4-"a"�"If V�L�yr^n"rWr eJr�u7nr.Vbp��z„wti ll'''t�>u¢ .raru,al..�tixeu t.d¢'a�ry�crtl�:,�'tVt�u i S G TA1000 •.cailtrnu 6NctRic Lrrt ( tGrnralr'focnn,.tira'iru' a VvQa7�.: __ �I..t�.re.. ai V.� Gpai�ll��rwq 9°�^ui w. 1 �C ;i�i:�rrr�rutrrv�a o i�,r.uu��,Gr r u¢ac� ouM '' Ir .......�.. �I 0tz76nA V'"m "sol lCerp']i�ued '44& S.,., `� oi.e,u,.0N a i c Vlaom!eil7o[o r,i[r Irr,N Plaiii k l'ojui le(� ,. 4"rur1.1"pctI[lc lm2 D Pi 11iei['0 inr P"r„ tuii'V,i ......................................... ..... SURVEY Of PROPERTY IN SITUATE: SIOUTHOLD TOWN: 5OUTHOLD w E 5Uf FOLK COUNTY, NY SURVEYED I 1-19-2014 s 5 UffFOLK COUNTY TAX# 1000-54-3- IG CERTIFIED TO: EDWARD N.FELDSTEIN AMY E.FELDSTEIN WELLS FARGO BANK,N.A. ABSTRACTS,INCORPORATED gap z/1 tow kb A� cq-O,�41 ;Z- 0 0 0 S V ti cl 0 0 CP 1�p % c9iX NEt: ............ MONUMENT FOUND 3S NE. 1.1lba—b, JOHN C. FMLFR5 LAND 5URVEYOR VINYL FENCE CHAINUNK FENCE C_EH e G EAST MAIN 5TREET N.Y.5. LIC. NO.50202 Area 28,928 Sq�ft. RIVEPHEAD,N.Y. I 150 1 3C9-8288 Fax 369-8257 b,lh. Y�f4sz, Area =O.G(A Acres I'=30 lon,3i5landland5urveyor.com 14-109cid r 2 =v e' � r , r , to h rt r � r , m t 1 'x 1 l � r t i r ° t Cd I rr ® 1 t Ir 1 S I V+ qs E Y I, N � k b �3FYY gg Y I L N P I AL P llr. i LL Y�uYWW,-: WMiM"'IMN LL _ 1 d I I t IN Mill / f I I > t