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Home My WebLink About40774-Z TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health- SOUTHOLD,NY 11971 4 sets of Building Plans TEL: (631)765-1802 Planning Board approval FAX:(631)765-9502 Survey—_ Sol thold.Town.NorthFork.net PERMIT NO. Check —- Septic Form___, N.Y.S.D.E.C, Trustees C.O.Application Flood Permit Examined--b 20 Single&Separate Storm-Water Assessment Form Contact: Approved 20 Mail to: Disapproved a/c Phone: V 7 -7 IS- 13 V!-1 D. piration 120__L_[ MEN 6ding rt;--tcto"r, AD CATION FOR BUILDING PERMIT JUN -8 20 Date 20 14. INSTRUCTIONS a.This� :OPSO=0141etely filled in by typewriter or in ink and submitted to the Building Inspector with 4 ""'t," sets of plan!, �urate p of plan to scale.Fee according to schedule. b.Plot plan showing location oflot 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,.iii 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. .............. (Signat of applicant or name,if a corporation) (Mailing address of appjivant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder ....... ..... Name of owner of'premises.— Rld./(-6-`e- )6c-" ............. (As on the tax 1-611 or latest deed) If applicant is a corporation,signature of duly authorized officer (Name and title of corporate officer) Builders License No. ..... .. .... Plumbers License No. Electricians License Other Trade's License No. 1. Location of land on which proposed work,will bedp�tie'. -33,?E , ............... House Number street Hamlet County fax Map No. 1000 Section eci Block Lot ............ Subdivision— ............ 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._ b. Intended use and occupancy 4L- ............ 3. Nature of work(check which applicable):New Building Addition -Alteration V I,- Repair_. Removal ...-Demolition—.—Other Work (Description) ...... 4. Estimated Cost- Fee ................ (To be paid on filing this application) 59 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 X Z 14 Rear 7-5- Depth 3S- Height Number of Stories 2- Dimensions of same structure with alterations or additions: Front -2- - JI/ Rear , 41 '� I /K Depth 3 3 qht Z 2� a Numb 1�1 8. Dimensions of entire new construction:Front Rear Depth Height Number of Stories KUL d "j, Size of lot:Front Rear— Depth k0414�4"'LTN K 10.Date of Purchase -7 X /jj- Name of Former Owner 07,onQ or use district in which premises are situated - ----- 12.Does proposed construction violate any zoning law,ordinance or regulation?YES NO_X 13.Will lot be re-graded?YES NO Will excess fill be removed from premises?YES_NOV 14.Names of Owner of prem - 0 5-/ ises f--Ac w),#L'9 Address�7.5-6-AjV6-X. s,4j Phone No. �Z2 Name of Architect'-rJB sP6%�K 3(71 Fr -rTa,, Phone No 1-2,3 17 0 2-- L, Name of Contractor 6(j&1W'A- -Address Phone No. 15 a.Is this property within 100 feet of a tidal wetland or a freshivater wetland'"YES NO_._Y *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 OFSAQ ..........being duly 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 f his knowledge and belief-,and that the work will be performed in the manner set forth in the application filed therewith. TRACEY L.DWYER Sworn to before me this -NOTARY PUBLIC,STATE OF NEW YORK day oft Qf& 20 (,,p NQ.OIDW63069001 QUALIFIED IN SUFFOLK COUNTY " , � _ COMMISSION EXPIRES JUNE 30,26.15 Notary PubluSignature of App'Va[it- ' - Scott A. Russell , _ ST(0)]KIM[WA�C']E][Z SUPERVISOR I��l[ANAGIENHENT SOUTHOLD TOWN HALL-P.O-Box 1179 p 53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of Southold %,Z) CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) DOES THIS PROJECT INVOLVE ANY OF THE FOLLOWING: Yes leo (CHECK ALL THAT APPLY) A_ Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. . Excavation or filling 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. ',. :1 _ Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. u El �E_ Site preparation within the one-hundred-year floodplain as depicted 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, Signature, Contact Information, Date & County Tag Map Number! Chapter 236 does not apply to your project. If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan and a completed Check List Form to the Building Department with your Building Permit Application. APPLICANT: (Property Owner,Design Professional,Agent.Contractor,Other) S.C.T.M. 1 OOO Date #: District eK _ NAME d Sectwn Block Lot FOR B 1 D3 `G DEP ARTN-Ii=NT USE ONLY Contact Informatiore 12L 7=2!� Reviewed By: Date Approved for processing Building Permrt- PrOperty Address 4 - � w Management Control Plan Not Required. � / Location o Construction Ion or Stormwater Management Control Plan is Required. (Forward to Engineering Department for Review.) FORM A SMCP -TOS MAY 2014 Kms$ Cwt N M z. x Jlz � Axa 2,'d La . J q:ts k � C34$ 3 ty� at o'm�: p J ke 44 Li b >: ®B ^o- 0W,I7' LU ZZ It p� tit drP6 CC Ul U- 70 os �s W t$ m491 /® a Ty a h c d e f -}- h i j k 1 m n s� revision b`7 lit"thio bolt&:washer set 31"A36 steel plate connector ` Drill and bolt thru to Connector radius all corners Cd; 114"R. Plate#3 on opposite side �-.------. ---. i TyTical for all bolts(JUN I � DO 0 0 f t( MI�1 1():f (U BEAM BEAM v 1 0 0 3 M M 1/2"thru bolt&washep t dolt thru to 3/8"A36 clipseangle (This bolt only) r ct F'+"I GLUM c dxd poKt" ,obearin$ PLATE R CONNECTt� 1 ( 1X i' CONNECTOR 42: --.._...___._---- --_..---.__--_— •w�l Q t..�.l r See detail this sheet JOIST - ~"" I 1 — 1/2"tl-rru bolt&washer set �✓ fir/ ` JOIST \ - I I - Drill and bolt thnu to Connector s Plate#2 on opposite side V-0 �y Typical for al[bolts SOLID DIAGONAL ' I 3i8"A36 steel plate connector TT^� BRIDGING BRIDGING i radius all comers(c,) 1/4"R. TYPICAL FRAMING DETAILS SCALE: NONE E� V ' t, � 0 CONNECTOR detpu this heel \ dxd pposr to bx6 ing, I to bear�g � � cars �,- -� 1RIDGING — ---� QD - � •- I N Provide Simpson clips i - rafter to top plate& Lollar tie to rafter t _ g ('Typical DUN) a 1 CO N):�',, ort#3: _ ec d-to this sheet _ JOIST 4n 91„ BPI i- 9�1 GIRDER Existing masonry fireplace _ — to be removed. '�` DETAIL cl 11'''01)prefablunit O TYPIC�A.L FRAMING _ S SGALI's: NON>:: /! F d4 poMt t6 txarin� O Existing wood frame walls �^ to be removed. V1 9b PLATE CONNECTOR -� CONNECTOR#2. See detail this sheetIZI 0. v 1 U 4 a 318"A36 st .-1 plate onnector «p radius all coi ners : 1;4"R. `n cT �24„ ” °C SCALE 1/4 r f � 1 r-O r r BEAM I^;6`, rt, BEAM -- 0 1 2 3 4 5 1020 �••:� 1 i2"thru bolt&washer set- i; a Drill and bolt thm to Connector Plate# I on opposite side Typical for all bolts >` NR 4 1/2"thio bolt&washer set Bolt thru to plate#'•1 (This holt only) p lase COLUMN PERMIT SET sheet title IMPORTANT - COPYRIGHT NOTICE / LICENSE AGREEMENT STRUCTURAL NOTES: -- PLAN & DETAILS 1.) ALL DIMENSION LUMBER SHALL BE DOUGLAS FIR #1 OR BETTER. The copyyrighted information contained in this pack "Drawings" are not for re-use. Drawings are as defined in drawing index. 2.)ALL ENGINEERED LUMBER IS PER ^ � scale Th ey are Licensed only to you as a client of TJB ARCI11T ECTS LLC:(TJB)for construction of this project only.. Carefully read the following license terms: BOISE SPAN TABLES. PL /� T '-�, CONNECTOR 3 YOU F'I' • F S AND CONDITIONS: (2X) BY USING TIlI:SF DRAWINGS, 1 OL A.RE INDICATING YOUR ACC>rPTANC'E O EIl;FOLLOWING TERM I � 3.)ALL ENGINEERED LUMBER GIRDERS In return for consideration as per contract with TJB you are granted a license to use these Drawings SHALL BE CONTINUOUS UNLESS OTHERWISE NOTED You may use the Drawings for construction of only cine pro ect. YOU MAY NOT MAKE COPIES FOR,ANOTHER PROJECT, date TJB retains copyrights to and ownership of the Drawings. TJransfer of this License and or Drawings to third parties is prohil-)it:ed. DO NOT BREAK ALONG LENGTH OF GIRDER 5/16/16 c_ 0 2