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HomeMy WebLinkAbout40873-Z '�'C���i�1 C)F'��U�` fJLI) F3UILI�INC'r PERMIT AP�'I�IC�ITIC3N C�T�CKI,IST° ���� ������������� Do yau have or need the followin�,hefore ap�SEyin�"? '�'C.DW1�I EI�.I�L �aacdofHea(th ............. SC3LI�'T3C)I1 ,l�d�1297�. 4 sets ofBuilding Plans ..�. "I'E�,e (631)765m1�02 Plannii7g f3oard approval .. _�— bo�hm d'�`o���1���hk crc-�,re�t �F`FL]�[�'7["1��a �"�i� (���y��' Survey � , � _....._ __ ......_ . � ,—,�— d��u,�c9� __�.... Septic F'osrrz �_��.... N.Y.S.D.E.C. Trustees � �_.. .......����.� C:.�.Appticatron� . Flood'��rra�i[ � ._.... Exai�iined_�'.��. 20 ..... Single&S��r�i�age ... .. � Stcsrm-Water Assessment Fornt .... t:or��act: A€sproverJ.. � ,2Q Mail ta: Disapproved alc �....�._.__ �. — �,. —.... . ��m .., .....�.— _ ... ....... . � �"� Phone: � -.��� .�. Expiratio�b .2� w . ..., .....� �� � C�C�L��,` � � �����;� . _�.. ���'��.,���'�`�CDlY F(3I2�lUt�IlIIyIG I�]Ei�II`�` � �. �I 9 �01 Dat� .........�r 2Q ������7������ a.'' i� campletely filled�n by ryp�writer ar zn ink and submittea to the F3uild`rng Inspectar with 4 sets of plans,acc�€rate plat plan tcs scale.Pee accord�ng to sc�aeduCe. b.�'lat plaaa showirig Iocation of 1at and of buildangs on prcrnises,relatianshap to adjoxncz�g pr�rraises ar pu6lic sYreets or areas,ancl waterways. c,Tl�e worl<cavcred by this a�pl�cation may not b�cammenced before issuance of'Bu�Sding Perrni2. c[.Upon appraval of this applicatran,the Surid�ng Inspector will issLte a Bt[�ldizag Permat to ihe applic�nt.Such a permit sl7all be I<ept on the prem�ses available for ins�eclion tEaroughaut th'e work. e.No buildie�g shall be€�ccupied or used in whe�Ie or in part for any purpose w(a�t so ever until the F3uildin�Inspectc�r issues a Certificate€sf C3ccupancy. f. Every builcfii�g perrnit sl�all expire if the work autharized hzts not cornrnenc�d withzn 12 mon9hs after th�riate of issu�tnce or I�as not bean compCeted within 1&months frc�m suuh date.If no z,onrng amen�finents€�r other regulaticrns affecting the property have been enacte€1 in the interirr�,the F�uilding Inspector tnay authoraae,in�n�ritrng,the extension afthe permat far ax� additior€six anantl�s.T'here�rfter,a new perrr€it shall be required. , APPLICATIC7N fS HEREF3Y Ml�LJE to tl�e F3u�lding i�epatrr�ent for the issuance af`a�uitding T'ermit pursuant to the Building Zane Ordir�anc:e of'the Town of Southold,Suffcrlk County,Ne�u�'ork,ant�other applicable Laws,Qrd�nances or RegEilations,fbr tC7e ccsnstruct€Qn of buildings,adciitians,or aiterat3ons car far removal car clsma�itian as her�in descrtbec�.`I'l�e applicai�t agrees to cca�np[y with al[appficable laws,ordinances,building code,hous�ng cade,�nd regc�l�tions,and to aclmit a�.itl�orizecl in�pectors on premises and in buildieog for necessary inspectians. .�__.r................__.__... ...... (Signature of applic�nt or name,if a corporatian) .._...._..,._..... (Mailing address of applicant) State whethec applicant�-c���n��lessee,agent,architeut,e�gineer,general cantractor,elecirzc�a�n,plumber ar builder �"� �. ��_.�. . _.........�.. _.......�-m��......� �.__.�"�.�.............................. ....,...,.,........._._ -M-� . Narne of awner af premises �..�m���n��5 ���� . .. _.__.______. (As on the tax.rcal�or latest deed) If�aa�ali�ry�o��ts� ���erc�t�an,signature of duly autharized officer �` ��`,�� �,Q `aix�e�nd title c�f c�zporate offieer} F3ui8�i��ti Zicer�se Na. Plumbers L�cense No. ..........._ Electricians L,icense N�T�f.�.�.�..__.__m___..._.__m_.._...__.._.....�.......__� CSther T'rade's I�icense No. 1. I c�catic,n of land o�n whzch�r��rp+�sed u�csrk�vill be c�czne: - � 4 .�'.�+�.�..._. P��P.�..����'�� � ..�m ... __...____...m__ ........_ _ � __.�....�... .....� ....... _.._.__....._. Hause Number Street H et C.o��nty T`�i,�Map Na. 1(}()(� Section �Z� �31oc�C � I.c>t J u ivasion Filed Map No. I,ot . State existing use and aecupancy of premzses az�d intended use and occupar�cy af proposed construction. a. Existin�use and occuparzcy_ _ b. Intendec�use ar�ci occupancy . Nature af work(check which applicable}:New Bu�Ic�ing�__ Additian 4atti;r��xic�n��� _ Repa�r_............ Remova�___ Dem€�lzrian C3ther Wc,rk ..._. .. "t+,�.'�t0� _....__. (Descript�on} . Estimat�d Cast Fee ..... ....... .........._.._ (Ta be paid on filzng this application) . If dwelling,nurnber of dwelizrcg units�Number af dwell°zng units an each floorw _ .�..................� If garage, number of cars . If buszncss,cammerciai ar mixed accupancy,specify n�ttue�nd extent af each 2ype af ti�se. ww_ . Dimensions of existing structures,if any:Front _�Rear 1C��q:at�� Height Number of Stories � �mm � � Dimensions of same structure with alterations or additions: Frant� 1 Rear �: � Depth Height Number c� ta'���s ,�"°��-.?� � � �° ...�_ ., ; �. ; �, � � . .a , Height Number of S�tod�r e����ea�r�.���_���;p cl� ,�- Dimensicrns af entire new construcfi€�n:1"��a��� � > ������ �����a� � . Size of lot:Front Rear �Depth x _. .�:. Q.Date of Purchase Name of Forxner Owner � . . �'_��� � ������ 1.Zone or use district in which premises are sit�aated - y�, 2.Does propased constructic�n vzolate�.ny zarung�aw,ord�nance or regulation?YES 1�l�b��'" �✓"r 3.Wi111at be re-graded?YES______NO_ �Wiii excess�11 be removeci from pierr�ises?Y�S�. Na�""'� 4.Names vf Owner of premzses Adcfress Phone No. Name crf Architect Address I'����a��'�s Name of Contractor, A�dr��;� Phone No. � 5 a.Is this pro�erty within 1f}0 feet of a t�ctal we2land ar a freshwater wetlan�?*YES S^���A � * IF YES,SC}UTHOLD TO TRUSTE�S&D.E.C.PE ITS MAY EiE REC�UT�D. b.Is ihis praperty witF�in 30C1 feet of a tidal wetianc�?*YES NO *IF XES,I�.E.C.PE ITS MAY E3E �QUI D. 6.Prov�c�e survey,tc�scale,with aceurate foundat�on plan and dist�tnc�s ta property i�nes. 7.Tf elevatzan at any point on property rs at 1 Q feet or b�low,must prov�cie tapographrcal data on survey. 8.Are there any covenants ancf restrictians wxth respect tc�tl�s prt�perty`?* YES NO_ � *IF YES,PROVII�E A CC7PY. TATE C1F NEW Y(�RI4) SS: :OUNTY C} , � „�c,o r'+` .� _m _n_�1(2 R __Y w___betng duly sworn,de�oses anc€says that(s}he is tl�e applicant {Name of indiv`rduai s�gning contract}aE�ove narned, 5}He is the �IrM'P. ���" h`�- ., .. �.�. ........... m._m...._,.,.,�........... {Contractor,Agent,Cc�rpnrate Offic�r,e�c.} f said owner or owners,and�s cfuly autharized ta perform or have performed the said work and to make and file this application; �at all statements cont�ined in thls appticat€on are true to the best of his knowiedge and betief;and that the work wilE be erfarmed in thc manncr set forth in the applzcation filsd th�rewrth. worn� b�t"bre rne this-�"'"`� ���� �l�ig� `r 20 � .._.. � �� ,rr . ��&�'���,&�G�u������"b1�N�1��R , t� � � �, �?"`� �a�y� �d�a� ec ��`�aa��r°�6'�as���Gms �r���a����R"���'"�"�'� .�_ � Signnt�.tr�c�f�,p�linant ��w�9��"��a�� ���r�Y���V,���" ,�, � "�'�a������ac��g��s�w�p�r�-r���y,��r"��Ua�.sm��' Subdivision Piled Map No._mww Lot State existing use and accupaney of premises and intended use and oecupancy of proposed eonstruction: a. Existing use and occupancy� b. Intended use and r�cc�i�����;w�� N�etu�r�e ofwork checRe o al� licable � Demalition� � o�Adci�tior� A]ter�}tion_8 � Pp ) � ._. .... P .....� er Wark���"�,,�L �c� ..... �. (Description) Estimated Cost Fee _ _...... ...... ......... _._ .. ...._ .. (Tc�be paid on flling this applieatinn) If dwelling,number of ciwelling units � Nurnber of dwelTin�units on each flaar ........ ........ If garage, number of cars If business,commercial or mixed accupancy,specify nature and extent of each type of use. Dimensions of exist�ng structures,lf any:Frc�nt Rear. _ l�epth�__ Height Number of 5tories IT� ����� Dimensions of same structure with alterations or additions; Front � ��Rear /y Depth Heighfi Number af���ir�,�s� "��,���" �� ,_ �... .. � r... ) �.' � r�-' �; 1 Dimensions of entire new eonstruction:I�s�a�a�� �.���---,��� '. C,�����k; �.. ', , Height Number of�tar���� _: �,�,„,.. _� ; � � ryG��� Size of iot:Front �a;aa� I����tg� �.Date of Purchase Name of Fornier Own�r '� � ";��+� � �;�°��° .Zane or use district in which premises are situated .Does proposed canstruction violate any zoning law,ord�nance or regulation?YES NC} .Will lot be re-graded?YES Nd �V`i11 excess fill be removed from premises?YES NO �^'"''� .1Vames of Owner of premises Address Phone No. Name of Architect fi�c{�3x�ss p',�������� Name af Contractor ,h ef�9 r���, Phane No. a.Is this praperty within 100 feet af a tidal wetland or a freshwater wetland?*YES NO R,�^''� IF YES,SOUTHOLD TOWN TRUSTEBS&L).E.C.PERMITS MA�BB RBQUIREL7. b.Is this property witkun 3 QO feet of a tidal wetland?* YES Nd TF YES,D.E.C.PERMITB MAY BE REQUIREI3. .Prcav�de survey,to scale,�vith accurate founc3atioaz plan anci distaaces to property lines. .If elevat�an at Any paznt on praperty is at 10 feet or below,znust provide tc�pc�graphrcai data on s�zrvey.' .Are there any covenants and restrictians with respect to this property?*YES NO '�r� IF YES.PROVIDE A COPY. ;^�T���f��NC1�'YC���� �S� ��di"�17"1'r����: �, ' r''�.` .��d�„,,������� b�ing duly sworn,deposes and says that(s)he is the applicant (Name of ind�vid€aal signing cantract)above named, He is the ��P�, � h "' ` . _.....__ ................. ... (Contractor,Agent,Corporate Officer,etc.} said owner or owners,and is e�u1y authorized to perform or have performed tha said work and ta make and fiIe this application; t atl staterr�ents ccantarned in this apptication�tre true to the best€�fhzs knowl�dge and betief;aztd that•the wesrk wi[1 be formed tn the manner set forth rn the applzcatzon�leci therew�ttt. �orn C �1"r�a°�me tP�as°--'"'"�� _c.��av � � 2Ck�'� _ � ��� r" �.x�-C'P���.�r��'6��¢"�v�d'N�""R� � e �`---..�..�::�, .�' � .� ��r��� �i�fi�. �az��H°�6�a��r�b� ����¢�a�m I"�aur,��i�a���"� � Sagnature of t�pplicar�t __........� ��+���4���V� �rt,u���ze�,��s�E�'� ��30"k'V"��.9�"4tl14C�'�aww�',sf7"��I',�°AiFMM"��ia.�a.".A�''� Form Na.6 TOWIY OF SOUTlT4LD BUILDING dEPARTMENT TOwIV HALL 765-1802 APPLTCATION FCl[t CERTIFICAT[�E7P OCCIIPANCY `I'his application tnust be filied in by typeweiter or ink and sixbmitted to the Buildirig L7epartment with the folfowing: A. For new bualdang or new use: 1. Fgnai survey of property with accurate[ocatian of nJl build�n�s,property lines,streets,and unusual natural or topographic features. 2. Frnat Approval from Health i7ept.of water suppiy and sewerage-disposal(S-9 form}. 3. Appresval rsf`electrical installatian from Board of Fire C7nderwciters. 4. Sworn statement from plumber certifying t}sat the scalder used in system contains less than 2/tQ af 1%Eead. 5, Comme�cial buildzng,industria[building,artultip[e residences and sicni[ar buildangs and anstallations,a certificate of Code Compliance fram architect or eng�neer respansible far the bu[lding. 6. Submit Plann�ng B�ar3 Approval af�camp4vted site plan requixements. B. For existmg bualdAngs(prior to t#pril 9,1957)non-cc�nforming uses,or bulldings and"pre-existing"land uses: F. Accurrite sarvey€�f properry showing a11 proper(y lanes,streets,b�ailding and unusua�naturat€�r togographic features. 2. A properly campleted appiicat�occ and ccrnsent to inspect signed by the applicant.If a Certifieate of Occupancy fs denied,the Building Inspector sha31 state the reasons therefor in writ�ng to the appl�cant. C. Fees l. Certificate o£Occupancy-New dwelling$56.00,Additions to dwellang$SO.dQ,Aiterationa to dwetlzng$50.0�, S ' m7ng pool$SO.QO,Accessttry bsx�lding$50.00,l3dditions to aceessory buxldAng$50.00,Btcs�nesses$Sf3.OQ. 2. Certificate of Oecupancy on Pre-exist3ng Building- $I OO.OQ 3. Copy of Certificate of Qccupancy-$.2S 4. Updated Certificate nf Occupancy- $50.00 S. Tempo Csrtificate€�fOccupancy-Residentaal$15.�0,Comrr�erczal$tS.(�Q _. _ ._ _ Date. �`��F ~'Z� New Constcuction, C3Id c>r Pre-ex€sting Building: (check one) .__.... Location of Progerty .. ��Q(� � ��„C�"� �,,,�,,�- ._w. ... ...... �_,..�. ...... ...,.., .�.�. Hause No. �.- ,,�m Harulet C?wnec ar Owners ofProperty:� � ���� �-� Suf£oIk County T`ax Nfap No 100(l,Seet�on BEock Lot Subdavzs�on .. _ FiEed MaF•_.._ . Lot: Permit Ato.�...._....._.�.....Date of Permit. ^��lalic�r3t:�. ... Hea�th Dept.Approval: _Une�erwriters Approvale m Planning Board Approval: yA, R.ec�uesf for. Temporary Cert€ficate Fireal Certificate: �°`s (check one) �, ........ __m. � Pee Submitted:$�� _ �� �"... �.... ° � a pla8acdrti Srgn.. � ��... ��^"�a° s�¢�2a,i;�����-�---��_., UF0 __........... �� 4 (- �c;C��t�t �., �.����I� � , ��� ���C'�0���_�`�C������ �E)� ��a��R.vr��� a ,, e,� � tf: . f-�;� t,"¢ � ' '� � b; I��/1[1����.�,\�C�rI�,I�V1[1�,�`"�� l�` SCJCFI`HC3LC1"I'CJ WN ELA$.[.-C'_C3_F3ax 1174 � "s"��"r s� ;'��„ "�.^�y r' Cv {�,`,� ] 53055MaixiTLoed-SOUI'HOC.CJ,[JELn+YORK 119'71 "�r,P" �-�"/ft� �1.��� ��1.�.9��LfL�L� a� r ,x., ��`� ���y G r � . ��;� w `"�� ,-,�a�'iJt� l.i TE 23� - cS'd` ��� ''.—.:,...:�..._l.�fR�...,.§J`;N A...��. .....�. .�J......�-�r ._�...__...�...... .._. ....�........�............�.--.—.._ C TQ d.7E. C.UI�E�r..E CED BY �HF APPC.[�.fil�T 1 , � ..�. . ._. `tNfl]lTCie ��T�4 D�.,'4/� fi��f"§� �.P�" �"��&�" �'�E,m�.......� I�C��,`'1 �'��S �°�a.�d�Ulf 4(CHE.._-_� �. . _�.. ._—..._� ' �...�u..����. . CK ALL TtIAT A.{'F'LY} � ��� �°es��a�� ; [��'(� A_ C;le�ring, gr��zb�ing, grad�ng �r str�i�a�Jing of land tuhich aff�cts znor� ` �� th�n 5,OQ0 sq�a�.re �`e�t c�f gco�zid srarface� �_ �x��.v�ti�r� a� f�iiling it►vol�ir�g rr�«re tClan 20Q cubie y�rcls�f materi�l withzn �ny p�rcel c�r any contig�caus ar�a. � � ' Sit� �reparation t�n s[ap�s �ulticE� exceed 10 f�et vertic�l ris� Ca � 1Q0 feet of horizontal distarrce� D. Site preparation within 100 feet of wetlands, beach, bluff ar �aastal ^� erosion �azard area_ ' � r" ,J � �� °1��f��ndred-year f�oodplain as depicted �� � Site preparation within t . ...._en �"�-�;����-�� ���a� �-���c-����-��: _.......__ _ _. __. ... _ ,.,... .. . . T. . . � ... _ _.�, F. Instaliation of �e� or resurfaced impervious surfaces of 1,00Q square � feet ar ore, �nless prior approva� of a Stormcuater anagement • ' Control Plan was received by the Town and the proposal includes it�-kir�cl repl�c� e�� cr� i p�rvious surfaces. If yau _ _ _ . , .. _. _ . �answered Ndinforma6on� . Sfgnature,Conta_^ µ � q�testtnns above,STOP! Cttmpiefe ihe A,pplFcant sect5on 6elow 'fh your Name, ' I3ate� Cow�ty Tag Map N�auzbea? d�apCea z36 doe5 nat�ppIy fo your project If gao� ered t�a one ar mare of the above,please submit ��vo copies s�f a Stnrmwater l4fana�e�aa�rt C6nirol Plan 4� and a cewa�a�lefied Cheek Lrst Form ta the�ualding�9e�artrnerti wr^�:CY���uus L��ild�s��ff e EL Applic�fian. __ . , S.C.T.M. *:� 1 d00 n��:�u, � APPLIC11i�i':(Property C7u?ner.De,ipn Prufessioseal.Aaent Coacrac�ar,Otherl , piyr;�i ������ .... � �, � 2� � _L_6 �. _�. � I�tAME ... .. ��� .�...�..._,.,_.,...� �- Sec[ion Block LoC aeM.e � ... . . � . ... � .. ' � � �� � . ,, . . , � �.. �-...��._..�...�.m.m,,.. _ -, . cr��,.� .�4;.=t��R.E���'ii.�iJE'�zr;;P}1�P:�P.T`�i:r.i�IT f.�tiL tl��.?'`<:� Concac�En€ormatn�rc , ' �� °'�"' .....�._..�.,,--� -�.���.�;;�" fteviewed Eiy- ...— ....�.C�'-��.�... _._ .Y_, _ � _ . _.. _ � — �, _... � � .� — ._ _ "', '"� P.�''' , Date: __.—., � —...... Pro�ea-ty Address/l.ocatirrn c�f Canstruct�c�n Work: - - - — _ - ... , _ _._ _ T ���_°°� A r��^ec.io� rr�r,a�:,�,ingP�udldrng�'r�rmit k:aea.) _...._ � Contr€�I b'lai�IdoE Require.t� ��c�_...�1.�4�_..w�._ _ I�P — ... wStoc�i�wu.�REr{�awvA����7�rer�t� _. _ _,_ .__ ___� �����(' �._� � Storn�water Management Conlrol Plan is Require�l. �_.. —. tForward to Errgineerii2U Departrr�ent(or Review_) FOP.M " SNICP- fC)S MAY 2Q14 ����.����������,�, ��.. ,�`�', T����� Telephone(631)7651$42 54375 MainRoad �,.y ,�:(�3BR 7�a5-�.yQ` P.O.Box I179 � � �'����.�"ta�hf:���,IC�"�N�i.SCY4���L�1�.,9i .0.15 Sauthold,NY 1197I-0959 "'� �•� ������������ �-.,�+=� $UII.DING I}EP NT TO O�SOUTHU APPLiCATION FOR ELECTRlCAI�1NSPECTION REQUESi'ED BY. L �l�,.w Date: 7 �3 �,� ��mp��y�Jamea �."`� � ° I��a�e:: � �icense Nae ������ �,d��°��s_ , � `�� �� k� � � �har��.No.: � r '� d � JOBS[TE INFOI�N1AT10N: (�Ind.icates required informatian) *Name: . �Address: �� • *Gross Streef: r . /Yi ' Q. #F'hone Na.: �l���..-` �..3� I'erm�E I�o.: Tax�Map Distr�ct: 100d Secfion: Bfock: Lata *BRIEF DESCR�FTiON OF WQRK(Please Print�[ea�iy) (Pfease Crrcle AI17°hat p!y) *1s jo6 ready for inspection: ��7 Rough In F�nal k�o yau need a Temp Certf�cate° ��� � Temp lnformation(ff�neededJ � 4SenriCe Size_ 1 Phase 3Phase 100 150 2fl0 300 350 400 Ofher kNew SefviCee Re-connecC Underground Number at Meters Change of Service Overhead 4dd9tiona!Infarmation: PAYMENT DUE WiTH APPI�I�A�tON �a ����. ���° � N � _� 82=Requestfortnspec6nn Form ;n;�v�l%r�i�,��9wr v i r „���uu�//r i , . rJl�� � IN'l,s' �� ��. ,,,,,, y ��',��rY nr,-� '�� .;, 9 ; .. a;,, � ,, �; b ��, ) �r/>�; � .� , � �; , � � . �,,,,, - ', �;' � ",' „ ,'; r�' � �r�, � r�,� � � � ,�, � - ,-,, „ � , � ,, � � � ;. .. � � �, �� „ � � ;. �� � -,,,. � e. �� �' , � ��,,;:. , �� �-� . , . _ � i� �. �"� , ; � � _ r � �� „> r a � e, �� � � 'l; „ � � ;, � �„ � ; ; " � . = �� � � � %� , .:. ,. �� i ,�, � ,: �,���r��, � , ���� � �, �� � �, ��, i , �. � ;° ,�� � � z �� �� � y, � " � ' � ',U�N�UrC✓nXt�/�l`���Jkwl,7� � z ,"-, , , i . ,, , � .. 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