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Home My WebLink About39583-Z �SUFfat�.c TOWN OF SOUTHOLD BUILDING DEPARTMENT co z TOWN CLERK'S OFFICE o . ¢ SOUTHOLD, NY 4,1 BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 39583 Date: 3/13/2015 Permission is hereby granted to: Hart, Thomas & Hart, Anne Marie 11000 N Bayview Rd Southold, NY 11971 install a Handicap ramp as applied for fb 1"a,0- At At premises located at: 2555 Youngs Ave Unit 17D, Southold SCTM # 473889 Sec/Block/Lot# 63.1-1-34 Pursuant to application dated 2/25/2015 and approved by the Building Inspector. To expire on 3/12/2016. Fees: SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $200.00 CO -ALTERATION TO DWELLING $50.00 Total: $250.00 u Building Inspector e3 � OF S0(/T�o IS cOUMY,� TOWN OF SOUTHOLD BUILDING -DEPT. 765-1802 INSPECTION [ ] FOUNDATION IST [ ] ROUGH MBING [ ] FOUNDATION 2ND [ ] IN ATION [ ] FRAMING /STRAPPING [ INAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL'(ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: f � DATE l INSPECTOR °l Sg3 O��pE SOUTyo! � o coutomm TOWN OF SOUTHOLD BUILDING.DEPT. 765-.1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING ['/FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: hp(5 v,,'v DATE Yl INSPECTOR FIELD 3NSPE (}NE'O�T DATE CONIlYI�NTS j�A FOUNDOION(1ST) Eli FOUNDATION(2ND) N 0 CJS ' ®. 0 rA , y ROUGH FR. DM Q& y PLUMBING INSULATION PER N.Y. � STATE ENEPGY cbDB t� FINAL f ,, " e� G _� 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) 765-1502 Planning Board approval FAX: (631) 765-9502 Survey SoutholdTown.NorthFork.net PERMIT NO. 3q j D Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined 3 ,2015 D Single&Separate FEB 2 4Storm-Water Assessment Form z 201 Contact: Approved 310 ,20 S Mail to: BLDG DEPT Disapproved a/c TOWN OF SOUTHOLD //� Phone: 5I(�— �21J'- l'� YExpiration ,20 C 2 it �iOM0Y_1 1440 i Building Inspector APPLICATION FOR BUILDING PERMIT Date 520 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 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 an QpAt 7 179 - H�l' 'OW6@ 'UE NEW YORK STATE & TOWN CODES AS REQUIRED AND COQ®iTl (Signature ofap i ant or name,if a corporation) o . al h act �•li• ) ani, `u 5 ilder ' State whether applicant is owner, lessee, agent, architect, engineer, general ��Tt �- ow&JUL/ q-C_ FEE4�2 BY l--a NOTIFY RI-III DI' Nn DEPART6qENT AT 765-1802 8 AI49 TO 4 PM FOR THE r� n nn. . ip;n_rnrir Ai( Name of owner of premises U `� ` �"•°�� el ° TION-TWO REQUIRED al(° gnha1tax roll or lalte�t� If applicant is a corporation, signature o duly authorized.office FOR POURED CONCRETE (C I a I. s� 1 ��r s 2 ROUGH-FRAMING,PLUMBING, �"#t�` '3F9 ` 6 �L STRAPPING, ELECTRICAL&CAULKING (Name and title of corporate officer, l p ? Rill � ' INSULATION Builders License No. "�1 ° ° �'�bt 1 4. FINAL-CONSTRUCTION &ELECTRICAL Plumbers License No. MUST BE COMPLETE FOR C.0��® ��lry� i�.. :=;P�,,x�; , Electricians License No. v Y ALL CONSTRUCTION SHALL MEET THE Other Trade's License No. REQUIREMENTS OF THE CODS OF NEW YORK STATE NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS 1. Location of land on which proposed work will be don D v \ Ivo ou, vkllOce. C,3N�0 House Number reet Hamlet County Tax Map No. 1000 Section Obi -0 Block 01- 00 Lot 0_� 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 Zell_, b. Intended use and occupancy Rk� 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work AMD _ (De cription) 5 4. Estimated Cost 0®"30 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 1A X-0 ^, �, 8-.11 6. If business, commercial or mixed occupancy, specify nature 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 Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase I Name of Former Owner C A ' %C 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO V,- 13. Will lot be re-graded? YES NO ,,_tk_Will excess fill be removed from premises?YES NO ur- 14. Names of Owner of premises llimum \A/A(\ Address 11000 P, v%e,, Phone No. S76-�Z 3-63 V4 Name of Architect Address Phone No Name of ContractorJ44ry-r Address Phone No. 516- SZ3- 6�u�1 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 ) —rlAa M4.-� Anrx 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 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 Z�l day of (� 20 er mU ..VI\1 / ! t;-Nof jX96fltpte of Ne'�' c,— SigntVe of Applicant o. 52-4507224 Cuaaglf ad In Suffolk Counl,+ 31,12--'1 S Scott A. Russell � SUFFq'f � ��C'(��[�I��1[WA�C')EI[� a ��rJn SUPERVISOR j I�vJ[A\ISA\(GJEMUEN`]C' SOUTHOLD TOWN HALL-P.O.Box 1179 p 53095 Main Road-SOUTHOLD,NEW YORK 11971 'L� (jam Town of So u th o l d Cl-LA,IPTER 236 - STORNAWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT) . . . .... . . . s DOES THIS pRo1ECr INVOI-VE ANY 0'F 'THE FOLLOWING: Yes NO (C1tECK ALL THAT APPLY) ❑[� A. Clearing, grubbing, grading or stripping of land which affects more i 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. [.��i�e_„>�ir .r��r� inn. on sl�p�;�w�h'_c_.�� exr��cl 10 feet vertical rise to 100 feet of horizontal distance. ®® D. Site preparation within 100 feet of wetlands, beach, bluff or coastal I erosion hazard area. i El E. Site preparation within the one-hundred-year floodplain as depicted on FIRM Map of any watercourse. k - - -- - -- -p`: fnstalration=of-rew=or=resurfaced- impervious=sur-faces of= -1, 0" square__i—_ feet or more, unless prior approval of a Stormwater Management Control Plan was received by the Town and the proposal includes in-kind r_eplacemen_L 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 Tax 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 Deparlment with your Building Permit Application. s.C.T.M. 1000 Date: APPLICAN?: (Property Owner,Design Professional,Agent,Contractor,Other) punct IVAzti,r: � -1�/�n Section Block Lot FOR 31 U L1 ING D1=PA}tT;NIENT USE E Oj�1-Y Contact InfOrfnatlarc � Reviewed By" Date- a-aq- 15 ---- ProPerty Address / Location of Cons[ructlon Work: — — — — -- — — � - — -- --- approved fcc procesbing Batidirlg Permit. -- -- _------____-- -__---- , stor'nwater,vJanagement Control Plan'(ot Req#wired. - - ❑ _>torn<<:�atei ivls:na;enient Cor:tro! Pl�r,r.ReQ irE^ (;o warl io Engjaetr:nv Dep-r,rnert :o;Revir+'i O� �p I s 0 1 z 12, t '-roM ccs � Ac a- L� n n eJ yxy icy. Pos-lP co woo . COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED AND CONDITIONS OF