HomeMy WebLinkAbout42023-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 �ts of Building Plans
TEL:(631)765-1802 Planning Board approval
FAX: (631)765-9502 Qrvey..............................................................
Southoldtownny.gov PERMIT NO. Check
Septic Form.
—1ftistees
Application
d Permit
Examined —20 ---------
�ngle&Separate
-Truss Identification Form_....
SEP 2 7 '20,17 Contact:Storm-Water Assessment Form_
Apprcved............... Joscp i)S 2—,j I-w-st-
BUILDING DEM r
Disapproved aJc TOWNOFSOVMl
Phone:
in j>/ ?3
Expiration 20]f
Bea&Rng�rs actor
APPLICATION FOR BUILDING PERMIT
Date 120
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 and in building for necessary inspections.
(Signature of applicant or name,if a corporation)
................
(Mailing address of applicant)
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
...............
Name of owner of premises t,6 .C_p ti S Z u 61 ou� .............
(As on the tax roll 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 No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
7- �, ek�c.. ..........
House Number Street Hamlet
County Tax Map No. 1000 Section —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
3. Nature of work(check which applicable):New Building _Additlon Alteration—
mm
Repair—Removal Demolition OtherWork
(Description)
4. Estimated Cost 1777, lt
Md�•je paid on filing this application)
5. If dwelling,number of dwelling units Number of dwelling�i� on each
If garage, number of cars
6. If business,,commercial or mixed occupancy,speci;ypqture and extent of each type of use...
T 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:Fr11;?-5-Lk§r7-1—Rear
Height______161_5 '� .Number of Stories
9. Size of lot:Front D K*®Z lle Rear / 3 Z,08 Depth (9
10.Date of Purchase Nameof Former Owner
11.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—NO "l<ill excess fill be removed from premises?YES—NO
14.Names of Owner of premises Address 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?*YES—NO
* IF YES,SOUTI-TOLD 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)
COUNTY 0171��
being duly sworn,deposes and says that(s)he is the applicant
ua signing contract)above named,
(N'a i i I-�d i"—id
(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.
S,,vorn to before me thi
day of Xe . Wxy- 20
TRACEY L.DWYER
Nov Public Y'PuBLfC-.STATE OF NEW703�K .........
j, Notary Public NO.01 DW63M900 Signawre of&,�plicant
QUALIFIED IN SUFFOLK COUNly
COMMISSION EXPIRES JUNE 30,220
OW'Scott A. Russell ] b
SUPERVISOR G)E AM I ETN\
SOUTHOLD TOWN HALL-P.0.Box 1179 Southold
53095 Main Road-SOU ®T Y7e r�T�VV YC� 11971 ;n�
CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET
( rO BE COMPLETED ET1E D BY "i'HE APlE LI C AN )
1)01��S "rERS 1141- (.XJ11Q(1'1" l:l yl:1,V1E ANY oi[l "rll-ll[1F' lr"C)LILOwlNG:
...........
(Ck#F"CK ALL. I'H.A.T APPLY)
Yes No ,
A. Clearing, grubbing, grading or stripping of land which affects more
than 5,000 square feet of ground surface.
El B. Excavation or filling involving more than 200 cubic yards of material
within any parcel or any contiguous area.
cc. Site preparation on slopes which exceed 10 feet vertical rise to
100 feet of horizontal distance.
Site preparation within 100 feet of wetlands, beach, bluff or coastal
erosion hazard area.
E11I YE. Site preparation within the one-hundred-year floodplain as depicted
on FIRM Mapof any watercourse.
El F. Installation of new or resurfaced impervious surfaces of 1,000 square
feet or more, unless prior approval of a Sor water Management
Control Plan was received by the Town and the proposal includes
in-kind replacement of impervious surfaces.
f you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name,
Signature, .. .Count T a berg Chapter 23moes not apply to our project.
y p r ° �, gy..�
lease submit Two copies o a Stormwater Management Control Pan
If answered S to one or more of .. m ° lap
Contact Information,on, Date
u the above,
and a completed Check List Form to the Building Department th your Building Permit Application.
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H-10A HURRICANE CUPS Q Z
2/12 PITCH BOTTOM CHORD SCISSOR TRUSSES = LLj
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ALL INFORMATION SHOWN
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2-2X10 MSR SYP � ' � � PROPERTY OF SHIRK
TRUSS CARRIERS III vvv III 1 POLE BUILDINGS LLC.
THIS DRAWING MAY NOT
BE REPRODUCED WTHOUT
PERMISSION.BUILDER AND
OMER ARE RESPONSIBLE
f0 VERIFY ALL DIMENSIONS
41F1g BEFORE CONSTRUCTION
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REVISIONS:
FLOOR PLAN r
ATE: 8/29/17
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STRUCIUR L -�' ------ PROPERTY OF SHIRK
STUL SIDINq POLE BUILDINGS LLC,
2X4 S°F WALL GIRTS 24.OI:.:. THIS DRANLNG MAY NOT
W� SCR- BE
REPRODUCED
BUILDER AND
GRACE GRADE E---TREATED DINNER ARE RESPONSSLE
RE TREATED TO VERIFY ALL DIMENSONS
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PS1`SCE 'I - PL.AN � � F
(SEE ON PLAN 7�
DATE: 8/29/17
/ SITE:IONS I
r l SECTIONS
TYPICAL FRAME TYPICAL FRAME ��' < z
SECTION i / % a SECTION /
(ENDWALL VIEW) (SIDEWALL VIEW) 'o �,,_§
SCALE 1 4"SCALE: 1/4" 1'0" / 1 0" ` �I __
BUILDING DESIGN NOTES AND DETAILS
I A4.1 GF2AD1dG & EXCAVATIONv
A4.8 CONCRETE FLOOR(OPTIONAL)
I FINISHED GRADE SHALL BE BELOW FLOOR LEVEL WITH ADEQUATE FALL TO CARRY FIBER REINFORCED 4000 PSI CONCRETE SLAB ON GRADE OVER COMPACTED BASE.
SURFACE WATER AWAY FROM BUILDING. FOOTINGS SHALL BE CIRCULAR (UNLESS SLAB WILL BE POURED AGAINST SKIRTBOARD WITH NO TURN DOWN.
NOTED OTHERWISE) AUGERED TO THE DEPTH AND DIAMETER SPECIFIED, WITH ALL A4.9 STRUCTURAL DESIGN PARAMETERS
LOOSE FILL REMOVED BEFORE CONCRETE FOOTING MATERIAL IS PLACED.
Wilk
A4,2 FOOTINGS BUILDING USE= STORAGE a
STANDARD DEPTH FOR FOOTING EXCAVATION IS 44" FROM FINSIH FLOOR HEIGHT USE GROUP=U —
EXPOSURE CATEGORY= C
FOOTINGS SHALL BE A MINIMUM OF 36" DEPTH FOR FROST PROTECTION OR; HEIGHT & AREA LIMITATIONS=SB UNPROTECTED
LOCAL BUILDING CODE DEPTH REQUIREMENTS FOR FROST PROTECTION WILL BE OCCUPANCY LOAD=AS PER DESIGN
FOLLOWED. DRY MIX CONCRETE HYDRATED IN—SITU WILL BE USED UNLESS
OTHERWISE SPECIFIED. TOTAL NUMBER OF FLOORS= 1
TOTAL FLOOR AREA SQ FT)=750 -Sf A4.3 FRAMING � (
LUMBER FOR SIDEWALL GIRTS AND PERLINS SHALL BE #2 SPRUCE OR COMPARABLE. BUILDING VOLUME (CU FT)=13,700 O u
LUMBER FOR SKIRTBOARD, POSTS AND BEAMS SHALL BE #2 OR BETTER SOUTHERN STRUCTURE IS DESIGNED FOR A MAXIMUM WIND LOAD OF 130 MPH (3 SECOND co
YELLOW PINE. TIMBERVALUES FOR 3 PLY 2X6 GLU—LAM :FB=2150, FC=2050. LUMBER GUST), AND 103 MPH (10 SECOND GUST) UNLESS NOTED OTHERWISE. Q) > rn E
FOR TRUSS CARRIERS SHALL BE #1 OR BETTER SOUTHERN YELLOW PINE. ALL GROUND SOIL BEARING CALCULATIONS ARE BASED ON SOIL BASE CONDITION 3000 PSF
CONTACT LUMBER SHALL BE TREATED TO AWPA U1-09 (COMMODITY SPECIFICATION A, @48" BELOW GRADE UNLESS NOTED OTHERWISE. ac o d
USE CATEGORY 4B AND SECTION 5.2) AND ASAE(ASABE)EP559, .60 CCA MINIMUM AND 30 PSF(LIVE) MIN.SNOW; 5 PSF TOP CHORD & 5 PSF BOTTOM CHORD LOADS. a 0) '
SHALL BEAR AN ACCREDITED LABEL USING #1 OR BETTER SYP. 0 0 0,0 r
A4.4 ROOF TRUSSES A4.10 APPLICABLE BUILDING CODES Y J In
cn a
ROOF TRUSSES SHALL BE PRE-ENGINEERED. GROUND SNOW LOAD, DRIFT LOAD, THESE PLANS ARE DESIGNED IN ACCORDANCE WITH THE FOLLOWING BUILDING CODES: d O .N 0
COLLATERAL LOAD, AND WIND LOAD ARE TO BE IN ACCORDANCE WITH BUILDING CODE. 2015 IRC/2016 NY SUPPLEMENT CODES v� E
TRUSS ERECTION AND BRACING SHALL BE PROVIDED ACCORDING TO MANUFACTURERS .6
SPECIFICATIONS. BOTTOM CHORD OF TRUSS SHALL HAVE PERMANENT LATERAL BRACING A4.11 DESIGN CRITERIA
OF 120" OC. OR AS REQUIRED PER ROOF TRUSS DESIGN. THE DESIGN PROFESSIONAL OF DESIGN REFERENCES=NFBA GUIDLINES FOR POST & FRAME CONSTRUCT ION& NDS 2005 tr
WER
RECORD HAS REVIEWED THE PRE—ENGINEERED ROOF TRUSS DRAWINGS AS PER R502.11.1 AMERICAN FOREST & PAPER ASSOCIATION (WFCM& NDS 2005 FOR WOOD CONSTRUCTION) '
& IBC 107.3.41 AND THEY COMPLY WITH THE STRUCTURAL DESIGN REQUIREMENTS, SOUTHERN PINE COUNCIL (JOISTS & RAFTERS/ HEADERS & BEAMS) � M
A4.5 ROOF TR+'SS UPI IFT AN 1,AT1 RAl CQNNNECTIONS THE AMERICAN INSTITUTE OF TIMBER CONSTRUCTION (AITC 117-93 AND 2/98 ADDENDUM) 0 01
PRIMARY ROOF TRUSSES SHALL BE CONNECTED TO THE SIDE OF THE STRUCTURAL POSTS SOUTHERN BUILDING CODE CONGRESS (SSTD10) Y Q r
[ AND INTERMEDIATE ROOF TRUSSES SHALL BE CONNECTED TO THE STRUCTURAL HEADER MINIMUM DESIGN LOADS FOR BUILDINGS AND OTHER STRUCTURES (ASCE-7
[ WITH UPLIFT BLOCKS WITH A SUFFICIENT NUMBER OF FACE NAILS TO OFFSET THE WIND GEORGIA PACIFIC ENGINEERED LUMBER (EDITION VII) 0 Z
UPLIFT FACTOR AND LATERAL LOADS NOTED ON THE ROOF TRUSS DRAWING IN
ACCORDANCE WITH IBC SECTION 2304.9.1, 2308.10.1, AND 2308.10.6 A4.12 WARRANTY NOTES
A4.6 EAKTEN S AN'U t1RAMING CONNECTIONS STRUCTURE COMPLIES WITH ASAE(ASABE) ANY DESIGN MODIFICATION OR ANY STRUCTURAL MODIFICATION BEFORE, DURING, OR N = 0
EP484 DIAPHRAM DESIGNS& ACTIONS FOR METALCLAD BUILDINGS, IBC WIND BRACING AFTER CONSTRUCTION TO BUILDING BY ANY PERSON(S) OR COMPANY OTHER THAN W 0 0
REQUIREMENTS, IBC CONSTRAINED/ UNCONSTRAINED POST REQUIREMENTS& POST TO WORK PERFORMED OR APPROVED BY SHIRK POLE BUILDINGS LLC WILL VOID ANY AND 0 (.) _
FOOTING CONNECTION, ALL FRAMING CONNECTIONS SHALL BE OF A SIZE AND DESIGN ALL WARRANTIES PROVIDED BY MANUFACTURERS AND/OR SHIRK POLE BUILDINGS LLC.
TO MEET DESIGN LOADS SPECIFIED. NAILS USED IN .60 ACQ/CCA TREATED WOOD SUf H OESfGN 1 ODIFICATIONS Att fOR STRUCTURAL 1 QfFICATIONS 1 C 'DE T
SHALL BE 12D HOT DIPPED GALVANIZED; ASTM A 153 PLATED 1.2 MIL SCREWS, AND A DRILLING, REMOVING, CUTTING, SAWING, SPLINTERING OR DAMAGING ANY V
65 CLASS G 185 HARDWARE. THE MINIMUM AMOUNT OF 12D NAILS IN 2X4 ROOF STRUCTURAL MEMBERS INCLUDING FOOTINGS, POSTS, GIRTS, BEAMS, TRUSSES, r
PERLINS IS 2. THE MINIMUM AMOUNT OF 12D NAILS IN 2X4 WALL GIRTS IS 3. THE PERLINS, PANELS, WINDOWS, DOORS, NAILS, SCREWS, AND BOLTS.
MINIMUM # OF 12D NAILS IN 14" STRUCTURAL TIMBER IS 1 PER 4" BOARD WIDTH. IJC! LPSI;fd 15 301FiC T3CiN AND�CIR T UC I F€L M[3 =CATp{NS As O INCLUO ALL INFORMAnw SHOV4
TRUSS CARRIER CONNECTION TO POST: i "x4" GRK RSS STRUCTURAL SCREWS. SCREW ADDING ADDITONS, SNOW DRIFT LOAD FROM ADDITIONS, LEAN—TO'S, ATTIC ol R OF sw K
VALUES; SHEAR STRENGTH=1328 LB, TENSILE STRENGTH=139,000 PSI, PULLOUT=2644 STORAGE, CHAIN HOISTS, OPENINGS, SKYLIGHTS, ROOF VENTS, AND LOUVERS. THS A%MNG A LLC
NOT
M O DUD MAY NOT
LBS, HEAD PULL THROUGH=825 LBS, MIN. BENDING ANGLE=35' SHIRK POLE BUILDINGS LLC WILL NOT BE LIABLE FOR ANY FAILURES RESULTING �REPRDDucED wmaur
€J�a55IEN BUILDER AHD A47 META! SIDING AND R O11NG METAL SIDING AND ROOFING SHALL BE INSTALLED FROM THOSE MODIFICATIONS LISTED ABOVE, OR FROM ANY OTHER MODIFICATIONS 3�ARE RESPONSIBLE
WITH #9 WOODGRIP, HEX HEAD, METAL AND RUBBER WASHERED GALVANIZED NOT APPROVED BY A CERTIFIED ENGINEER. RJ VERIFY ALL DIMENSIONS
`B§6kli4 -¢? BEFDRE ONSTR€UCTR'M
COLOR MATCHING SCREWS. FASTENERS SHALL COMPLY WITH THE ROOFING & SIDING Z nvN ev: ALs
MFG'S REQUIREMENTS. METAL SIDING AND ROOFING SHALL BE WARRANTED F�_
#1 GRADE 80,000 PSI MIN. TENSILE STRENGTH CORRUGATED 29 GAUGE PAINTED ` — g.}0 ii REM N
ABM STEEL PANELS GALVANIZED TO A MINIMUM OF G-100.
METAL SIDING AND ROOFING SHALL BE TRIMMED WITH CORRECT FLASHINGS AT
EXPOSED EDGES, ROOF ENDS, CORNERS, DOORS, WINDOWS AND RIDGES, EXCEPT; *BOTTOM EDGE OF STANDARD ROOFING MATERIALS_ Flz fTIATE: 82917
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8_01D PAu,,g 14 2017 NbTpk Irl Inc W%d Sep 06 14:51:012017 Page I
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LOADING(pst) SPACING- 4-0-0 CS]. DEFL. in (Icc) I/clefl Ud PLATES GRIP
TCLL 30.0 Plate Grip DOL 1.15 TIC 0.61 Vel -0.62 8-9 >467 240 MT20 197/144
(Roof Snow--30.0) Lumber DOL 1.15 BC 0.92 Vert(CT) -0.85 8-9 >343 180 MISSHS 1971144
TCDL 5.0 Rep Stress Ina NO WB 0.61 Horz(CT) 0.48 6 1 1
BCLL 0.0 Code IBC2015frPI2014 Matrix-S Will 0.40 1 >735 360 Weight:122 lb FT=0%
BCDL SO ......
LUMBER- NOTES-
TOP CHORD 2x6 SP 240OF 2.OE 1)Wind:ASCE 7-10�VuR=130mph(3-second gust)
BOT CHORD 2x4 SPF 211 1.8E Vasd=103mph;TCDL=3.Opsf-BCDL=3.Opsf,h=25ft;
WEBS 2x4 SPF No.2 B=45ft;L=25ft;eavel Cat.II;Exp C;enclosed;
WEDGE MWFRS(directional)and C-C Exterior(2)-1-7-13 to
Left:2x4 SPF Not, 1-4-3,Intel 14-3 to 12-6-0,Exterior(2)12-6-0 to
Right:2x4 SPF No.2 15-6-0 zone;cantilever left and right exposed;end
BRACING- vertical left and right exposed;C-C for members and
TO
TO forces&MWFRS for reactions shown;Lumber
2-0-0 oc pudins(3-4-1 max.) DOL=1.60 plate grip DOL=1.60
(Switched from sheeted:Spacing>2-0-0). 2)TCLL:ASCE 7-10;Pf--30.0 psf(flat roof snow);
BOT CHORD Rigid ceiling directly applied or 5-0-9 oc bracing. Category 11;Exp C;Fully Exp.-Ct=1.2
WEBS
3)Unbalanced snow loads have been considered for
this design.
I Row at midpt 3-9,5-9 4)This truss has been designed for greater of min roof
live load of 20.0 psf or 1.00 times flat roof load of 30.0
REACTIONS. (lb/size) psf on overhangs non-concurrent with other live loads.
2 2224/0-8-0 (min.D-2-12) 5)Dead loads shown include weight of truss. Top
6 2224/l (min.I chord dead load of 5.0 psf(or less)is not adequate for
2
Max Harz 140(LC 12) a shingle roof. Architect to verify adequacy of top chord
- dead load.
Max Uplift 2 li -927(LC 14) 6)All plates are MT20 plates unless otherwise
6 = -927(LC 14) 7)Plates checked for a plus or minus 0 degree rotation
FORCES. (lb) about its center.
8)This truss has been designed for a 10.0 psf bottom
Max.Coml Ten.-All forces 250(lb)or less except
chord live load nonconcurrent with any other live loads.
when shown.
9)Bearing at jol 2,6 considers parallel to grain
TOP CHORD ;°
value using ANSlfTPl I angle to grain formula.
2-1 1=7074/2607,311=-6894/2629,
3-12=5538/2084,4-12=5441/2096,
Building designer should verify capacity of bearing d
t )JI, 4
surface.
4-13=5441/2074,5-13=5538/2062, 10)Provide mechanical connection(by others)of truss r-
5-14=-6894/2647,6-14-7074/2624 L
to bearing plate capable of withstanding 927 lb uplift at
BOT CHORD
joint 2 and 927 lb uplift at joint 6. 0 f Ilk
2-10=2332/16545,9-10-2336/6552, k
11)Graphical purlin representation does I depict the
&9=2377/6552,6-8=237316545
size or the orientation of the pudin along the top and/or
WEBS ol 1")8 rl I
4-9=79212483,34 0-0/385,5-1 bottom chord. k's"
rk
3-9=1796/6911.5-9--1796/686 k.,
September 6,2017
fo
WARNING-Verify design parameters,and READ NOTES ON THIS AND INCLUDED mil REFERENCE PAGE MI-7473 rev.fil BEFORE USE.
Design valid for use only with MI connectors.This design is based only upon parameters shown,and is for an individual building component not
a truss system.Before use,the building designer must verify the applicability of design parameters and property incorporate this design into the overall HE'
building design.Bracing indicated is to prevent budding of individual truss web andlor chord members only.Additional temporary and permanent bracing
is allays required for stability and to prevent collapse with possible personal injury and property damage. For general guidance regarding the flffrek
fabrication,storage,delivery,erection and bracing of trusses and truss system,see ANSIrl Quality Criteria,DSB-89 and BCSII Building Component 16023 SWngley Ridge Rd
Sal Infcnnation available from Truss Plate Institute,218 N.Lee Street Suite 312,Alexandria,VA 22314. Chesterfield,NO 63017
.............
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. For new building or new use:
1. Final survey of property with accurate location of all buildings,property lines, streets,and unusual natural or
topographic features.
2. Final Approval from Health Dept. of water supply and sewerage-disposal (S®9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1%lead.
5. Commercial building, industrial building,multiple residences and similar buildings and installations, a certificate
of Code Compliance from architect or engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings(prior to April 9, 1957)non-conforming uses,or buildings and"pre-existing" land uses:
1. Accurate survey of property showing all property lines, streets,building and unusual natural or topographic
features.
2. A properly completed application and consent to inspect signed by the applicant.If a Certificate of Occupancy is
denied,the Building Inspector shall state the reasons therefor in writing to the applicant.
C. Fees
I. Certificate of Occupancy®New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00,
Swimming pool $50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00.
2. Certificate of Occupancy on Pre-existing Building® $100.00
3. Copy of Certificate of Occupancy®$.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy®Residential $15.00,Commercial$15.00
Date.
New Construction: Old or Pre-existing Building: (check one)
..........
erty. ........ �[S
se
Location of Prop ......— --- —-------
House No. Street FBarlflet
Owner or Owners of Property: e:�,.,S-k i� �
T7,'r14k,)ck ............ . Lot
I/i"' Suffolk County Tax Map No 1000, Section o,L
Subdivision Filed Map. ......... .................. Lot:
Permit No. Date of Permit Applicant:--....... .........................
Health Dept. Approval: Underwriters Approval: ... ..........
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted:
09
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HEALTHLK CO, DEPI APPROVAL
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