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Home My WebLink About42049-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 SoutholdTown.NorthFork.net PERMIT NO. ' Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined, _ 20V Single&Separate Storm-Water Assessment Form Aph�j Contact: l7roved V 2 M.a" Disapproved a/c �" N I Fxplratlon m 20 a Pho s. ON ��- 6017' B i BUII;IDING DEPT. TOWN OF SO OLD APPLICATION FOR BUILDING PERMIT Date OL J, 120_4_7 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 shal I 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 shalt 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,anew 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. (Srgnarure of appl,icart or name,if a corporation) (Mailing address of applicant) /A5;Z State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber o ,deer Name of owner of premises '" (As on the tax roll or latest deed) Ifa pI' is a co ,drttion,sigi ture 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 p k will be done: / f land on which r��ose,wore House Number Street Hamlet County Tax Map No. 1000 Section 00& Block 01 Lot /� Subdivision Filed Map No, Lt-- 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 Addition Alteration Repair Removal Demolition Other Work (Description) 4. Estimated Cost Fee .......... (To be paid on fifiing this application) S. If dwelling,number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. If bq4iess,commercial orini%ed occupancy,specify nature and extent of each type of use. f 7. "j),mensions of existing structures,if any:Front Depth of Height Number Stories ........... f Dime,qsions-,of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction:Front Rear eptly Height —Number of Stories 9. Size of lot:Front Rear— I . Depth 10.Date of Purchase —Name of 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 Will excess fill be removed from premises?YES_ZNO kf�j 14.Names of Owner of premises �j AM,06' Address IRS-�AK64e Phone No. -,;7,S Name of Architect Address PO4rf"l-c' Phone No Name of Contractor r .4,cl&ess f 40 , I - Phone No. 4'-�) 15 a.Is this property within 100 feet of 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 da:ta on Survey. V 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 P being duly sw om,deposes and says that(s)hf��is the applicant (Name of individual signing contract)above named, CONTE E).8UN6H Notoy PiJbIk-,,State of 4M Yofk (S)He is the No,01 Mel 86060 �Agent,C.,po�r—ateOfficer,',�,, QU6�n — etc.) Cornmissl6n E)Vras AprH 14, 0 of said owner or owners,and is duly authorized to perform or have performed the said work and to rn�ke and file this application; that all statements contained in this application are true to the best of his knowledge and heflef,and that the work wil I be performed in the manner set forth in the application filed therewith. swom to before IneIlI 's d ay ef 20) Notary Public Signature of Applic,]"I-t- Form No.6 'I` ®STI ors Ur L U[ IN DEPARTMENT TOWN FIALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter ori 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 froth Dept_ of water supply and sewerage-disposal(S-9 form).. 3. Approval of electrical installation from Board of Fire Underwriters. 4, Sworn.slate et from-plumber certifying that the solder used in system contains less than 2/10 of I% lead. 5. Coramercial 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 liries, streets,building and unusual natural or topographic features. 2. A property completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied,the Building Inspector shall to the reasons therefor in writing to the applicant. C. Fees 1. 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. Certificate of Occupancy on Pre-existing Building- 100. .00 3. iapr dI'CerliacfdLLeimf op y .. 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) Location of Property: House No. Street Hamlet L Owner or Owners of Property: k) 6' Suffolk County Tax Map No 1000, Section B lock— Lot Subdivision it Map. Lot: • Permit No. Date of it. Applicant: j L b? 2 Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate it Certificate: (check one) Fee Submitted: $ k Applicant Signature Scott STOI AWWATIEIK A. Russell SU I Ir > SUPERVISOR AM[A.NAGEMIJENT SOUTHOLD TOWN HALL-F.0.Box 1179 0 53095 Main Road-SOUTHOLD,NEW YORK 11971 11 A i own of Southold CH"TER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) O .a. 1111S P1t0°IECF INVOLVE Y OF ".ITIE F 101 ING: r (CHECK ALL THAT APPLY) yes [] 11CA. Clearing, grubbing, grading or stripping of land whis ec s more dthan 5,000 square feet of groundsurface. Excavation r filling involvingre than 200 cubic yards of material withinarca r any contiguous area. a Site preparationes which exceed vertical rise to 100 f eet of horizontaldistance. Site preparation within 100 feetwetlands, beach, or coastal erosion hazardarea.. ® Site preparation withinthe one-hundred-year floc a e is e on FIRM Map any watercourse. F1 11 Y: F. Installation or resurfaced ervi® s surfaces re feet or more, unless priora r®v 1 of a Stormwater Management Control s received by the Town and the ® includes in-kindreplacement of impervious s rfce . If C e e Applicant section below y _ e, you ere to of a questions above, art —Chapter 236 does of l o o project Signature, Contact Information, ate & County T ST Complete PlyIf you answered IES to one or m of the above, please submit Two copies of a Stormmwater Management Control Flan and a completed Chec ist Form to the Building Department with your Building Permit Application. S.C.T.M. 1w�00 Date: APPLICANT: (Property Owner,Design Professional,Agent,Contractor,other) ' � i N- - w n ' Section Biock Lot sxurc �, „ ,iu OR R [.0,A 11 Coniact lrformatimi: Reviewed By: — - mm — — 6"'us Y r[ P..m T ..-. e.... —. Ad(.lre s LI acct(cm orf Construa�`t on 'work: Date: [:rS';PoPrmwater roved for processing Building Permit. Management Control Plan Not Required. SVor arwater Manan uW"r em. Control Plan is Required.. (Foi ward to Engineering Department 1'oi° Review,) FORM * SMCP-TOS MAY 2014 � 1 � i MAP or ul,. LOT 9.�1 R"m wmrllofta ID,I— B f A"uMa IwnM. IUUifIATAW AT I,oWM OF G, �Nm�ro.N�) E '� NEW V'IX"UPN9G "A, r A". `w• °" 5X 'YA# IA' PoPDdD 54" PUB-4.9e Aw l A d � l4AU Awo� A w r Mal MI n 1 wnnAr A « W. WWI ' '. r i /l d ANYRA 049"IV.,Am� PY. wA.MAA nm 4 17 IgIsir Aw 11j4W:'A Rtlll'Iil l IW�Ng*Awk[ RAF uWN"Ing J IwCDNAI'PAa6f C WARMPoATPON pm) aNAwrc oAa�W WAIA A"AaB.. s I d' mN" ' hA Ib x M � 7 �vEz A �r8f A� d A. ImV id >UrVlayor A m _ V, S� � � wv� N avuwrw-wwMwm ir, tl*wrl.r..�orr„rn n � " _. �m,,.m...-....,.....«.,._..��.-,.-.... ..................�.,,,..,,,..�... �, . .....,,,,.,.V... ..,.,.�.,..�««.w..w.w„�..,.».".,.,�., .�, .......... ~ ® N CA ti TE; SIZES Y- S�0 SHAPE: - FLOOR PATTEAM DEPTH : _... _ Y 20 GAUGE 27 GAUGE (drds wo) ' r 4 i .g • i, d 9 `c", No�rth Fork Pool Careqloo 1w A aA 4 i ° l f � � '! IdlA, 10 as ,a as 10 ewe 11 cati