HomeMy WebLinkAbout42160-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. w, Check
Septic Form
N.Y.S,D.F.C. ,
Trustees
C.O.Application _a
Flood Permit
Examined 2£I G'! "„g Single&Separate—.
Examined
Storm-Water Assessment Form
SIC 1 2 ,.1 2017 Contact:
Approved... ,20 Mail to: Robert Wilson
Disapproved alc_ + PO Box 49 Southold NY 11971
"HOLD O S Phone: (631)544-8842
A
expiration 20__
B.. ng I actor
APPLICATION FOR BUILDING PERMIT
Date October 26th 120 17
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 ofbuildings,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)
PO Box 49 Southold NY 11971
(Mailing address of applicant)
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
Name of owner of premises .William Gorman ...
(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:
45805 Route 25 Southold -
House Number Street Hamlet
County Tax Map No. 1000 Section 75 Block 02 __ Lot 14
Subdivision– Filed Map No.____...__ Lot-------"-
2. State existing use and occupancy of prentises and intended use and occupancy of proposed construction:
a. Existing use and occupancy Single family-residence
.............
Demolish 585.5 sq-ft.ofexsiting 1-1/2 story wood framed residence. Add 260 sq.ft.afnew two story wood
framed addition to existing 738.4 x 2=1476.8 sq ft two story residence. Finished total structure will be
b. Intended use and occupancy... ..... X 2=1996.8 so ft.
3. Nature of work(check which applicable):New Building__ .,,Addition—V Afteration—......
Repair Other Work
(Description)
4. Estimated Cost Fee
(To be paid on filing this application)
5. If dwelling,number of dwelling units—.1....—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 26' Rear 29'-3-1/2" Depth 59-11-3/4"
Height 29-7-1/2,,, Number of Stories 2
Dimensions of same structure with alterations or additions: Front 26' —Rear 26'
Depth 294-3/4' _Height 29-7-112" Number of Stories 2
S. Dimensions of entire new construction:Front 26' Rear�_ 26 Depth 101
Height 29-7-1/7' Number of Stories 2
9. Size of lot:Front 186.80' Rear 182.1 G' Depth 121.70'
10.Date of Purchase Name of Fortner Owner
11.Zone or use district in which premises are situated AC
12.Does proposed construction violate any zoning law,ordinance or regulation?YES NO.V
13,Will lot be re-graded?YES NO V Will excess fill be removed from premises?YES—NO–V
45805 Route 25
14.Names of Owner of pre rmsesWI�Iiam Gorman Address Southold NY 11971 Phone No. (631)294-4241
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 V
•IF YES,S® COLI)TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED.
b.Is this property within 300 feet of a tidal wetland?*YES--,,,-NO V
•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
Robert Wilson being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the Agent
(Contractor,Agent,Corporate Officer,etc.)
of said owner or owners,and is duly authorized to perform or have per-formed the said work and to make and file e 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.
TRACEY L.,DWYER
Sworn to before me this NOTARY PUBLIC,STATE OF NEW YORK
day of NO.OIDVV6M.5900
-i lr"L 20 1-7
4-1 7MALIFIED IN SUFFOLK COUWTY
COMIMISSION EXPIRES JUNE 30,,2'
Notary Public L) Signature of Applicant
® N .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 at supply and sewerage-disposal( ®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 forte 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
demed,the Building Inspector shall state the reasons therefor in writing to the applicant,
C. Fees
1° Certificate of Occupancy®New dwelling$25.00,Additions to dwelling$25.00,Alterations to dwelling$25.00,
Swinaming pool$25.00,Accessory building$25.00,Additions to accessory building$25.00, 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, October 26th 2017
New Construction: Old or Pre-existing Building: V (check one)
Location of Property: 45805 Route 25 Southold
House No. Street Hamlet
Owner or Owners of Property: William Gorman
Suffolk County Tax Map No 1000, Section 5 lock 02 Lot 14
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: S
Applicant Signature
ctt ll r ST�O)) l��l[\�vA\7r]E)
SUPERVISOR
SOUrHOLD TOWN HALL-P.O.Box 1179
53095 Main Road-SOUTHOLD,NEW YORK U971 Town of Southold
CHAPTER 236 - STORMWATER MANAGEMENT WORK
( TO BE COMPLETED BY THE APPLICANT )
.......
DOES THIS PROJECT INVOLVE ANY OF THE FOLLOWING:
(CHECK ALL THAT APPLY
ye� No i
A. Clearing, grubbing, grading or stripping of land which affects more
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.
C. Site preparation on slopes which exceed 10 feet vertical rise to
100 feet of horizontal distance.
D. Site preparation within 100 feet of wetlands, beach, bluff or coastal
erosion hazard area.
E. Site preparation within the one-hundred-year f loodplain as depicted
on FIRM Map of any watercourse.
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 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 Department with your Building Permit Application.
APPLICANT: (Property Owner,Design Pro e::
.._: ..... ....: __. S.C.T.M. #: 1000 Date-
pe g Professional,Agent.Contractor,Others District
NAME: i75 02 14 10/26/2017
Robert Wilon"A' M
Section Block Lot
nA"Vr' ,..... ... ,., .,.....
_ ._..w....
�.5 �i. i....�,�•
Contact Information, (631)5048842 r� �,➢. t 1' l,i ,,, ,
Reviewed By:
Date:
� Pro erty Address / I. ��ai'la�i°a tai (`:i�n��ll•ItollG��fi Work: _� � � _.... ._. �.. _ _� ��._.�.
45805 Route 25 Approved for processing Building Permit.
...... Stormwater Management Control Plan Not Required.
Southold NY 11971 Stormwater Management Control Plan is Required. 1
Li (Forward to Engineering Department for Review.)
.. ... . .
.... . ... ... ..
FORM * SMCP TOSMAY2014
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BUILIDIN-G—D-EPIARTMENT
NOTICE OF
-R,USS TYPE C-ONSTRUC 1"'10
N, PRE-ENGINEERED
WOOD UTILIZATIONSTRU
F I ION .ANDIOR TIMBER�.._.._ m.. — CONS
_..'
RUCTION
.._ .
Cate: October 27th 2017
Owner-- William Gorman
ol SCTM: 1000-75-02-1
Location ®f Prue cute 2 45�0�..�-._.. _.�..._.,.. ath� ..n.�,M.-�. .�.�._
Please take notice that the (check ap trcable line)=
e resi ential structure
Addition to existing residential s(� d 're
Rehabilitation on to an elating residential structure
w..
r be conStructe �- r°performed -at ct -� rcaf rp , above ill Utilize
(check applicable. linea
v
._.._ ........_ .
Truss type construction )
Pre-engineered wood construction(PW)
Timber construction )
in the following location(s)( p ll le line)-
..... .. ..... . . loot framing. i udm it and beams (F)
�. . . ...�_. ..._
Roof timing ( }
Floor and roof fFarning (FFA)
Signature-
Name,
gnature-a e erg®n submitUng thiso Robert Wilson
Capacity(check applicable fine): a
... _...._ -_ Owner
r
. er representative �.
REScheck Software Version A
Compliance Certificate
Project Gorman Main Rd.
Energy Code: 2015 IECC
Location: Southold, New York
Construction Type: Single-family
Project Type: New Construction ]
Conditioned Floor Area: 0 ft2
Glazing Area 120
Climate Zone: 4 (5572 HDD)
Permit Date:
Permit Number:
Construction Site: Owner/Agent: Designer/Contractor:
Main Rd Robert Wilson Joan Chambers
Southold,NY 11971 Press Start Permits Press Start Permits
PO Box 49 PO Box 49
Southold, NY 11971 Southold, NY 11971
(631)504-8842 (631)294-4241
pressSTARTpermits@gmail.com joanchamberl0@gmail.com
Compliance: 2.3%Better Than Code Maximum UA: 298 Your UA: 291 Maximum SHGC: 0.40 Your SHGC: 0.27
The%Better ar Worse Than lode Index reflects haw close to compliance the house is based an code trade off rules.
It DOES NOT provide an est mate of energy use or cost relative to a minimur- ode home.
Ceiling 1: Flat Ceiling or Scissor Truss 898 30.0 0.0 0.035 35
Floor 1:All-Wood Joist/Truss:Over Unconditioned Space �'' �
98 30.0 0.0 0.033 33
Wall 1: Wood Frame, 16" o.c. 4 762 13.0 1.0 0.075 68
Window 1:Wood Frame:Double Pane with Low-E �` i- 13 0.300 4
SHGC: 0.27 " .w �''' n °
Window 1 copy 1:Wood Frame:Double Pane with Low-E ,+ t +
SHGC: 0.27 0 13 0.300 4
Window 1 copy 2:Wood Frame:Double Pane with Low-E 13 0.300 4
SHGC: 0.27
Window 4:Wood Frame:Double Pane with Low-E 11 0.300 3
SHGC: 0.27
Window 4 copy 1:Wood Frame:Double Pane with Low-E 11 0.300 3
SHGC:0.27
Window 6:Wood Frame:Double Pane with Low-E 10 0.300 3
SHGC: 0.27
Window 6 copy 1:Wood Frame:Double Pane with Low-E 10 0.300 3
SHGC: 0.27
Window 6 copy 2:Wood Frame:Double Pane with Low-E 10 0.300 3
SHGC: 0.27
Window 6 copy 3:Wood Frame:Double Pane with Low-E 10 0.300 3
SHGC: 0.27
Project Title: Gorman Main Rd. Report date: 11/17/17
Data filename: C:\Users\QDust\OneDrive\Documents\GormanMainRd.rck Pagel of 2
■
■
Window 6 copy 4:Wood Frame:Double Pane with Low-E 10 0.300 3
SHGC: 0.27
Window 6 copy 5:Wood Frame:Double Pane with Low-E
SHGC:0.27 10 0.3.00 3
Door 1: Solid 20 0.160 3
Door 1 copy 1:Solid 20 0.160 3
Wall 2: Wood Frame, 16" o.c. 1,062 13.0 1.0 0.075 69
Window 12: Wood Frame:Double Pane with Low-E
SH13 0.300 4
GC: 0.27
Window 12 copy 1: Wood Frame:Double Pane with Low-E 1
SHGC: 0.27 3 0.300 4
Window 12 copy 2:Wood Frame:Double Pane with Low-E 1
SHGC: 0.27 3 0.300 4
Window 12 copy 3:Wood Frame:Double Pane with Low-E 1
SHGC: 0.27 3 0.300 4
Window 12 copy 4:Wood Frame:Double Pane with Low-E 1
SHGC: 0.27 3 0.300 4
Window 12 copy 5:Wood Frame:Double Pane with Law-E 1
SHGC: 0.27 3 0.300 4
Window 12 copy 6:Wood Frame:Double Pane with Low-E 13 0 300 4
SHGC: 0.27
Window 12 copy 7:Wood Frame:Double Pane with Low-E 1
SHGC: 0.27 3 0.300 4
Window 12 copy 8: Wood Frame:Double Pane with Low-E 1
SHGC: 0.27 3 0.300 4
Window 12 copy 9: Wood Frame:Double Pane with Low-E 1
SHGC: 0.27 3 0.300 4
Window 12 copy 10:Wood Frame:Double Pane with Low-E 13 0.300 4
SHGC: 0.27
Compliance Statement. The proposed building design de cubedhere is consistent with the building plans,specifications, and other
calculations submitted with the permit application.The prppo ed building has been designed to meet the 2015 IECC requirements in
REScheck Version 4.6.4 and to comply with the mandatory requir Qents listed in the REScheck Inspection Checklist.
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ldarne Tit&'e Sigiita�
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Project Title: Gorman Main Rd. Report date: 11/17/17
Data filename: C:\Users\QDust\OneDrive\Documents\GormanMainRd.rck Page 2 of 2
SCALE 1"=3(
TOTAL LOT COVERAGE DATA FEBRUARY 11 ,
:RIPTION AREA X LOT COVERACE. NOVEMBER 18, 2008 ARCED P
®PORCH 9,470 sq. ft. 6.8% AREA = 21,895 sq.
222 sq. ft. 1.0%
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872 sq. ft. 4.0%
)5 231---sq. ff. 1.1%
--. -- 495 sq. ft. - 2.3% .
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