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Home My WebLink About42176-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 Southoldtownny.gov PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application t FloodPermit Examined_J, t 20 Single&Separa e... Truss Identification Form Storm-Water Assessment Form Contact:NOV 1 it ��0 'ry Uam2, 20 Approved 4�j n .5"°f,ed 6(/ Disapproved a c TBTD' G DE _ Phone: Expiration 20 OFSOUM Buil or APPLICATION FOR BUILDING PERMIT Date �� rl ,aa/ 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. (Sighature of applicant or name,if a corporation) o. II (Mailing address of applicant ppl les=see, int,architect,en&ieer„ .neral eontrac toi electrician„plumber or builder State whether applicant ioe lessee cA �i ..... ^I Name of owner of premises (As on the tax roll or latest deed) If apple'nt Wisaorporation,signature of duly authorized officer dmf d 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- 1 P ," I louse Number Street Hamlet County Tax Map No. 1000 Section U� Block 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 LA OV44)j 3, Nature of work(check which applicable):New Building Addition � it eration W Repair Removal Demolition Other ork nl�t It a�oo CL— (Descript . :i 4. Estimated Cost Fee �Toibepaid on filing this application) 5. If dwelling,number of dwelling units-_ elw,J�,VJulg units(j �,qi�floor—...... If garage, number of cars 6. If business,cornrneI6al or mixed occupancy,specify nature and extent of Bach type of use. 7. Dimensions of existing structures,if any:Front Rear V"--7 Depth Height Number of Stories Dimensions of same structure +th alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction:Frdnt Rear -Depth Height —Number of Stories 9. Size of lot:Front Real' Depth 10.Date of Purchase Name of FormerbwnQr 11.Zone or use district in which premises are situated ......... 12.Does proposed construction violate any z ng law,ordinance or regulation?YE'S IN Ol/ 13. re-graded?YES NO W ill lot be reill excess fill be removed from promises? YES NO - 7 14.Names of Owner of prernises 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, SOUT14OLD 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 topographicaG d survey, 18.Are there any covenants and restrictions with respect to this property?*YES .7 IF YES,PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY 0 being duly sworn,deposes an�' says that(s)he is the applicant (Name of individual signing contract)above named, (S)Fle is the Qzif�Agent„ -orporate Officer,etc.) of saEd owner or owners,and is duly authorized to perform or have performed die said work and to make and file this application-, flial ali statenients contained in this application are true to the best of his knowledge and belief,and that the work will be performed in the mannei-set forth in the applicationFiled therewith. Sworn to before me th day of NCVf MILT r- 20 0 JI-0 TI AC L.DWYER JIM 6tary Public 0� NOTARY PUBLIC,STATE OF NEW YORK Signitu f XA p icant NO.OIDW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,2,QLt Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN ALL 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 I%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) Location of Property: ....................................... 11 // / ....... ................ ........... House No. Street Hamlet 1 Owner or Owners of Property:—Lo/tz 7........... ............�,,'I" ............... .......................—-—----- 4, 116 the oo) () / 0,, Suffolk County Tax Map No 1000, Section 0 ......................... Block __11� —Lot Subdivision ......................... ..........Filed Map. ............._... Lot: ............................. Permit No. -F/ Date of Permit............. ...... Applicant: ..... ..... .......................... Health Dept. Approval- ............................. ..........— Underwriters Approval: Planning Board Approval. ................. .... Request for: Temporary Certificate Final Certificate: LI/ (check one) .................... ...... Fee Submitted: $ n14/t,6 R p L_.. .................. _'Z_,�------------ ..... 4laaiil Signature (FARM) 40&-- REEW, ROAD upcQ3 1P IOLA- I M42 CL�Q°03 CL 409.97 CL 102AZ EP 14 IIP 1114 � okil 17800' U.P. cot 8*Dtk 9 VXt rn Lam° r d F X' 41 Z =W FRAK Tf wauma I FR F3.144.4 R u �7 r $ z g Zr. t f� LOT No. 4 40',092 LAMM } ARX LTD, CIHW"AGO 0 C a•. Fac, 91."1 .�. 1 2l1. THE y >. d LOT"6 LOT"j cM UNAUMMM ALTElB T M OR AMIM TO TIN SURVEY IS A WMA WIN C =1M 72+19 OF 1W AV YOW STATE EDtIMaA MW LAW C8 OF TfiB•SUR4lY MAP NOT THE L4ND SURIEYI"##=SEAL CR M BE A VAUD ME OWT.. 4' N � INELEV 1ME Fw `sww W4 M�ROVPE44T W14F9'W Me OF TATtf 4S Pd7EPAREi�, AND HIS"AV To THE 8Y3 TEi1 ARE 1R4 PlMBLIO WATERY T A# SHOYM MLE fiPAN'Y, COlEWAMYTAL AWWYAl LENDWG P&MM Li IED AM04 AND ALL DMENSONS AND QrMM SHOW TM�ITMCUM; CUARANIaS ARE NOT TMA ARE TO .w„M . ... su v r OP LOTP dF marr ES TA 'p FILED MAY 1, 1975 FILE No. 6249 w91�dDIL SITUATED IN: rn7U ► -w 1814 Middle Cauutry 30ad uite D TOWN OF: SOUTH � ° .' ligel NEW YORK E aFAAMM _ SUFFOLK COUNTY, N" DATE-- 8,412012 JOB NO. 812-14498 DIST. SEC. BLK. Lar xw4y w1 /100: $14-4,509 S.C.T.M. NO, 1000 too 03 =4 000040w 4> 75 ,r 1 DETAILW 2" x 2" LATH W1 4" SPACES ff J. l is 2 X 6 RAFTER @ 16" O.C. Ln 2 X 10 BEAM TECO COLUMN "0 ANCHOR 2" x 6" BRACE 6 X 6" CEDAR POST, CLAD WITH 1 X 6" CLEAR CEDAR CD CD 12" DIA. X 3' DEEP DETAILW aCONC. FOOTING TYP, SIDE VIEW Lp FRONT VIEW 49 6" X 6" CEDAR POST, CLAD WITH 1" X 6" CLEAR CEDAR 14'-5" 41— FRONT VIEW ASIDE VIEW A COLUMN LAYOUT PLAN VIEW- FRAMING PLAN FRAMING PLAN pw E A,70. SCALE: NOT TO SCALE PERGOLA DETAILS 11/4/17 Raymond J. Rolfe PERSONAL TOUCH LANDSCAPING Landscape Architect 4 GRACE COURT A10 GREENLAWN,NEW YORK 11740 (631)261-0538 1A,