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Home My WebLink About42267-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 mm Surve3^ Southoldtownny.gov PERMIT NO. c Check Septic Form N.Y.S.D.E.C..._.... Trustees—.......... C.O.Application - Flood Permit Examined_)A g� 20-0 Single&Separate Truss Identification Form Storm-Water Assessment Form Contact: Approved—1-2-�-;z 20.-J Mail to: Disapproved a/c....... ............. ........................ .................... Phone.: Expiration 20 t7 ................. A14�d 'Inspector APPLICATION FOR BUILDING PERMIT J INSTRUCTIONS Date 8L 9,- 20 17 a.This )h be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plailltW - scale.Fee according to schedule. - , W. 'ST P0,L'OST'lion 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 steal I be kept on the premises available for inspection throughout the work, c.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,an "regulations,and,to�;affliljt` authorized inspectors on premises and in building for necessary inspections. .... ....... a corporation) (Mailing address of applicant)'- State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder C9L,j N-(Z -------...................................................... Name of owner of premises /-tf-sl I f &,,) � , .......... (As on ffie 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: CD,rt�c' J D House Number Street-' Hamlet County Tax Map No. 1000 Section 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 ` I b. Intended use and occupancy__ 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal ,Demolition Other Work m ...... 4. Estimated Cost Fee (Description) (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 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— Height Number of Stories r i . 9. Size of lot:Front Rear Depth � Q 10.Date of Purchase Name of Former Owner 11.Zone or use district in which premises are situated "µ 12.Does proposed construction violate any zoning law,ordinance or regulation?YES_NO x 13.Wilt lot be re-graded?YES NOX—Will excess fill be removed from premises?YES NO V 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_X *IF YES,SOUTI-IOLD TOWN TRUS'T'EES&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 IX *IF YES,PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF pp ) ��TaLl to L7eAd')A 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 DUCE L. McDONALD 'Z Z day of 20 l Mary Public-State of New York No.01 MC6224291 c Qualified in Suffolk County _...... lssion Expires Ju+rae-2 Notary Public Sig a i ofApplich 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 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. 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: J9 :.., . —..... ore67"u, ..,.,....-u. House No. Street Hamlet Owner or Owners of Property: R Suffolk County Tax Map No 1000, Section .. Block Lot Subdivision Filed Map. _ _Lot:......... m.. Permit No' w1 „Date of Permit. Applicant: .. Health Dept.Approval: Underwriters Approval: Planning Board Approval. Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ ' Applicant S trod x e 17 �`" �0 F a Scott A. Bussell 55T(0 R IAWXIER, SUPERVISOR �. L. I�\JtA\_NA(G]EMHENT SOUTHOLD TOWN HALL-P.O.Boz 1179 ate ? 53095 Mai., ..._._ nRoad-SOUTHOLD,NEWYORK 11971 ✓ Town �Jm -IT SoutholdX T CH w TER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) DOES THIS PROJECT INVOLVE OF THE FOLLOWING: Yes No (CHECK ALL THAT APPLY ❑ A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. ❑�C] 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. ❑''Q D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. �Jc E. Site preparation within the one-hundred-year floodplain as depicted on FIRM Map of any watercourse. E[P 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, Sig; attire-Coj3tact-;Information,-Date---Cotanty ax Alap- um e'L-!_.. Clt;apter:_23 .does-,not apps o-your-projecL-. If you answered YES to one or more of the W W above, Please submit Twocopies of a Stormwater Management Control Plan and a completed Check List Form to the Building Department with your Building Permit Application. APPLICANT: (Property Owner,DesiProfessional," Agent.Contractor, Cher) S.C.T . ]O0imt0r0 Date: 1217 tNAME: /L erau" Section Lot F p N uY tl, Coniaci Information Reviewed By: _ Date: Property Acrr e�s / �oc�ttr , rf � ot ti ttets� t Work - . Approved for processing B uildin_g Pe_r mt_ _. .. _-_ --- �.. ._ Stormwater, Management Control Plan Not Required �t"Cw L �I Z Stormwvaler Manaacrnent Controi Plan m�Required- (Forwa.rd to EnIc.,meerm" D(.Tp)i Irnent for Review) K'6'3-5'3'30"'F' 300.00 ' z Ito o Ce 3 fb q �" PARCEL / Q A M n ~ y r. o 053'30W- • p is f�s+:'.�-'EL 2 °' '[" 85-00 f' i f SO, C 1OH� FOR Mqr t RJy4, OF,S C �;4 f o. Ari , ,, r y em q 4oVF4, IVdIq