HomeMy WebLinkAbout42300-Z TOWN OF SOUTH,OLD .. 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
www.northfork, et/Southold/ PERMIT NO. Check
Septic Form
(\�� 1 Trustees _
Examined ,2Q �-' � M-1Contact:
Approved,— 120 Mail-to: �j�i�G` f�a�Z�fS f►
Disapproved a/c_ DEC 2 2 17
t.xpxrat➢on 20� p'
OL
Building Inspector
APPLICATION FOR BUILDING PERMIT
Date ,20
INSTRUCTIONS
a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3
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 whale 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 suchAate.If no zoning amendments or other regulations affecting the
property have been enacted in the interim,the Building Inspeet6r 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 rem demolition as herein described.The
applicant agrees to comply with all applicable laws,ordinances,building code,ho ,;'ng c c,and regulations,and to admit
authorized inspectors on premises and in building for necessary inspections.
(Si tear plica
nt or name,if a corporation)
f .Jc
(haingddeVea.nt) 1 �o
State whether applicant is owner,lessee,agent,architect, ngineer,general contractor,electrician,plumber or builder
Name of owner of premises W W Tr
(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:
House Number Street Hamlet
County Tax Map No. 14)00 Section Dq-7, C O Block_ 4-,O O Lot tD
Subdivision- e)A . Piled Map No. -� Lot o
(N
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction;
a. Existing use and occupancy \(A d P4T— LAN D V 5Z'0 f (A N V 56AK", A R )
b. Intended use and Occup ncy
3. Nature of work(check which applicable):New Building Addition Alteration
Repair_ Removal Demolition -Other Work
(Description)
4. Estimated Cost
1" w (To be paid on Ming this application)
5. If dwelling,number of dwelling units t�imibpr of dwelling units on each(loos N,A ,
-If garage, number of cars
6. If business,commercial or mixed occupancy,specify nature and extent of each type of use. A -A ,
7. Dimensions of existing structures,if any:Front C. ,Rear r .i -. Depth
Height Number of Stories
Dimensions of same structure with alterations or additions:Front Rear
Depth Height Nlumberr�ofnnStories
8. Dimensions of entire new construction:Front � Ream Depth
Height 2 5, -5 Number of Stories ('}a
f
9. Size of lot:Front a R Rear .0 0 Depth Yrs 14 q�
10.Date of PurchaseC( Name of Former Owner M t C %l (til!° d
11.Zone or use district in which premises are situated A c-
12.Does proposed constrltction 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_NO
14q`1- Skvn11,-1A
14.Names of Owner of premisesWA19 (VOT7" Address 5 udTci"6 I 1 Phone No, 1-76 Co
Name of Architect Ml WAIrY�-KCbib l A Address " ��d� Phone No G-81- 52'Zf 3
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,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 data on survey.
STATE OF NEW YORK)
SS:
COUNTY OF r�t1 rrf U*Z
(Y1Llw l �J l being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the ..._ / GEN 1 t2Gkf l rECil'
(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;
thal 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
day of jDjCLM� —20_A�
Notary Public Signa of Applicant
CoNererrPe fd�
P etany Pum',State of aw Ya€k
QUWdi d in SUN*Ca angy
Cammtesjon Na.01PEF*vd586�}5
My Commission Expi s May 15,20,1k
Town Hall Annex �� Telephone(631-1802
54375 Main Road Fax(631)734-9502
P.O. Box 1179ewo
Southold, NY 11971-0959
BUILDING DEPARTMENT
NOTICE OF UTILIZATION OF TRUSS TYPE CONSTRUCTION PRE-ENGINEERED
WOOD CONSTRUCTION AND/OTS TIMBER CONSTRUCTION
Date:
Location of Property: , ` �, P
Please take notice that the (check appl'p bl) line).
Irv. New msiderAialstructure ,.� J
a
Addition to existing-residential structure
Rehabilitation to.an eAsting.residential structure
to be constructed or performed at the'subject prooerty•reforence above will Utilize
(check applicable line):
Truss type construction ff T)
Pre-engineered wood.,ponstrudon(PIS'/)
Timber construction(TC)
in the following location(s) (check applicable line): R
Floor framing, inclUdin g,gltders and - s O
_ Roof h in:'O
Floor and roof framing (FR)
Signature:
Dame (person°s rnitting this form):
� 1
Capacity(check applicable line):
Owner
Owner representative
TrussResRegl5.docx Effective 1/1/2015
Scott A. Russell 10 STO]E LAM[WA\T]ER,
SUPERVISOR MANAGIENCENT
SOUTHOLD TOWN HALL-P.O.Box 1179
53095 Main Road-SOUTHOLD,NEW YORK 11971
Town of Southold
CHAPTER 236 - STORMWATERMANAGEMENT WORK SHEET
( TO BE COMPLETED BY THE APPLICANT )
.. »_
DOES TLIIS PROJECT INVOLVE ANY OF THE F'OLLOWMG:
(CHECK ALL THAT APPLY)
Yes No i.
A. Clearing, grubbing, grading or stripping of land which affects more
than 5,000 square feet of ground surface. hr
_ B. Excavation or filling involving more than 200 cubic yards of material
a
within any parcel or any contiguous area. JC
C. Site preparation on slopes which exceed 10 feet vertical rise to
100 feet of horizontal distance. ( 1
E10 D. Site preparation within 100 feet of wetlands, beach, bluff or coastal
erosion hazard area.
[3 ED E. Site preparation within the one-hundred-year f loodplain as depicted
on FIRM Map of any watercourse.
r
�® 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
I
In kind replacement acement of impervious surfaces.w_ .�. ..
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 witFyour Building Permit Application.
APPLICA-N- lPro(aertg° wnrr Iiar,r^nPraaF oodal.mmmment.Contractor,0[herl S.C.T.M. IOOO Date:
NAME: W " blA, Section
�F`•uww++
BDociccr �. .. .._w......
�****
FOR BUILDING DEPARTMENT USE ONLY****
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Contact]rzloerntarm
ek a`:umFerp e
Reviewed By: �1
Date: .. — �]—
Property Address / Location of Construction Work: -- — — — =c "" """_L 7.—
Approved for processing Building Permit.
t
t .. �� Stormwater Management Control Plan Not Reqaired.
<�/U-T—ck 0 C?(-16 4a Stormwater Management Control lan is Required.
_
� (Forward to Engineering m Department for Review.)
FORM * SMCP-TOS MAY 2014
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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 fi-om 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)
N ..._..._ '"
Location of Property: .._� �.t ......._
House No. Street Hamlet
Owner or Owners of Property: KJ&y4
Suffolk County Tax Map No 1000, Section Block mm Lot
Subdivision • Filed Map. Aa Lot:
�.._ PP ....�. �..
Permit No. Date of Permit. Applicant: tiL C' G (rl1 I _ .. _.
Health Dept. Approval: ITmmmmmmmmm - ... Underwriters Approval:
Planning Board Approval;, m. .Ae1.�.
Request for: Temporary Certificate Final Certificate:" IT (check one)
Fee Submitted: $
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