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Home My WebLink About42338-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 2 Surve SoutholdTown.NorthFork.net PERMIT NO. ✓� ✓ Check Septic Form__._ N.Y.S.D.E.C._ Trustees C.O.Application Flood Permit Examined .. «20 D Single&Separate V Storm-Water Assessment Form Contact: Approved,_ JAN 1 8 2018,20 M�aii'to: Disapproved a/c } _ d OF SO O Phone: Expiration 20 Building ns APPLICATION FOR BUILDING PERMIT Date lo?—lo?— ,20 JT 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 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 inch date,If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector tray 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. �✓ �.dAarm zh C-44 (Signature of applicant or name,if a corporation) 9700 4 ,T (Mailing address of applicant. .165'P State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder r Name of owner of premises (As on the tax roll or latest deed) If ct a aI' r7 is a cta oration,signature of my 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.1000 Section I Block �� Lox H I 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 3. Nature of work(check which applicable):New Building— rfdit+guy Alteration Repair Removal Demolition Other Work 4. Estimated Cast .u.. •I r,.tm (Description) (To be paid on filing this application) 5. If dwelling,number of dwelling units. Number of dwelling unitsinn each floor If garage, number of cars 6. If business,commercial or mixed occupancy,specify nature and extent of each type of us 7. Dimensions of existing structures,if any:Front= 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 Depth Height. Number of Stories 9. Size of lot:Front Rear_ 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_N 0 13.Will lot be re-graded?YES NOWiII excess fill be removed from premises?YE NO ww_ 14.Names of Owner of premises kti"�- !Jlh Z�ddress �4r ;3Phone No. 3 1-,2 95 -5160 1 Name of Architect Address ms.,µ tjPhone No Name of Contractor ) xr r t-K 'R>:)C Address Of-70 f"1 o� 3Jl_e'. Phone No. S/- �W co 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 1NIA'r" F.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 fa 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) S : COUNTY OF t'7 mi y w _ 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, .orpocte Office,etc.) f , of said owner or owners,and is duly authorized to perforin or have performed the said work and to me 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. 7 Sworn to before me this 4-� a �� day of � � ��w. 20 jf3 Ij Notary Purl �PUBLIC,E`C] D.'4ltk'YER!, � :,:_�- C,STATE OF NEW YORK Signature of Applic:cit NO.01 D W6306900 QUALIFIED IN SUFFOLK COUNTY COMWSSION EXPIRES MUNE 30,-12+"'" Form No.6 TOWN Or SOUTHOLD BUILDING DEPARTMEN"C TOWN FALL d : " 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 fromHealth 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. . Submit Planning Board Approval of completed site plan requirements. B. For existing,buildings (prior to April 9, 1957) lion-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. C6py 6F-Certifciife of-0664 r� �-=$25-... -:-- 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00, Commercial$15.00 � Date. New Construction: O O Old or Pre-existing Building: (check one) Location of Property: House No. Street Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Section 5 Block Q Lot P Subdivision Filed Map„ Lot: Permit No _4a?2Date of Permit. Applicant: I rq C Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: A plicant Signature Scott A. Russell S'7C'OIRLMWAT]E]E, MA\NSUPERVISOR ASG 1EI\\I[]ENT SOUTHOLD TOWN HALL-P.O.Box 1179 Town of So u th o l d 53095 Main Road-SOUTHOLD,NEW YORK 11971 d CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) DOES THIS PROJECT INVOLVE ANY OF THE FOLLOWING: (CHECK ALL THAT APPLY 6Yes o A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. Ej 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. [:]R3 D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. EIN E. Site preparation within the one-hundred-year floodplain as depicted n FIRM Ma of an watercourse. o p Y 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, MapNumber'County Chapter 236 does not apply to your project. If you answered YES to one or more of the above, submit Two copies of a Stormwater Management Control Plan and a completed Check List Form to the Building Department w%tla your Building Permit Application. S.C.T. ", 1000 Dater APPLICANT: (Property Owner,Design Professional,Agent.Contractor,Other) District T) NAME. Section Block Lot �. . t, � k:''^� �:°r� °p.��ai�,�t.� .�l�.:u-�.�,1�1 ��.•1�.i p.�.. ry... .�. �. Contact 7ntarrxiaUart Reviewed By: Date- Pro ci l Address / Lw,,I at jori of C.loan ct ion Work: n Approved for processing Building t t mwater Management Control Plan Not mit. Required. cStormwater Stormater Management Control Plan is Required. (Forward to Engineering Department for Review.) FORM SMCP-TOS MAY 2014 Cr — . F I �C �s! Oil S m .�I �eG.� �I�I _ r �F t lil Id . P INI I 1 µ - T,, I �' FAQ �� 7n I I � �� I_•, � �. � .,�� ,JJI Y ,, I � I o I"Im— �� .. __. xo�_may smmn _m novo 'nn9x m nFIEo AM �n zz o G °z 28 a¢o ' 0 _' r �qn 3zo� cz oo ao�N �,o mo o`� oma,,. oo °o mg6z fica monvm ozF� ?°oF oozz�N �op Do z Fnnvm r �mz° °a nom M. mom quo x Fo °moa v� m„ CCN �o'zpo aLRnm os�m�"�' -gym om 00 m�xo - ymo mo �= nim ti m nm ISM m o ' n >"y zo y n � m t m n I GLOVER STREET s l II _._.......... Y AA 1 � y uv , A ,j =14 ._..._, I a I p V91:1 [LTits n i ' y NU DESCRIPTION DATE Qp m OSS LLiIY AN o `2 9�JPDAMDTONEWCODES� 9717 R o m m RESIDENCE m e" o - } w m = 280 TERRY COURT o A z `-' SOUTHOLD, N.Y.11971 _. Kem� O(soihuod North Fo�rk Pool Care couri- ,SXA- I 0,1,3 , j �y' 119 "71 f5 x 30` �.li�►y 1 a� ��cl� jd� Rr cz 10 Cj .-eWJS /0, /0 /011 &5-1 NAME. SIM- Ur aL _. DEIN P WALL , w FLOOR PATTERN: CORNERS._ OVERLAPHUNG �• .rrn. r ... 20 GAUGE 27 GAUGE (dmW cm) V I v04 u oq,s- 8