HomeMy WebLinkAbout42385-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,,,,,,,,m,
TEL:(631)765-1802 Planning Board approval
FAX: (631)765-9502 Survey.— m
Southoldtownny.gov PERMIT NO. CheckITITITIT
Septic Formw,w_____
N.Y.S.D.E.C.
—.....,._................
Trustees _
_.............
C.O.Application _____
" Flood Permit
Examined 20 CJ Single&Separate,.._
Truss Identificatron Form
Storm-Water Assessment Form
�j .. � V�� �' �°11'�� Contact: -y-
Approved ..,. _ � Mail to:MSLfUL2/l4—I�dGS L!f�'
tl__w_...
TOWN Phone -?LtG �J/C' Z; ff 'r
Disapproved a/c S O ,.
Expiration 20-d-
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BrI 1 7g,. nspector
APPLICATION FOR BUILDING PERMIT
Date. 20S�
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'regu^lations,and to admit
authorized inspectors on premises and in building for necessary inspections. i
tSignatul of applicaa f nam ;if a corporation)
s �
(Mailing address of applicant) !�
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
mJ M 2 Mr _.
Name of owner of premises o f A
(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 world will be done:
f
House Number Street Hamlet
ot Lot
County Tax Map No. 1000 Section _ �....,mBlk .. e'
Subdivision Filed Map No. LWL
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, Addition Alteration
Repair Removal-.-Demolition Other Work �GUlr�i
(Desc pti
4. Estimated Cost ._ _ Fee
5 If dwelling number of dwelling
units lf1umber ofd gfTc�be pard filing this application)
t. on eachh floor
number �y
�,
dwelling�tni
garage, _...i ;
6. If business,commercial or mixed occupancy,specify nature and extent of each type of use.µµwww__ww
7. Dimensions of existing structures,if any:Front f „-RearDepth
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 N0,7`'
13.Will lot be re-graded?YES NO1'1- Will excess fill be removed from premises?YES NO
14.Names of Owner of premises ✓ter dZ I Pr's' AddressS 1-16fSl-v ST Phone No.,6f'%,
Name of Architect Address Phone No
Name of Contractca.--7=dZ+A' 6 L71-9 -Address/crcl & Phone No. 63/'��7 �1
4 L,'
15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES NO X
*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.
18.Are there any covenants and restrictions with respect.to this property?*YES NO X
*IF YES,PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF�
1u'7-k;duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing- tract)above named,
(S)He is the (1)� /e�/� m..............................,._.._...
(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 e re me thi {'IOc tldfa'f' ° u°lssliuwoj
�- tiauno S w P'!i!Iena
of
RNOA,Ih-4N d0 31V1S 3118nd k11l `
Notary Public Signet a of A plica.nt
.a_,
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
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
,a
Date.
New Construction: ......Old or Pre-existing Building: (check one)
Location of Property: "House �f
Street Hamlet
Owner or Owners of Property: :,
Map .�...�. _:.
Suffolk County Tax Ma No 1000, Section Block S� Lot �
Subdivision _ .. ...�....m_ m.. ..Filed Map Lot:
Permit No. Date of Permit. _ m Applicant:
Health Dept. Approval: ____ m_ Underwriters Approval:
Planning Board Approval:
Requestuest for: Temporary ryCertificate _ � Final
Certificate: � (check one)
Fee Submitted: $ l
PT
c:b Si11 LI
c
STO
Scott A. Russell � �vJ[A\NA\(G�JEI��]UE1��C'
SUPERVISOR
SOUTHOLDTOWN HALL-P.O.Box 11791-01- Town ofSouthold
53095 Main Road-SOUTHOLD,NEW YORK 11971 ��r
C-fLIWTER 236 ., STORNIWATER MANAGEMENT WORK SHEET
( TO BE COMPLETED BY THE APPLICANT)
_ _. _.. .
cr
l�I o �� .. . -
LVE OF FOLLOWING:
CILLOiNIN
DOE
S THIS (CHEOC All THAT APPLE
Yesl
E;l l radia or stripping of land which affects more
. Clearing, grubbing,bbil�g, g pp
than 5,000 square fee of ground surface. ds of material
EjjB_ Excavation or filling involving more than 200 cubic yards
within any parcel or any contiguous area.
C. Site preparation on slopes which exceed 10 feet vertical rise to
100 feet of horizontal distance_
l _ Site preparation within 100 feet of wetlands, beach, bluff or coastal
k
erosion hazard area.
E Site preparation within the one-hundred-year floodplain as depicted
on FIRM Ma of an watercourse. p
P y - impervious surfaces of 1,000 square °=
F. Installation of new or resurfaced ia�Wnn
feet or more, unless prior approval of a tormwater Management
Control Plan was received by the Town and the proposal includes
in-kind replacement of impervious surfaces.
'. to all of ns above,
Complete a ihe CbApplicant3�-de��aotP appty-n below t with
O c...�..�Name, '... ..
.Sig�rat :.CoalaasNOlnf(arraa,ati�el��tt�. ollnt�y- +�- � �. .
If you answered
)f you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan
uilding Department with your Building Permit Application.
and a completed Check List Form to the B
S.C.T_M. 1000 Matte-.
(Property roperty owner,Design Professional,Agent,Contractor,other) District
NAME: �......
�.
�..
Section L,t
' ✓ r+^"'" I.,...m.�^^•^^,�'^re ..,�.....�-, :¢:a%3 3_. ➢ D' `G tri R NI -f I--„`kON
S
OR
Contact 4.rcm7d paart .,,�"—"�"..
...�...�i�. � ice,
Reviewed
w
Date: op
..._. .....
_ pr wale d pan Not R _
Stornoved r�Mana ement Control PI- �
F'r'o em t�
Address / Location of Construc}ion work: { processing Building Permit.
Required.
Storrilwater Managen-tenl Control Plan to Required-
...
.— fFocuwvtrrG to I-.nguneering Depatlment for Re ie
FORrrl SjlviCP - TOS MAY 2014
HM ENGINEEFUNG P.C.
3 CHERRYWOOD DRIVE
EAST NORTHPORT,NY 11731
TEL:516-476-5392 D
EMAIL:HMARNIKA@OPTONLINE.NET
B 2 2018
January 31, 2018 TG° 1 OFSOUTHOLD
Town of Southold
Building Department
Town Hall
Southold,NY 11971
Dear Sir/Madam:
This is to certify that the drainage facilities to be used exclusively for the construction of a swimming pool
on the premises of:
Galanis Residence
5 Madison Street
Greenport,N.Y. 11944
will not require draining because the pool is constructed with a vinyl liner. The pool water will be
continuously recirculated through the filter and will be reused from year to year. The drainage from the
filter backwash is nominal and will not interfere with the public water supply, the existing sanitary
facilities or public highways.
Sincerely,
HM En " tiering P.C.
=a P.E.
HM ENraINEEPING P.C.
3 CHERRYWOOD DRIVE
EAST NORTHPORT,NY 11731
TEL:516-476-5392 DD
EMAIL:HMARNIKA@OPTONUNE.NET y 2
..n'0,..n. .x..K III��IIIIIurrAW 4W
TOWN OF
OLD
January 31, 2018
Town of Southold
Building Department
Town Hall
Southold,NY 11971
Dear Sir/Madam:
This is to certify that the drainage facilities to be used exclusively for the construction of a swimming pool
on the premises of:
Galanis Residence
5 Madison Street
Greenport,N.Y. 11944
will not require draining because the pool is constructed with a vinyl liner. The pool water will be
continuously recirculated through the filter and will be reused from year to year. The drainage from the
filter backwash is nominal and will not interfere with the public water supply, the existing sanitary
facilities or public highways.
Sincerely,
HM En itiecring P.C.
Hrvoje Marnika P.E.
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POOL NOTES:
2" X 6" CCA 1.POOL ANDPROPERTYTO CONFORM TO 2017 NYS UNIFORM CODE,THE 2015 IRC,
PRESSURE 2 nd PRINTING,AS AMENDED BY THE 2017 NYS UNIFORM CODE SUPPLEMENT,2017
TREATED WOOD SUPPLEMENT TO THE NYS ENERGY CONSERVATION CONSTRUCTION CODE,TOWN
PUMP VINYL LINER OF SOUTHOLD CODE AND 2014 NATIONAL ELECTRIC CODE.
FILTER SKIMMER R� 4;Z'
(MIN.) 2.POOL SHALL CONFORM TO ANSI/NSPI STANDARDS R326.3.1.
3.SECTION R326.7 POOL ALARM REQUIRED.
(TYP.) FOAM PADDING- 3,500 PSI CONCRETE 4.POOL SHALL COMPLY WITH BARRIER REQUIREMENTS SECTION R326.5.
5.POOL SHALL COMPLY WITH INTERNATIONAL ENERGY CONSERVATION CODE
Ir L SECTION R403.10:
POOLS AND PERMANENTSPA ENERGY CONSUMPTION(MANDATORY).
SECTION R403.10.1 HEATERS
1 4'X8' #4 REBAR TOPSECTION R403.10.2 TIME SWITCHES
PROPOSED VINYL FIBERGLASS & BOTTOM SECTION R403.10.3 COVERS
STEPS 6.REBARSHALLBE 3"MIN.CLEARTO EARTH.
RETURN ( SWIMMING POOL 7.CONSTRUCTION METHODSAND PRECAUTIONS ARE DICTATED BY GROUNDAND
TN SOIL CONDITIONS TO BE DETERMINED BY CONTRACTOR.
MN800 S.F. 20' 8.LOCATION OF PROPOSED SWIMMING POOL AND POOL EQUIPMENT BY OTHERS
)1 DUAL MAIN DRAINS AND SHALL COMPLY WITH ALL LOCAL ZONING REQUIREMENTS.
WITH STRAINER (VGBLq 4 9.ALLDRAIN COVERSTO MEETALL REQUIREMENTS OFTHE VIRGINIAGRAEME
1SAFETY ACT APPROVED BAKER(VGB)POOLANDSPA SAFETY ACT.
DRAINS) 1 10.SLOPE PATIO SURFACE 1/4"PER FOOT AWAY FROM POOL.
11.BACKFILL MATERIAL TO BE FREE DRAINING GRANULAR MATERIAL(NO CLAY OR
I LARGE.ROCKS).
_
12.5"
12.SUCTION OUTLETS SHALL BE DESIGNED AND INSTALLED IN ACCORDANCE WITH
-- ��qq�� A AN51(APSP-7.
_ W
40' IOL LL IYJA L 13.NO SURCHARGE ALLOWED WITHIN 4'OF SHALLOW END AND 6'OF DEEP END.
SCALE: 3 4" = 1'—O" 14.THIS SWIMMING POOL HAS NOT BEEN DESIGNED FOR USE WITH DIVING
NOTES: / EQUIPMENT.FOR DECK LEVEL DIVING BOARD REFER TO ANSI/APSP/ICC-5 2011
jdlf't k
T. SHALL BEAR ON UNDISTURBED SOIL. REQUIREMENTS FOR MINIMUM POOLDEPTH AND INTERIOR POOL DIMENSIONS.
t'"SsiL PLAN. 2.ALL CONCRETE SHALL BE PLACED ASA MONOLITHIC POUR, 15,CONTRACTOR SHALL VERIFY SOIL BEARING LOADS PRIOR TO INSTALLATION OF
NOT TO SCALE POOL'
16.THIS PLAN IS FOR CONSTRUCTION ON PROPERTY AT 5 MADISON STREET,
GREENPORT,N.Y.11944 ONLY.
17,REINFORCING STEEL SHALL BE INTERMEDIATE GRADE BILLET STEEL WITH A
MINIMUM LAP OF 30 BAR DIAMETERS.
18.HM ENGINEERING,P.C.SHALL NOT BE RESPONSIBLE FOR CONSTRUCTION
-- MEANS,METHODS,TECHNIQUES OR PROCEDURES UTILIZED BYTHE CONTRACTOR,.
3'-4" CONCRETE WALL NOR FOR THE SAFETY OF THE PUBLIC OR CONTRACTOR'S EMPLOYEES,OR FOR THE
h! 8'_0" 11- (SEE SECTION FAILURE OF THE CONTRACTOR TO CARRY OUT THE WORK IN ACCORDANCE WITH
gT( THIS
3 1J- THIS SHEET) PLAN.
�1�
1 _
UNDISTURBEDmmmjffj — ' t t/2" ro WASTE
EARTH (TYP.) f HAIR&LINT STRAINER
4' r 10'� 14' 12' PUMP
3" COMPACTED SAND FILTER AUTO SKIMMER
1�
POOL PROPEL
NOT TO SCALE POOL
BACK TO
POOL
PREPARED FOR: -
GALANIS RESIDENCE
DUAL MAIN
5 MADISON STREET
SCHEMATIC PIPING ARRANGEMENT DRAINS
GREENPORT, N.Y. 11944 NOT TO SCALE
f
t I ENGINEERING. DATE 99f3HOWN
/2018
NOTE; HM SCALE: AS SHOWN
THESE PLANS ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF HM ENGINEERING P.C..UNAUTHORIZEDj { -SHEET 1 OF 1
ALTERATIONS OR ADDITIONS TO THESE DOCUMENTS ARE A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE t� / t 3 CHERRYWOOD DRIVE EAST NORTHPORT,NY 11731
EDUCATION LAW.INFRINGEMENTS WILL BE PROSECUTED. Tel:(516)476-5392 Fax:(631)980-7671 www.hmarnika@optontine.net RESIDENTIAL CONCRETE
VINYL LINER POOL PLAN