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Home My WebLink About42406-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 rSurvey I ............. ........... Southoldtownny.gov PERMIT NO. �JoCheck Septic Form N.Y.S.D.E.�..................... .......... Trustees C.O.Application L/� Flood Permit,, Examined— 20_ Single&Separate P,771 Truss Identification Form 1 4 1Storm-Water Assessment Form__ FEH 208 Contact: IL ell Approved 20Mail to: —Caul�------------------- Disapproved a/c TO ............................................. :n Expiration 20_ Idin 711as APPLICATION FOR BUILDING PERMIT Date ,9- Z_ 20/,Y- 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 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. (Signature of applicant or name,if a corporation) (Mailing address of applicant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder C-0 AJ7,ZA<,;1',"Z ................................................... Name of owner of premises ....................... (As on the tax roll or latest deed) If appliys a corpo'aton,s rat 0,e of dilly authorized officer ame ah-d-title of corporate officer) Builders License No.__Z_&/&7/ ............ Plumbers License No. .... Electricians License No. ..._..... O. ......... Other Trade's License No. ................................. 1. Location of land on which proposed work will be done: 21—'L ........................................... 4/4 Z:�157 /-//9,Z.,oA/ House Number Street Hamlet County Tax Map No. 1000 Section............... Block _Lot ;2 ..................... Subdivision _ __Filed Map No.m_.... Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy SQA y y—� 2r3/,Ay - b. Intended use and occupancy_,7,� y ,z, „J_ ,,�,,,� n, 3. Nature of work check which applicable):New BuildingAd r �Alteration Repair Removal Demolition 4. Estimated Cost'*/,�'Dvv,uo Fee (Description) 5. If dwelling,number of dwelling units i1, kit r Ot dwelling (To na.... a ^ id on filing this application) g _ A g 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--&—d') Rear �� Depth ( Height Number of Store T"; 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 /Gt Z ..69- _Rear ,/l51. S3 ' 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 NO 13. Will lot be re-graded?YES Y NO Will excess fill be removed from premises?YES lY NO 14.Names of Owner of premises Address/,?o rc e Phone No..'7/5--4r/f6'73709- 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,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED. b.Is this property within 300 feet of a tidal wetland?*YES NO-y *IF YES,D.E.C.PERMITS MAY BE REQUIRED. 16.Provide survey,to scale,with accurate foundation pian 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 *IF YES,PROVIDE A COPY. S'1 AT r OF NEW YORK) S) CCk[IT�?TY Ol ) being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the r%Z. 7v (Contractor,Agent, orporate 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 q before me this t"l ay of i Tr p lic of ya Not d d iIm6a o Si wire of Applicant t� a.ticdd 1n Surrolk Coun , Commission Expires Dec.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 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. � 8. New Construction: Old or Pre-existing Building: (check one) Location of Property: -- House No. Street Hamlet Owner or Owners of Property:� /51 Suffolk County Tax Map No 1000, Section 1 Block Lot w Subdivision .�^' ��..... . ..�m'__________. .Filed Map .... ...... �.._Lot: Permit NoDate o _ f Permit _ ..n.Applicant, Health Dept. Approval: .......,.,.M...... Underwriters Approval: Planning Board Approval: Request for: Ten porar ertifcate ._. Final Certificate: �_ (check one) Fee Submitted: $ Scott A. Russ ell �v]C�\-N A\(Gr]EMIENT SUPERVISOR SOUFROIDTOWN 13ALL-F.0.BOX 1179 0 4 Town of,Southold v- 53095 Main Road-SOUTHOLD,NEW YORK 11971 CHAPTER 236 - STON 'I'ER MANAGEMENT WORK SHEET ( TO BE C Mpji�- 7�1 T7 BY THE APPLICANT) _ :.. DOESw _. . . PROJECT. . .. .._ .. �.. .. . . . FOLLOWING: INVOLVE (CNECC ALL THAT APPLE Yes No A. Clearing, grubbing, grading or stripping of land which affects more d surface. than 5,000 square feet of groun B. Excavation or f 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. D_ Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. Og E Site preparation within the one-hundred-year floodplain as depicted on FIRM TV.1ap of any watercourse. F. Installation of new or resurfaced impervious surfaces of 1, 000 square feet or more, unless prior approval of a Stormwater hrarIagernent Control Plan was received by the Town and the proposal includes in-kind replacement of impervious surfaces_ STOP! . ..._......t.. e p licantdocs-n be l ourN�� If you answered NO to all of the questions above, - the � with y°�Nie' _. t}i iiatur ont o iiafoxib tion, l?atc-• -Ceaun y i - p_Nu be _ a Applicant section below If you answered YES to one or more of the above, please submit Two copies of a Storm-water Management Control Plan and a completed Cbeck List Form to the Building Department with your Building Permit Application. .. � I1000S C TN : APPLICANT- (Pro nYOwner,Design Professional,Agent,Contractor,Other) District NAME .. lata � � � Section Block 9..tat dt� ... . _ i°01F1 BU D1�u D,EDA-11.1 -`11LN l im`L��l Centacr lnformatwrc t ... Reviewed B Date: .. on uc t.._...W ork: essPro —Approved _.....Wa. for pro StomwierMna— em_eni,._Co�n. rolPlan Not Required. C Starnmater Management Control Plat} a Required. 621 i 1 ... a (Forward to Engineering Deparimenl for Rrvtew-) FORM ` SiviCP- TOS MAY 2014 1 MAIN mom r cr �° om w t+i 9 r �f 104.68' i 9 41 / :EXkop� Cq w d� �' ®b Q1 T ` r _+ rl° — z Oro 0 Xl 'ILL 2A q mss, - 0 r to :27 US �-a R jw� r96,1!918119113 2!x 1-159 Sad0 1m p = _ S2a;��G4m =Z3§ Za§§ Gtw a b app §§§§§ §§§§ 0 6 §§ft;a §z§§13§ X .,.. SO R¢ M Ai ga Ar 2 C E / V f \ 1 rX /r � \ J O $ \\ ft O \ f T V ` N t $ \ 1 a "' p n —I N m z y m r A O m m m m / \ A 0 1 \ to / \ v N 1 \ N f 1 1 \ / M 0 / W CL .�^. = cr > > f., N a m m �1 tO 14 T O au , „ y J'., c /NEER m a � r 7c r