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Home My WebLink About42440-Z TOWN OF SOUTHOLD BUILDING PER-NUT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying?. TON"HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL: (631)765-1802 Planning Board approval FAX:(631)765-9502 NO. Survey,-. Southoldtownny.gov PERMIT Check Septic Form -- N.Y.S.D.E.67 ................. Trustees C.O.Applications .... ---—............. Flood Permit Examined--- 20-- Single&Separate Truss Identification Form Storm-Water Assessment Form Contact: I � Approved_ 20 Mail to:---- Disapproved alc.., Phone: :1%A1 Ef Me Expiration _20 _ snectol 1 I —1`u01-h—g spect PLICATION FOR BUILDING PERMIT Date 0 7, 20 INSTRUCTIONS TOWN OF SOU'1°11,(,)JD 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 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,age ,architect, 't sneer,general contractor,electrician,plumber or builder Name of owner of premises JAAi (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 1. Loca on of land on which proposed work will be done: 0 5 01 t A-U 12. L7Z Lt-i2A2— House Num1 ber Street Hamlet County Tax Map No. 1000 Section- Block__aj Lot O Subdivision Filed Map No. Lot 2. State existing use and occupancy of prep "ses s nd intended use and occupancy f proposed construction: a. Existing use and occupancy e b. Intended use and occupancy, 3. Nature of work(check which applicable):New Building, ddition Alteration—...— Repair lteration—___m__Repair Removal Demolition Other Work (Description) 4. Estimated Cost Fee (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,commer 'al or mixed occupan y,specify nature and extent of each type of use.w. .. _.... 7. Dimensions of existing structures,if any:Front.... Rearm..... ww ww 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: From Rear Depth Height Number of Stories 9. Size of lot:FrontRcat Depth 10.Date of Purchase Name of Former Owner 11.Zone or use district in which premises are situated 124 12.Does proposed construction violate any zoning law,ordinance or regulation?YES NOx- 13.Will lot be re-graded?YES NOVWill excess fill be removed from premises?YES(,)<'NO 14.Names of Owner of premises )rfoL 6 Address phone No 51 5 73 � Name of Architect f% _Address Phone No , 3 t M � 1 5 ' - 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___. NOIL *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 *IF YES,PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF / C K� . j ,._ facia duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above nai icd, NNVE 11BUND-1 (S)He is the d ab r9V puut9Vuc tr e 01 York w�!� _ V �d A ntraclor, gent, or orate Officer,etc) Qua�Vrrdi ira Pujfotk county C mirsrsan'Expires App 14,2- D 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 day of 1 �7 2,,'L IL 4'Yr 20 m- Mh � Notary Public '-'n ; of Applicant 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 D,ept, of water supply and sewerage-disposal (S-9 form). 3. Approval ofelectrical installation frorn 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 Cornpliancefrorn 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, Swinuning 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 $15.00 Date.—0 LP New Construction: Old or Pre-existing Building: (check one c Location of Property: Hamlet House Nfo. S et Owner or Owners of Property: _'J'4- eq I....... Suffolk County Tax Map No 1000, Section -Block —Lot Subdivision- -,..... .... Filed Map. .,— Lot:__, —. Permit No. Date of Permit-,--, Applicant:.. Health Dept.Approval: Underwriters Approval: Planning Board Tppo rval:_ __ -- V-1--, Request for: emporary Certificate Final Certificate: (check one) Fee Submitted:$ App can Signature y A , gill 3 ii '� 8�c ` b ICY{Ia ° M m.D � N —a q fi� 1 � CP \1 11�IiL a p Y IC mow. yy w a _ L roam ' is M + .E=1 e s E•: .._..,.......-._�. ,�,..w...., ..... ..e....... .... ...........m.. m �� TO>][�I�� WAT]E]K Scott A. Russell ' a 5 SUPERVISOR IMIANAG IEIMIIENIF SOLTTHOLD TOWN HALL-P.O.Box 1179 N �"j N 53095 Main Road-SOLIT HOLD,NEW YORK 11971 Town of Southold l � CHAPTER 236 - STO . WATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) DOES THIS PROJECT INVOLVE ArNY OF THE FOLLOWING: ri (CHECK ALL THAT APPLY! Yes No []OA. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. 0 B. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. 1; 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. lip E. Site preparation within the one-hundred-year f food lain as depicted P P Y P on FIRM Map of any watercourse. 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, 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 wit y-o-ur Building Permit Application. APPLICANT: (Propert%Owner.De�wn Profeajional.Agent Contractor.Other) S.C.T.M. 1000 Date: �� —60 I� District Section Block Lot �. �aQ i�. _ �sM„ ��w. �:i i IVIWl _�� IJ V "dHPME' I U '� d �I��., u r Contact Information Rev-ievt,-ed By-: " ° Date: Property Address/ Location of Construction Work: --- --- -- -- — — — — — ---- --- — --- --- -- - Approved for processing Building Permit. , e"- C � — Stormwater Management Control Plan Not Required. ' �^ +�� F�"� r I f y G. Y Br' Zr_" f: Stormwater Management Control Plan is Required.— (Fong and to Engineering Department for Review.) FORM * - MAY SMCP TOS ........ Y 2014