HomeMy WebLinkAbout42444-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 -1 Survey
SoutholdTown.NorthFork.net PERMIT NO. V' "' Check
Septic Form ...............
N.Y.S.D.E.C,
Trustees
.. C.O.Application
°' Flood Permit
Examined '20-1
Single&Separate
Storm-Water Assessment Form
i Contact:
Approved 7 20 Mail to: Susan Young ...................
Disapproved a/c 215 West 88th Street,Ste.6H,New York,NY 10024
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Phone: 212 724-7204
Expiraliop
9 1
y qq p yyi din Inspector
APPLICATION FOR BUILDING PERMIT
'BUILDING DE . Date February 19, 20 18
TOWNOF SO OLD 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 regulations,and to admit
authorized inspectors on premises and in building for necessary inspections.
Si isaturd of aVe,
name
g pe ' corporation)
Susan Young, R.A., 215 W.88th St., ,New York, NY 10024
(Mailing address of applicant)
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
Architect
Name of owner of premises Neil D.Corcoran&Eloise P.Corcoran
(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. #57187-A
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
45 Avenue"B"and Crescent Avenue Fishers_Island.NY
House Number Street Hamlet
County Tax Map No. 1000 Section— 006 Block ,,,,2 Lot 10
Subdivision _wFiled Map No. Lot
2. State existing use.and�occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use;and occupancy SingW-Fancily residence
b, :Intended USC WId Oa°CUpancy Single-Family resideince
3. Nature of work(check which applicable):New Building Addition Alteration
Repair Removal Demolition Other Work_ Window door replacement add windows
(Description)
4. Estimated Cost $20;000; Fee
(To be paid on filing this application)
5. If dwelling,number of dwelling units 1 Number of dwelling units on each floor 1
If garage, number of cars
6. If business,commercial or.mixed occupancy;specify naturd and extent of each type of use._ ..._
7. Dimensions of existing structures,if any:Front Rear Depth _.._ ........__.
Height Number of Stories
L :.,i ��J
Dimensions of same structure with alterations or additions:Front Rear
Depth Height 15' Number of St ries 1 ,�': j
8. Dimensions of entire new construction:Front Rear Depth
Height Number of Stories .
9. Size of lot:Front Rear.. Depth
10.Date of Purchase 2017 Name of Former Owner- AIix&.Jamie Stanley
11,Zone or use district in which premises are situated R-80
12.Does proposed co nstructio'n violate any zoning'law',ordinance or regulation?YES NOX
13.Will lot be re-graded?YES NO X Will excess fill be removed from premises?YtS NO X.
Neil D.Corcoran&Eloise P.Corcoran 34 Firth Ave„Apt 4d',
14.Names of,Owner of premises Address New,York,Ny 10011, Phone,f`1o, 41§ 73Q-0982
Name ofArchitect Susan,Young,n A,., . Address 215 VVI 88 St«Ste.6h Phone,No 212 724-7204
Name of Contractor Paul Ford Address 544 Hound Lane,Box 661 Phone No,_631 788-5550;
The property is across the streeffrom Crescent Ave which is on the Fishers Island Sound
15 a.Is this property within 1 00 feet of a tidal wetland or a freshwater wetland?*YES NO X
*IF YE 8,SOIJTHOLD TOWN TRUSTEES&D.E.C.PERMITS'MAYBE REQUIRED.
b.Is t$is 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. provided with application
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 NY .........)
Susan E.Young being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the Architect
(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 before rue this MICHAEL ROBERTS
__j _day of �'' " p try Public.State of New York
No.02RO4732348
Quallflod_. in N
ow Notary Public _ urnlml �i� -
Signature op
�--,-.
Scott A. Russell STO1WMIWATIER,
SUPERVISOR NIA NA\GIEMDENT
SOUTHOLDTOWN HALL-P.O.Box 1779 t Town ofSouthold
53095 Main Road-SOUTHOLD,NEIN YORK 11971 J
CHAPTER 236 - STORAIWATER MANAGEMENT WORTS SHEET
( TO BE C O'NIPLETED BY THE APPLICANT )
DOES THIS PROJECT ENVOLVE A Y OF THE FOLLOWING:
No�G'.L""�a
CHECK ALL TH\T APPLY
I
A. Clearing, grubbing, grading or stripping of land which affects more
than 5,000 square feet of ground surface.
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.
D. Site preparation within 100 feet of wetlands, beach, bluff or coastal
erosion hazard area.
E. Site preparation within the one-hundred-year floodplain as depicted
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 x 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 with your Building Permit Application.
APPLICANOro Pmpert:Otcncr.Dc_tgn Profe-,tonal.Agent.C:ontractor.Othcr. S.0.1.N1. ` 1000 Uatc•
Ui i r ict
NANIL_ Susan Young, R.A. 006 2 10 2/17/18
&tilion Bloc). Lot
mg¢ I-OR BLIL. IDU I11L1P.\R-F\1L'NT USL ONLY ,..,
212° 4•-7 . -
— — _.. — -. — — ..W. ..- — .—. — ,.....
Date _ ...
Pro xri\ Addre=,-,L / Location of Con-itrucholl Work: — _.. — — — — -- _ — —. — — - -
Approved for processing Building Permit.
45 Avenue"B"and Crescent Avenue li Storinuatcr\•lanagcinew Control Plan Not Required.
—
Fishers Island, NY _ Slormwaler A-lanagen >ent Control Plan Is Required.
Woruard to Engineering Dcpartuent for Rex te\\.i
FORA 1 SMCP-TOS NIAY 2014
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