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HomeMy WebLinkAbout42455-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 FAX:(631)765-9502 �—� Planning Board approval /� � '� SoutholdTown.NorthFork.net PERMIT NO. `1 Check m Septic Form„ N.Y.S.D.E.C. Trustees n.., C.O.Application Flood permit Examined .20 --- _-�— Single&Separate_ Stone-Water Assessment Form �'// Contact: Approvet)_ v�>20 Mail to: Robert Wilson Disapproved aft m PO Box 49 Southold NY 11971 Phone: (631)504-8842 Expiration_. 20 ctor Goatin.p MAR — 8 2018 APPLICATION FOR BUILD RMIT r Date March 5th "-- 20 18 TOWN OF SOUTHOLD 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,anew permit shall be rewired. ^r APPLICA"T"ION IS HEREBY MADE to the Building Department for the issuance of a Building Permit p 'v' Buildurg Zone Ordinance of the Town of Southolcl,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. (Sia !�pplicutor name,if a ihn) qk,. PO Box 49 Southold NY 119ir (Mailing address of applicant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber oruilde'r 40ent n ' Name of owner of premises__George Ntavoultzis (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 work will be done: 870 _ Bay Shore Rd. _ Gregnpoll..... House Number Street Hamlet County Tax Map No. 1000 Section 53 Block 4 Lot ..36 Subdivision Filed Map No, Lot www 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Single family residential Replace front entry door.Renovate existi66-6athr000n.Abai-bathroom at cellar. Reduce 11 height of partition walls at cellar staircase to half walls and add new posts&header above.Replace existing wall insulation and b. Intended use and occupancy gypsum board.Refinish floors.Renovate kitchen including new cabinets.Add partt6ons and ypsum board at _. oeVlar. 3. Nature of work(check which applicable):New:Building_ Addition V Alteration Repair mm .. Removal Demolition Other Work � 4. Estimated Cost Fee (Description) (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 nature and extent of each type of use. 7. Dimensions of existing structures,if any:Front 40'-5" Rear 37-2-1a, Depth 23'-2-1/2" Height 13'-11-3/4" Number of Stories 1 Dimensions of same structure with alterations or additions: Front 40'-5" Rear 32'-2-1/2" Depth 23'-2-1/2" Height 13'-11-3/4" Number of Stories 1 8. Dimensions of entire new construction:Front 40'-5" Rear 32'-2-1/2" Depth 23'-2-1/2" Height 13'-11-3/4" Number of Stories 1 9. Size of lot:Front 100.00' Rear 100-00' Depth 125.00' 10.Date of Purchase Name of Former Owner 11.Zone or use district in which premises are situated R-40 Medium Density residential 12.Does proposed construction violate any zoning law,ordinance or regulation?YES NO V 13.Will lot be re-graded?YES NO V Will excess fill be removed from premises?YES NO V 870 Bay Shore Rd. 14.Names of Owner of premises George Ntavoultzis Address Greenport NY 11944 Phone No. (631)504-8842 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 V *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 V *IF YES,PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF I Robert Wilson being duly sworn,deposes anQ i ll the applicant e..... _...._.. e (N of individual signing contract)above named, Nary No.P'uic,U61 of Nerve York No.01 BU61$5050 4uallfied in Suffolk Count (S)He is the ... Agent Commission Expires April 14, (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 bis knowledge and belief;and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before rte this day of-nm-6) 20 Notary Public at e of Applicant Form No.6 ,rOWN OF SOS T1.1 RUILD111ING ID: EPAR77MENT TOWN .HA.I.,L 765�1802 APP11CTIO N FOR CERTIFICATE OF OCCUPANCY This application.must be filled in by typewriter or ink and submitted to tie.Building Department with the followin& A. For new building or new use: 1. Final survey of property. with accurate location.of all bitildings,property lines, streets,mid miusual naturdl or topographic features. 1 Final Approval from Heath p: of water supply and sewerage-disposal(S-9.farm. ). 3. Approval of electrical installation.from, Board of Fire Underwriters, 4. Sworn staternent from, PILITUber certifying tliat the solder used iinm. system contains less than 2/1.0 of 1%lead. 5. Cotrimercial building,industrial building,multiple residences and similar buildings and instaflations, a.certificate of Code Compliance from architect or engineer responsible for the.building. 6. Subinot Planning Board Approval of completed site plan requirements. B. For existing buildings(prior to April 9,1957).non con forming uses,or buildings and "pre-existing"land uses: 1. Accurate survey ofproperty 9howing all property linin s, streets,building umd unusual natural or topographic features. 2. A properly completed grppfication and crams it to inspect signed by the applicant. If a Certificate,of Occupan.cy is denied, the Building Inspector shall state the reasons therefor in writing to theapplicant. C. Fees 1. Certificate of Occupancy New dwelling$25,,00, Additions to dwtffling$25.00, Alterations to dwelling$25.00, SWIMMirig P001 $25,00, Accessory building$25.00, Additions to accessory budding$25.00, Busiren esses$50.00. 2. Certificate of Occupancy on Pre-existing Building .- $100.00 3. Copy of Certificate of Occupancy- S.25 4. Updated Certificate of 0couparicy- $50.00 5. Temporary Cettificate of Occupancy-Residential $1.5.00, Commercial $1.5.00 Date. �Mairrh tea 2018 ............................. - ------------------ New Constructimu Old or Pre-existing Building, (check. one) 1,ocation of.Property ...870 Bay ShorgPd_,__ r e e,n R Q ft...................... .. ........ . .............. Hou-se No. StTeet ID anflet mo r.Or Owners of 14-operty, Qeorg.e Ntavouftzis ....................... .................. Suffolk County'Fax Map No 1000, Section Block 4 ........................ Lot ............................... Subdivision Filed Map. .............. Lotti ................... ............... Permit No. Datc of Pernift....'.................1--.........................Applicant:............. ........... Health.Dept. ApprovaL ............,-- Underwriters Appiii­ovaE Planning Board Approval: ............ Request f.br: Temporary Certificate.. Final.Certificate- ............... (check one) ................. Fee Submitted- $ ----------------- 11 �5 Signature Fol 1110 �own f-aH Ar,ncx rea 1m,� � � a '"'pro 7eleph rone(631 W2 54375 Main Road � � V, Fax(6311 x'34-.9502 P 0 Box 11 79 a SoutYud d„ NY 11971-0959 BUILDING DEPARTMENT NOTICEw. WOOD CONSTRUCTION CO mm_t1 r1u0ST1�lED . REENG[NEE OF UTILIZATION OF TRUSATND/OR TIMBER CONRUCTION Date: March 5th 2018 Owner: George Ntavoultzis 0 Bay Shore Rd Greef� ort Ny..... Location of rape 8 __ .-1 _ Please take notice that the (check applicable line): New-residential structure Addition to existing residential stq i ' �1 g ure Rehabilitation to an existing residential structure to be constructed-or performed at the s bjpct property ibferi ince above will utilize (check applicable line): Truss type construction (TT) eIT Pre-engineered wood construction fPW) ...___ Timber construction (TC-) in the following iocation(s)(check applicable line): Floor framing, including girders and beams (F) Roof fuming (R) ,m-....... ._.... .._ Ftoor and roof flaming (FR) Signature-- Name.(person submitting this form): Robert Wilson Capacity(check applicable line): tl Owner Owner representative 1. TrussResRegi5.docx Effective 1!1!2015 µlb c t Russell l STO�RI��1 WA\T]E]R ell SUPERVISOR l��l[A\�A\GIEMIENIF SOUTHOLD TOWN HALL-P.O.Box 1179 �� '` wIN 53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of Southold' � u t CHAPrER 236 - s'rORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) D(JES THIS IS l'�l l .i l(lU: ;1 W INVOLVE A:II^4 ' 01^ THE f^(:'iyl<l X)'W'1l sll:: (CHECK ALL THAT APPLY) A. Clearing, grubbing, gNdding 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 & 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. APPLICANT. (Propertc Owner.Design Professional,Agent.Contractor,Other) S.C.T.M. 1000 Date D'utrict NAME- Robert _ Robert Wil4 36 3/5/2018 Wilson -.. Blak Lot wd' w,'; �-����. 1.k�..�M..4.,��1 iii l.�ll..:� .ik ����m,, . Contact Informatim mm„(631)504-6642 Reviewed By: I �I Property �A(IuV[a�,��� / �.�(,�u �r4lt�rt of Construction Work: APproved Date: for processing Building Permit. 870 B Shore Rd. ....... Storm�rater Management Control Plan Not Required. Greenporl NY 11944 Stormwater Management Control ntrol Plan is Required. (Forward to Engineering gpartment for Review) FORM SMCP-TOS MAY 2014 m ;Its ti o LL z 'nW cr) PN oo ., zl © LQ �© U 4 � � � ka W yp U e Il A w t� 11 rb' Vy,� NO 0 1 .t al MINA 0 }4 3 „00 ,90 s 2 t y �yyp d� Q n i r lu a6 Y N Q W � p % 11+ d ,p'Er a � .a•ri y3 ri Q �Fe A'jaw ,' M IeY 01, .40 N Z C Z � Mn' /w• a jjl a 1 0 ..1 f