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Home My WebLink About42470-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 Survey Southoldtownny.gov Check _ ....... , , Septic Form N.Y.S.D.E.C. Trustees MARPPC.O.Application ..., 2018Flood Permit Examined 20I Single&Separatew ✓yy Truss Identification Form Storm-Water Assessment Form fifi A Contact: Approved ) V 2Na(1(_,toga-te: L Nw F e W c,o_— M�jol.l AtX� q� .7 Disapproved a/c Phone: 20 Expiration ,219. APPLICATION FOR BUILDING PERMIT Date March 1st 20 18 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 let 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 shal_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) 1241 Brick Kiln Road,Sad Harbor N_Y 11963 (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 Adriaan Gnln (Tam __ ... (As on the tax roll or latest deed) If applicant is a corporation,signature of duly authorized officer Adriaan Gr ln,Owner (Name and title of corporate(N rp officer) Builders License No. K712ITH............ Plumbers License No. Electricians License N�_. ._._. .. Other Trade's License No 1. Location of land on which proposed work will be done: 21955 Main Road,Orient NY 11957 House Number Street Hamlet Map 17-4-23 Block Lot Coup Tax Ma No. 1000 Section,.. Subdivision Filed Map No.,1700004-0-002300OLot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Single family residential b. Intended use and occupancy Same... ................ 3. Nature of work(check which applicable):New Building Addition--X Alteration RepairammDemolition Other Work (Description) 4. Estimated Cost $150,000 Fee (To be paid on filing this application) 5. If dwelling,number of dwelling units_j_Number of dwelling units on 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 101' Rear 101' —Depth28'-7" Height 25-8" Number of Stories 2 Dimensions of same structure with alterations or additions: Front 101' Rear 101, Depth 28'-7" Height 25Number of Stories 2 8. Dimensions of entire new construction:Front 22'-02" Rear 22'-02" Depth 24'-8" Height 26--5,- Number of Stories— 2 9. Size of lot: Frojil, 228' ...—Rear 371 .—Depth 450 10.Date of Purchase 01/1212016 Name of Former Owner Lucinda Barnes 11.Zone or use district in which premises are situated R-80 12.Does proposed construction violate any zoning law,ordinance or regulation?YES NO x 13.Will lot be re-graded?YES_NO x Will excess fill be removed from premises?YES NO—x 21955 Main Road,Odent NY 11957 14.Names of Owner of premises Addaan G Addrc�s Phone No, Li rJLrj _IOA614Q4:469B � Name of Architect Lawrence McDonald Address 1241 Brick Kiln Rd.Sags rfrNo (917)224-2204 Name of Contractorj-kory Dominguez Address Phone No. (631)871-1192 346 Flander Rd.Riverhead NY 11901 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 x 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 x NO— *IF YES,PROVIDE A COPY. STATE OF NEW YORK) C, Ss' COUNTY(`.)F:�AaK) Lawrence McDonald ......................................... 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 OK Cj 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 C ore,Bic 041s TRACEY L. IDWYER 204TARY PUBLIC,S;fATE OF NEW YORK NO.01 DW6306900 L ALIFIED N-Sl (j No, Public COMMISSION EXPIRES JUNE of,A ppflw�ant 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. New Construction: r Old or Pre-existing Building: _m rrr (check ones) l Location of Property; 2..� ��...,"7 ..M ................ -� ,t, S House No. Street 1 Hamlet Owner or Owners.of Property � m ., .,_� � „�.� ___140VM�4r i� ,m.. Ultolk.COunty "`aX Map No 1000, Section ��—� ^��a�...Block Lot Subdivision ... .....................................Filed Map. Lot:. Permit No. Q Date of Permit.-tummy ___ Applicant: Health Dept. Approval: _...............Underwriters Approval: .. ------- Planning Board Approval: Request for: Temporary ryCertificate Final Certificate: � (check one) Fee Submitted: $ L r` A,plicant Signature Scott A. Russell ' STO�]R.M[WA' IER, Ig SUPERVISOR 4AMIA NA\GIENIHENT SOUTHOLD TOWN HALL-P.O.Box 1179 � z� 53095 Main Road-SOUTHOLD,NEW YORK 11971 " n Town ofsouthold , CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) O1 1`111S 13TROJ.EX717 INVOLVE V 1UNY O1•n FI-TE F01.A:U)W1. G- N,¢, ( PdifGK All.. THAI APPLY)�{P..,'s ®0 A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. ❑E] B. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. E]E] C. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. 0 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. J.C.T.M, laa ic Dai r a�NAfS.� , ,; !IP'ucp ira d� uaeA. k i,>i N" V'a r"a➢...�.a iruP.¢:'c>uuux;a 9rzu.�¢Ixeul Di_Irict r A�au U awre°tco I cDo!naW 17-4-23 03-16-2018 .......... . mm , ,., ;. �.)4t7l.Lf�.`v�x 't1..� ki•.. �;IA ""' 1..'.: �..: (,f C011Vao h1f(DIIIfIIa Nolf1: 9 17-224 1p2.0d Reviewed By: Da t e: Property address / Location of Construction Work: "epnpa med Bou psmc.e7;aaar;B£ti ildinn�Repair, 1955 Ma NIn.rorl. u'lir;u�II�,11�1� 1 9��t " � .... S �'aten I�'ba�lrnag�;�aneunt La�utp'na�p I'prsun Not Reqa.apa-ed, Stoi rim atea Manappemea7ui7a psana tu))Pllaiii p.s i-e fl[r�u�rrauni tcy l�au�xuaa�a au��n . Ificn naW��.1 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P_ O. Box 1179 �_ _..r .-... "t 4.- BUILDING-DEPARTMENT TENT NOTICE OF UTILIZATION OF TRUSS TYPE, CONSTRUCTION PRE-ENGINEERED WOOD CONSTRUCTION AND/OR TIMBER CONSTRUCTION DatQ: o5" Owner: Location � n of Properly: w � � Please take notice that the(check applicable:line): 1 New commercial orresidential structure Addition to existing commerdial or residential structure Rehabilitabon-td.,an existing commercial or residential structure to be consiuctod or performed at the subject property reference above will utilize (check applicable;line): Truss type construction (TT) Pre-engineered.wood construction (PW) Timber construction (TC) in the fOIIowin loc 0 Floor framing, including girders and beams (F) Roof framing (R) Flo r and roof framing (FR) Signature: ......... _..... . Name (person submitting this form): W Capacity(check applicable line): ..... _ Owner - Owner representative X TrussReg15.docx Effective 1/1/2015 SURVEY OF DESCRIBED PROPERTY � rs�fir°rms mnunrsw SITUATED AT ORIENT, TOWN OF SOUTHOT D aSUFFOLK COUNT) NEW YORK S.C.1.M. NO. JOCO-17-4-23 p AREA = 118,,268 SQ. FT/2.7 ACRES BY A PAR �rrPONAs C'$G ."n0R�7fOM 0'i 7'%,°M MADSMADSk�Pgqpppp MRYC y,G50 AtB'B$Aas OF Ma'43 AT 1',AG$Y02^aZE0. I' . ram y � ra 4m F Iy Y k M 'Md PAT T. SECCAM0 swccc.�xaa"ro- aaw� � `�'�'4-'J+d°Ou^p &AAN4CY mak6ly w:4 �4•�([kQ£ffi pwaC r c+.e�aarnn wW w.ar.ts, l�fW'CS d Y , �� haw.an sar' s7da;w9 dawu� ,vc.,,w,.wy,o-a x.Y 1 pp er. ys< Rng� r ffss"a�$ ry"i5 :rvSA" x�nyvr7, Y T,Td&1a••? H.Y.S UC.Nb. 0492&T A7&£l40.T61T98 SQVLd^!'=40' 447"8':11/09/501$ xcw>raiywr.wry ears r SGCV.+L^a✓~.:.5,.a.c,