HomeMy WebLinkAbout42473-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)765-9502Survey .................
SoutholdTown.NorthFork.net PERMIT NO. L4 ---
, Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.AppFjc;ii"o
Flood Permit
Examined Single&Separate
MMI - 9 2018 Storm-Water Assessment Form
Contact:
Approved r .........20
–74- V249.4-(4
Disapproved a/c TOWNOF OLD 71
"I
Phone: 09/-76 CS VIS
Expiration. 7—
B4' "Oector
APPLICATION FOR BUILDING PERMIT
Date November 22 2017
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.
McCarthy Management, Inc.
(Signature of applicant or name,if a corporation)
46520 County Road 48,Southold,NY 11971
(Mailing address of applicant)
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
AGENT
Name of owner of premises William&Maria Golde
(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:
1320 Harbor Lane,CutchoAueNY 11935
House Number Street Hamlet
County Tax Map No. 1000 Section 103 —Block 1 —Lot 20.10
Subdivision Filed Map No. Lot® �_
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy Single fam6ly cfwelli'ng
b. Intended use and occupancy Single family dwelling
3. Nature of work(check which applicable):New Building Addition Alteration
Repair Removal De 1 7$;26iO
r k Ingfou'nd swimming pool
(Description)
4. Estimated Cost Fee 50 Certificate of Oc_ cup n
T paid on filingthis application)
5. If dwelling,number of dwelling unitsNumber�fd1 e&g in.uts on each floor
Ifarae e� numbertof cars .......... ......
g g
. 1 f litiatass,p riraroialaor mint occupancy,sp 'l;,gleach type of use.
. , �, ..�
7. Dimensions o existuag`:structures,if any:Front 43'+ Rear 43'+ _Depth 34'+
Height Number of Stories 2
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 404.35' pear 394.85' Depth 121'+
10.Date of Purchase 5/4/2000 —Name of Former Owner Robert J.Droge
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 x NO_
14.Names of Owner ofprentises a 1320 Harbor Lane
Ool Address t0hogue, NY 110G)ne No.
Name of Architect Address Phone No
Name of Contractor __Address Phone No.
1.5 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES NO x
1F YES„SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAYBE 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 NO x
*IF YES,PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF_Suffolk )
Joshua Whalley being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the Agent
(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 he
performed in the manner set forth in the application filed therewith.
Sworn o e me this f
of 20
ot
Not
1 eofN�w
C Signature of Applicant
No.$004390 SdfolkCounT
Commisew expiros Nov.1%11 J
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$15.00
Dte. J 15 - I - 4-
New Construction:
Old or Pre-existing Building:mm ___..�.. (check one)
Location of Property
1�.A 4
� �
House No. � Hamlet
Street
Owner or Owners of Property:_.... ..:& 16
�"L .... _. _ w.... .
Suffolk County Tax Map No 1000, Section— Block
Subdivision .... �m Filed Map. Lot:
Permit No. Date of Permit. Applicant:.......,_�„. _ ...m ........................... .............. ...
Health Dept.Approval: Underwriters Approval.
Planning Board Approval.
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted:$
Applicant ....._.... ............. .......�.........,.
Signature
Scott A. Russell � � STO]E LIM[WA'7C']E][�
SUPERVISOR ,. 1\\1[A\,NA.G lEMLENT
SOUTHOLD TOWN HALL-P.O.Box 1179 A
53095 Main Road-SOUTHOLD,NEW YORK 11971 ,, '° Town of Southold
CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET
( TO BE COMPLETED BY THE APPLICANT )
. ..
.. . ®ems ® �.. .._ __ .. _.-,-- -------........................... ............ ............
DOES THIS PROJECT INVOLVE ANY OF THE FOLLOVaNG:
(CHECK ALL THAT APPLY)
'itws Naar
i
OE] A. Clearing, grubbing, grading or stripping of land which affects more
than 5,000 square feet of ground surface. 1
0 El 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.
OEI D. Site preparation within 100 feet of wetlands, beach, bluff or coastal l
erosion hazard area.
E. Site preparation within the one-hundred-year floodplain as depicted
on FIRM Map of any watercourse.
l ® 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 oIm
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 campleted Check List Form to the Building Department withh-your Building Permit Application.
Date
APPLICANT: (Property Owner,Design Professional,Agent Contractor,Other)
NqME: cCwrthy Management, Inca
- 0.10 11/22/2017
Dutnc[
103 1 2
Section Block Lot
.ill 11111�R �N4 111;� Iflll ➢)C � Q.AarC. ONLY
;;•;; .._
m�rxir '
Contact
631-765-5815
6�rtmp'u�utiabn 1 P �
r. rcs i I Reviewed By:
l
_ _ y _ .�.
al;c
Address /Location of cin-struclion Work:
Property " -
Stormwater Management Control Plan Not
1320 Harbor Lane
Approved for processingBuildingPermit.
_� ` Required. :.
CutchCpRu .' NY 11935 (Ftorwardto Engineering tManagement Control Plan is Required.
Department for Review.)
FORM .,
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SMP TOSMA -
2014
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Pool Size: 18' X 36'
Cardi-nal PoolShape: RECTANGLE
Pool umber: PRT10295
250 Route 61 South,Schuylldll Haven,PA 17972 a 370-365.4733 a fax:576385.1318 9 CustamerService@CardlnalSystemsinc.com
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