HomeMy WebLinkAbout42656-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 t1 Survey_
Southoldtownny.gov PERMIT NO. Check-----------
Septic Form
N.Y.
Trustees
C.O.Application..........
Flood Permit
Examined 20L� Single&Sep—arate ....................
Truss Identification Form
Storm-Water Assessment Form
Contact:
Approved 20ff Mail to:
Disapproved a/c..........................................................
Phone:
Expiration
—20
B
ng I ctor
DAPPLICATION FOR BUILDING PERMIT
F!E 8 2 2 P018
Date February 9 2018
' INSTRUCTIONS
TOWN Oi�WrROLD
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.
FI Ordnance Building LLC
(Signature of applicant or name,if a corporation)
915 Broadway, 19th Floor,New York,NY 10010
(Mailing address of applicant)
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
Owner
Name of owner of premises Fl Ordnance Building LLC .........................................
(As on the tax roll or latest deed)
If applicant is a corporation,signature of duly authorized officer
Mary Burnham,Member
(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:
Ordnance Building Fox Lane Fishers Island
House Number Street Hamlet
County Tax Map No. 1000 Section— 12 Block 1—Lot 2
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 StoragefFabrication Shop
b. Intended use and occupancy Storage/Fabftation Shap
3. Nature of work(check which applicable):New Building—Addition—Alteration
Repair X Removal DemolitionOtherWork
4. Estimated Cost $1,200,000Fee (Description)
(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
5,700 SF Fabrication
6. If business,commercial or mixed occupancy,specify nature and extent of each type of use. 10,700SFStorage
7. Dimensions of existing structures,if any:Front 182 feet Rear 182 feet Depth 83 feet
Height 27 feet —Number of Stories 2
Dimensions of same structure with alterations or additions: Front 182 feet Rear 182 feet
Depth 83 feet Height 27 feet Number of Stories; 2
8. Dimensions of entire new construction: Front Rear— Depth
Height Number of Stories
9. Size of lot:Front 532 feet Rear 584 feet Depth 301 feet
10.Date of Purchase January 5,2017 Name of Former Owner Carolyn Juleen 6oherty"
11.Zone or use district in which premises are situated B
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
915 Broadway,19th Fl,
14.Names of Owner of premises FI Ordnance Building LLCAddreSs NYC 10010 Phone No. (212)994-7880
Name of Architect MBB Architects AddresS48W37,14thFG,NYC 10018PhoneNo (212)768-7676x13
Name of Contractor BID Remodeling&Restoration Address 1420 The Gloarning Phone No. (631)788-7919
Fishers Island,NY 06390
15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES x 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 x 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 X
IF YES,PROVIDE A COPY.
STATE OF NEW YORK) I -NOtc--v Public•state of rjew y0rV
�
NO.jlMA1147503
SS: Qualified in New York C
COUNTY 01wExpires
LMY cornmission Mary Bumharn being duly sworn,deposes and says thatiolle is the applicant
(Name of individual signing contract)above named,
(S)He is the Corporation Member
(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 me this
day of;f=—;-Lvo—M _201S
Notary Pub Signature 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 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. February 9,2018
New Construction:_ _ Old or Pre-existing Building: X (check one)
Location of Property: Ordnance Building Fox Lane Fishers Island
House No, Street Hamlet
Owner or Owners of Property: FI Ordnance LLC
Suffolk County Tax Map No 1000, Section 12 Block 1 Lot 2
Subdivision Filed Map. Lot:
Permit _4 No. IT Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Teni porar Certificate Final Certificate:
q 1 y (check one)
Fee Submitted: $
Applicant Sigialure
Scott A. Russell ST(0)llKI��l[WA\T]E]E,
SUPERVISOR ( r �T�
I'M[�I�A\G]EI��[]E1� ['
SOUTHOLD TOWN HALL-F.O.Box 1179 "
53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of So u th o l d
CHAlyrER 236 - STORMWXfER MANAGEMENT WORK SHEET
( TO BE COMPLETED BY THE APPLICANT)
DOTS THIS PROJECT INVOLVE ANY OF THE FO'L '!KING:
iCHM ALL THAT AMn
ilO
A. Clearing, grubbing, grading or stripping radin of land which affects more
AP g
than 5,000 square feet of ground surface.
B. Excavation or f illing 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.
I D. Site preparation within 100 feet of wetlands, beach, bluff or coastal
erosion hazard area.
E. Site preparation within the one-hundred-year f loodplain 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 lChapter 236 does not apply to your protect.
If you answered YES to one or more of the above, please submit Two copies of a Stormwatar Management Control Plan
and a completed Check List Form to the Building Department!I your Building Permit Afaplieation.
M. !000 We
(Property Owner,Design Prorenional,Agent,Contractor,Other) S.C.T. 1000
w -
Mary Burnham 12 1 2 02/26/2018
NAME` Section Block Lot
FOR BUILDING DEPARTMENT USE ONLY
Coruna Information 212-768-7676 x13 ,G
Reviewed 13y:
)V
Date
Property Address Location f Construct Ion Work:: r-os5oroya foprceslnBuildln Permit.
Fishers s rmwater Management Control Plan No
t-Req�uired-'
- — — — — —
Fox Lane,Fishers Island Stormwater Management Control Plan is Required.
E] (Forward to Engineering Department for Review.)
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Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O. Box 1179
Southold, NY 11971-0959
BUILDING DEPARTMENT
NOTICE OF UTILIZATION OF TRUSS TYPE'CONSTRUCTION PRE-ENGINEERED,
"FOOD CONSTRUCTION ANDIOR TIMBER, CONSTRUCTION,
Date: February 9,2018
Owner: FI Ordnance LLC
Location of Property: Ordnance BtAding, Fox Lane, Fishers Island NY 06390
Please take notice that the (check applicable line).
New commercial or residential structure
Addition to existing commercial or residential structure
x Rehabilitation to an existing commercial or residential structure
to be constructed 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 following location(s) (check applicable line):
Floor framing, including girders and beams (F)
Roof framing (R)
Floor and roof framing (FR)
Signature:
Name (person submitting this form): Mary Burnham
Capacity(check applicable line):
X Owner
Owner representative
TrussReg15.docx Effective 1/1/2015