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HomeMy WebLinkAbout42663-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 PERMIT NO. �� � "�" Check Septic Form N.Y.&D.E.C. Trustees C.O.Application Examined­H4 1. Flood Permit ,217 Single&Separate Truss Identification Form Stone-Water Assessment Form hh Contact: Approved 5 U 201 Mail to; Disapproved a/c I Phone: 01— 97,J�-7 4y- Expiration k. 20 B Inspector APPLICATION FOR BUILDING PERMIT 1, J J t ^,� Date TOWN OP^SOMOLD 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 rewired. 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&name,if a corporation) (Mailing address of applicant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder Name of owner of premises (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. `{ 90'7 Plumbers License No. Electricians License No. Other Trade's License No. 1, Locati rn o©land on which proposed work will be done: House Number Street Hamlet County Tax Map No. 1000 Section 1-7 Block Lot ... ....Y..v. Lw 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work(check which applicable):New Building Addition Alteration (-^' Repair Removal Demolition Other Work (Description) 4. Estimated Cost )eq06yFee (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 6. If business,commercial or mixed occupancy,specify nature and extent of each type of use. 7. Dimensions of existing structures,if any:Front Rear Depth Height ..Dumber of Stories 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 Dear Depth 10.Date of Purchase Name of Former Owner ""' ti�M '" 11.Zone or use district in which premises are situated 12.Does proposed construction violate any zoning law,ordinance or regulation?YES NO 13.Will lot be re-graded?YES NO Will excess fill be,removed from premises?YES NO Name Architect / s�A�ddress l 01-P �Phone No. 14.Names o of Owner of premises, �C°" , Address Phone No Name of Contractor Address Phone No. �. 15 a.Is this property within 100 feet of a tidal wetland or a freshwaterwetland?*YES NO *IF YES,SOUTHOLD TOWN TRUSTEES'&D.E;G*PERMITSMAY BEE RE RED. 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 *IF YES,PROVIDE A COPY. STATE OF NEW YORK,} SS: COUNTY OF } being duly swom,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, E D.BUNCH No Public,State of New York ' , (S)He is the Contractor Agent,Corporate Officer,etcExpires No.01BU 8185050 ` { g , rp ) '.ornnti9aldn E res Apr?14,?, °�,2� 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 wi H be performed in the manner set forth in the application filed therewith. Sworn o before me th° day of 20 Notary Public 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). 1 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 bld Iding, :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. ct signed by applicant. if a Certificate of Occupancy is 2. A properly COMpleted application and consent to inspe 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. Cc,-tificate 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: Old or Pre-existing Building: (check one) 6 Location of Property: House No. Street Hamlet 4- ."s Az Owner or Owners of Property: ', j Suffolk County Tax Map No 1000, Section j Block...... Lot Subdivision -Filed Map. Lot: Date of Permit. Applicant-._. Permit No. i Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate. ---Final Certificate: (check one) Fee Submitted: $ --Ap_ Anplicant Signat Scott A. Russell S ST 1KIM[WATE K SUPERVISOR �' 1\M[A NA\G I E M I E N F SMain R TOWN HALL-P. Box 1179 * Town of So u th o l d 530955 Main Road-SOUTHOLD,NEW YORK 11971 �^ CHAPTER 236 - STOR WATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) L)OES T11HS lE'ROMECT INVOLVE ANY OF Trl-ClE FOL11,0 "ING. (CHECK ALL THAT APPLY) Y'cs,l No o A. Clearing, grubbing, grading or stripping of land which affects more ,',',,-,than 5,000 square feet of ground surface. ❑E" P. 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 1.00 feet of horizontal distance. ❑ D. Site preparation within 100 feet of wetlands, beach, bluff or coastal ,.,,erosion hazard area. . Site preparation within the one floodplain as depicted ole FIRM Map of any watercourse. 1-° . 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, P ! Chapter .....236 do apply ..�..project. Signature, Contact Information, Date & Cabove,a lease submbtrTwo copiesof a Stormwater Managemeno your and a completed Check List Form to the 11 If you answered YES to one or more of thep Control Plan tcil(iitig Department with your Building Permit Application. s.e APPLICANT: (Property Owner,Design Professional,Agent,Contractor,Other) S.C.T.M. #: l aIf Date fto�q��i ff Section Block .. 1 , N6M: I: r' ......., of rr M,R:ayqp p p ORl;��l.��q '^"l C�b�� Contact Information: r Reviewed y: Date Prog .Aitre�ss ML�ocation.of Con�structi�on work-' — Approved for processing" _ LLBuilding fltng Permtt". Stormwater Management oting Plan No t Required.ir e.d. ElStormwater Management Control Plan is Required (Forward to Engineering Department for Review.) 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