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Home My WebLink About42668-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 Southoldtownny.gov PERMIT NO. I 77� Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined 201 Single&Separate Truss Identification Form Storm-Water Assessment Form ...................... ° Contact: Approved 1` 201 Mail to: Disapproved a/c-- 111 Phone: Expiration 20SL Buz in pector APPLICATION FOR BUILDING PERMIT Date 20 INSTRUCTIONS TOWN i 'lll ST 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. (Signature of applicant or name,if a corporation) .,_ (Mailing address of applicant) State whether applicant is owner,lessee,aged,architect, gineer,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. Plumbers License No, Electricians License No. Other Trade's License No. 1. Location of House Numberd on which, H//posed work well be done: Hamlet -- Street County Tax Map No. 1000 Section 2- 5 Block 0 Lot 2 , f Subdivision Filed Map No, Lot 2. State existing use and occupancy of prenuses and intended e and occupancy of proposed construction: a. Existing use and occupancy p ®. .. b. Intended use and occupancy , 3. Nature of work(check which applicable):New Building Addition Alteration__ Repair Removal Demolition Other Work 4. Estimated Cost Fee (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 business,coiaunercial or mixed occupancy, ecif}r nature and extent of each type of use. 7. Dimensions ofexisting structures t ny Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth HeightNumber of Stone ✓.- - '9 8. Dimensions Number of Stories ions of entire new construction.:Front Rear epth! 9. Size oflot:*Front ° RearI Deptli 10.Date of Purchase Name of Former Owner Z ��;7 .,.. 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_NOWT I1 excess fill be removed from premises?YES NOS 14.Names of Owner of pr miles l Fess Plxone No.Q'1 Name of Architect T MJ K--„ 0-4, l r ? � Address Phone Na Name of Contractor,' Address Phone No, 15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES NO *IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE R.EQUIRE7D. 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. CONNIE M BUNCH Notary Publlc,state of Now York STATE OF NEW YORK) No,OIBU t18605l Quallfiad In Suffolk County SS' Cornmlaalon Expires April 14,2—Q�o COUNTY OF aj 1 being duly sworn,deposes and says that(s)he is the applicant (Name of individual signin contra t)a'ove named, (S)He is the (Con actcr,Agent, orporatf 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 Jday 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: accurate location of all buildings,property lines,streets,and unusual natural or 1. Final survey of property with topograpbic 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)Ron-conforming uses,or buildings and'"pre-e-xisting7' land uses: 1. Accurate survey of property showing all property lines,streets,building and unusual natural or topographic features. Occupancy 2- A properly completed application and consent to inspect signed by the applicant.If a Certificate of cup 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 budding$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$15.00 Date. ep 6' New Construction: OW or Pre-existing Building: (check one) J '7 ' ' _Z-5 -6' -&I, — I Location of Property:_L4, -!2" e. t House No. Sb C Owner or Owners of Property: Block �z Suffolk County Tax Map No 1000,Section Lot SubdivisionFiled Map. Lot: Permit No. Date of Permit.– Applicant:— Health Dept.Approval: Underwriters Approval: Planning Board Approval: (check one) Request for: Temporary Certificate , Final Certificate. Fee Submitted:S App ic c! X 11VT5 ORIEW 5WrHOLD w FOLK COUNTY, MY' r vo 06IK n �p�G�nem 0r 6 orfA r .�"` . a �8p 0-4 W � � rn ' 41 o5i. U s s G r SiF c � w ,ass w �. 0 RPF AREA - QA Ar, E$ JOHN C. E. LRS LAND SURVEYOR 6 PAST MAD;STREET MY S.LIC.NO 502M ArVERMEAD,N.Y.11901 360-=s Pu 36942$1 REF—MOEMPROSQ( ty i _--- _.. _ _ _ ► - ------- ................._.__ _. -w....... I 7'-0» , - - - _. ...._ II 101-011 Mark K.SeMw M ALA MANNDC PROPERTY AS BUILT SHED Ar chitect,pay M 14250RCELIRD STEET r.o.eos �'ORIENT,NY 0®1k - ELEVATIONS PueRtwv�.x-ozes era(su7>-zua F 10'-4" v m X V O D z r Q rn 2X8 RIDGE N \ /w" -pt II '" -------------------------- Ln r Z 21rn (J p 2 �- r z a o N I 6 N io x Mmk K.Schwartz,AIA MANNIX PROPERTY AS BUILT SHED Ar hitect,PLLC m 1425 ORCHARD STEET P.O.-9. 3 ORIENT,NY FOUNDATION PIAN FLOOR PLAN w