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Home My WebLink About42692-Z TOWN OF SOUTHOLD 6D BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT 5 Do you have or need the following,before applying? TOWN HALL _BQard of Health SOUTHOLD,NY 11971 �jCj fj m�L�h tflltrilding;plans TEL: (631)765-1802 FAX: (631)765-9502 4 S;Pe1 Planning Board approval _. ] s .5ti+rvey Southoldtownny.gov PERMIT NO. (p Check Septic Firm N.Y.&D.E.C. tees ------- C�. .Application Flood Permit Examined 20 Single&Separate Truss Identification Form Storm-Water Assessment Form Contact: Approved20 N Qr�, —3t4eil to: Disapproved a/c .. Phone: 1 1 1 Expiration 20 B I Inspector WAY ICATION FOR BUILDING PERMIT Il �" 1 1 ',G�i r�� Date ,20 lb fl 1 INSTRUCTIONS a.This R pletely 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 shat)be kept on the premises available for inspection througbgiufthe 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,anew permit shall be required... APPLICATION"IS HEREBY MADE to thePBuilding Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Soutbold,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,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. Plumbers License No, Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: �, . House Number t Hamlet County Tax Map No. 1000 Section (e`T Block 5 Lot 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 Fee (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 .Number 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 Rear Depth 10.Date of Purchase Name of Former Owner 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 14.Names of Owner of premises Address Phone No. Name of Architect Address-. Phone No 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.0 PERMITS MAY BE REQU.=. 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 sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, CONNIE D.BUNCH Notary Public,State of Now York (S)He is the (Contractor,Agent,Corporate Officer,etc.) OualifiC In Suffolk County Corrirnossion Explres April 14,2—b,;L 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 jo before me this _ _day of, �0� 20 h ILf`t$ ti Notary Public Signature of Applicant BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 roger.richerta town,southold.n ,us APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: Date: Company Name: Name: ., " V,,I License Nou: e ail: Address: t, r + /U Phone No.: —/3- -3 Cea JOB SITE INFORMATION: (Ali Information Required) Name: M �11 Ll � r Address: Cross Street: Phone No.: + t P" .� 3 BIdg.Permit#. email: 01,0 11 . Tax Map District: 1000 Section: 06 " Block: Lpo�� Lot: 0 BRIEF DESCRIPTION OF WORK (Please Print Clearly) y f0 � Aer Circle All That Apply: Is job ready for inspection?: YES Ig Rough In Final Do you need a Temp Certificate?: YES / Issued On Temp Information: (All information required) Service Size 1 Ph 3 Ph Size: A # Meters ........._. Old Meter# New Service - Fire Reconnect- Flood Reconnect- Service Reconnected - Underground - Overhead 0 UndergroundLaterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT_I E WITH APPLICATION ....., f6-7 92-Request for Inspection FormAs 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 I lealth 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 certif��g 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: Old or Pre-existing Building: V/.. ........ (check one) Location of Property: House No. Sta. ,et Hamlet t 56 ---Owner or Owners of Property—: --,� Suffolk County Tax Map No 1000, Section Block Lot Subdivision Filed Map. Permit No. ... 2.— Date of Permit.- Applicant:_ Health Dept.Approval:,___..—.—Underwriters Approval: Planning o ord Approval: Request fr: Temporary Certificate —Final Certificate: (check one) Fee Submitted: App an ignature w � L"4 iC �. L"�i •Tf G" F LjC.nJ a3 S 26'39'20"E X, 75.00' zca N r, V �• PuE.. i l O LL-V) OZ N .7 i — ., O a I— }- �Q F- y oz Li Li F A,3'.. >C) 3��// � s Z J 5'a= CO� p y LL- rt w j s ;a O OfLi �.., A4- _. 0 _ Z W Ra YPh � a. ..,�.a.._ A ..w OLD SHIPYARD.g D ROAD x rM h " r" z o