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HomeMy WebLinkAbout42698-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 [� / C4 �-7L Survey—..._ Southoldtownny.gov PERMIT NO. 1 V Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined 20 Single&Separate Truss Identification Form GStorm-Water Assessment Form 1 ' Contact: .Approved �.. 20 � Mailto: I—Ai� F�t� - — Disapproved a/c Phone_ (pat-5q9-0032._ Expiration 20 �- Building lrispector - APPLICATION FOR BUILDING PERMIT Y 0 2018 10 A Date_� i 20A _ B�J� ��a�,�y!,-� � INSTRUCTIONS 2 T:1ST 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 111 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 Building Permit pursuant to the BuildRegulations,tng Zone Ordinance of forr theconstruction ofbuildings,e Town of �additions,or alterationolk County, s or faze removal or demork,and other lition haws,Ordinances 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 i owne lessee,agent,architect,engineer,general contractor,electrician,plumber or builder /_A V Z �1 T Vii„ Name of owner of premises a uA VT e (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.___ q Plumbers License No. AT Electricians License No. 1'tt i Other Trade's License No. t 1`-,hra� 1. Location of land on which proposed work will be done: r e ?S lA(tr k lt"WVB lA�tc House Number Street Hamlet County Tax Map No. 1000 Section 3 Block 0 ala Lot to Subdivision N A .--Filed Map No. NA k4A 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy J4:-S,k a�g , kl"-s b. Intended use and occupancy---E-111'111—IMLLD�#A­ -'s 3. Nature of work(check which applicable):New B,u i]ding_ Addition X Alteration— X Repair—Removal Demolition----Other Work 4. Estimated Cost 41 /1"""d 0 0 0 Fee (Description) (To be paid on filing this application) 5. If dwelling,number of dwelling units-T)A Number of dwelling units on each floor NA If garage, number of Cars 6. If business,commercial or mixed occupancy,specify nature and extent of each type of use. NIA 7. Dimensions of existing structures,if any:Front NIT q(' 2 Z's� �Z % Depth Height , -S" Number of Stories 2- Dimensions of same structure with alterations or additions: Front L&�Z' Rear e," 1� — Depth 1-1 —Height 3 �5- Number of Stories— 'Z 8. Dimensions of entire new construction:Front Rear Iv, Depth—,?,o Height Number of Stories 9. Size of lot:Front— Rear 10.Date of Purchase,_"-ZLI-L(-)—,--J—Name of Former Owner 11.Zone or use district in which premises are situated A :;;' 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—NO­X 14.N es of Owner of premises f,A%4'PW FA,FfMoy. 124 .Address PhoneNo. G35�1'1­ 0t,``Z- Name of Architect LN Address Phone No, =63i"13,�3-, "'Ic fe,3 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 REQUIRED, b.Is this property within 300'feet of a tidal wetland?*YES—NO—X IF YES,D.E.C.PERMITS MAY BE REQLJIRED. 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 —102---being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, CONNIE D.BUNCH Notary Public,Slate of Now York (S)He is the No.01 BU51 BW60 (Contractor,Agent,Corporate Officer,etc.) rY Commission Expires April 14,2-Co 0 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 t before me this 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 fi,-om flealth Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn;statementfrom plumber certifying that the solder used in system contains less than 2/10 of 1%lead. 5. Commercial bui[ding, industrial building„multiple residences and similar buildings and installations,a certificate oFCode Compliance from architect or engineer responsible for the building.. . Submit Planning;hoard,Approval of completed site plan requirements. B. For existing buildings(prior to April 9, 1957) non-eonforming uses.,or buildings and."'pre-existing"'land uses: 1. Acture to survey of property showing all property lines,streets,building and unusual natural or topographic 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 L 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 $1.5.00, Commercial$15.00 Date. New Construction: X Old or Pre-existing Building: (check one) Location of Property: I 0 ,,° 1. tq House No. - Street Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Section ..' � Block Lot_ Subdivision Filed Map_ _..... Lot: Permit No. Date of Permit.-,-- �,...�. Applicant: Health Dept.Approval: Underwriters Approval Planning Board Approval: Request for: Temporary Certificate Final Certificate:... x...... (check one) Fee Submitted: $ App �c ..._ __---.. ._..._ ant Signature Town Hall Annex 54375 Main Road Telephone(631)765-1802 P.o. Box 1179 Fax(631)765-9502 Southold, NY 11971-0959 BUILDING DEPAR"rMENT" NOTICE OF UTILIZATION ' II rRuc­ "I N P PRE.-ENGINEIERED (Gate: . 1 : Owner.- / .... _.. � ... w Location of Property- Please take notice that the (check applicable line): New commercial r residential structure .. addition to existingcommercial residential re .. ._ h.� Rehabilitation to an existingcommercial r residential t ctur to be constructed or performed at the subject property reference above will utilize (check applicable line): Truss type construction (TT) Pre-engineered r i (PW) _a......�__.. __ Timber construction (TC) in the following location(s) (check applicable line): (Floor framing, including girders and beams (F) �°....°1..... Roof framing (R) Floor and roof framing Ilgnature Name (person submitting this form): Capacity(check applicableline): _.w __ .. Owner Owner representative TrussRegl5.docx Effective 1/1/2015 Scott A. Russell S1F01K1\M[WAT]E1K SUPERVISOR M[A�NA��GI]EM[]EN�[' SOUTHOLD TOWN HALL-P.O.Box 1179 53095 Main Road-SOUTHOLD,NEW YORK 11971 ^. . Town wn of So u th o l d CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) DQE.. T111S PROJECT' ]I lyOIX11, ANY OF T"t-111En Mll..,LO NG: Yes No (CHECK ALL THAT APPLY) ❑JZ A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. ❑© 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. ❑�] 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. ❑0 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! 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 completed Check List Form to the Building Department with your Building Permit Application. APPLICANT: (Property owner,Design Professional,Agent,Contractor,other) S.C.T.M. #' 1000 Date gg District NAME: L-.C.Ta41 C�i,1 c-� a Section Block Lot r Contact Information, f i ph—N� b� .................................. , Reviewed By: Date: Property Address f Location of Construction work: StormwaterApproved for processing Building Management of Plan Not Required. �... ...._ ._ St ..... ....... orrnwater ManagementManagement Control Plan is Required. orwa rd to Engineering Department for Review.) FORM # SMCP-TOS MAY 2014