HomeMy WebLinkAbout42705-Z TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Doas h e or need the following,before applying?
TOWN HALL and of Flealth
SOUTHOLD,NY 11971 _ 4 sets of Building Plans
TEL: (631}765-1802 Planning Board approval
FAX: (631)765-9502 ---Survey_
Southold town ny.gov PERMIT NO. —Check
Septic Form
N.Y,S.D.E.C.
Trustees
C.O.Application
Flood Permit
Examined 20 Single&Separate
Truss Identification Form
Storm-Water Assessment Form
Contact:
Approved � ,20� Mall to:
Disapproved a7r
le
..... Phone
Expiration 201i--
Ti-
DEC -d 2017
ldi rispector
BUMDING DEPT.
APPLICATION FOR SUILD3NG PERMIT Tom OF SOUCOID
NO 2 817 Date 20
INSTRUCTIONS
a.Thi: app'-4o'n MUST be completely filled in by typewriter or in ink and submitted to the Building inspector with 4
scrOftlr n to scale.Fee according to schedule.
b t la an S lov,ng kocation 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.?one Ord']nance 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.
(Sigriature.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 -0 GT-4 i
(As on the tax roll or latest;deed)
If applicant is a corporation,signature'of duly authorized officer LP 3
(Name and title of corporate officer) i SZ>y{7
Builders License No. bA PJ 1 :C C �^%+vim' �+L�• Rr� � C L�� �1�° � ��� ' "°'�
Numbers License No.rT . t�1•t t ,� '- .t:" ` t"5'' '° w
EBectri cars LicenseNo, rem �C Ctjf I 9,>- 3reil o7t t,+�J t t.i.,'t 71.E Iri t l
Other Vfrade's License No. V"Ar aet4l 4�76-t`&6 s t A tom°
g
1. Location of land on which proposed work will be done;
3 75 G4`4 t-11 A,
House Number Street Hamlet
County Tax Map No. 1000 Section 3 Block b2-- Lot `L7
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 M/ LR--a nem
b. Intended use and occupancy A A9F+✓ur �r�l a..s+b � `f Cwlsal-.7 J104e
3. Nature of work(check which applicable):New Building K Addition_ Alteration
Repair Removal Demolition Other Work _
4 (Description)
4. Estimated Cost lyco,ebr, 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 IStl iStrltct ares,if any:Front `f'i`g Rear '-f Depth P 2
'e 4. t Number of Stories 0
irG7inns of sam�4 re with alterations or additions: Front Rear
Depth Height Number of Stories
8. D irr=0 §'df'6&Trf e'h"ew construction:Front -72: Rear 7 2" Depth 32-
,
I-Lr!Pjt°°il� W-7, Number of Stories 2-
9. Size of lot:Front ISO _Rear__I S c,' Depth 13 6
10. Date of Purchase =r-A-1�3. I ' b Name of Former Owner L--Liz-11 S sru 6 ZA v
11.Zone or use district in which premises are situated P_
12.Does proposed construction violate any zoning law,ordinat7cc or regulation?YES_NO n
13.Will lot be re-graded?YES A NO Will excess fill be[removed from premises?YES'�OL NO
Am 13A ado t5e 1
14.Names of Owner of premisesb �- �� Address"" ^ '" f1-11 Ishone No,431.-
Name of Architect KL4W'F, FA1--mAddressl 41 Phone No 'A WI'-
Name of Contractor b 4�-C.,O-rj-00 Address 152-0 c-' x s� Phone No.6 -�8'�LS L
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 )e-
*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, lmust 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 New York
(S)He is the No.OIBU61BW50
utfoflk-County _.._ ._.
(Contractor,Agent,Corporate Officer,etc. ,omrnission Expires Apn, 4 2t�O
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 l I be
performed in the manner set forth in the application filed therewith.
Sworn to before me this ii�ryry
at4&...�day of 20_i
..__ Notary Public Signs sire 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,
Swintming 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:. (check one)
w.�,
Location of Property ... �i y , �,f .. � � z�H
House No. Street t
Owner or Owners of Property: " t
Suffolk County Tax Map No 1000, Section
Block ..- _Lot_.Lm...
Subdivision Filed Map. Lot:
Permit No. � 1 Date of Permit. Applicant:,.,
Health
Health Dept.Approval: Underwriters Approval.
Planning
oard Approval:
Requestfo poryCertifcate �-............. .....Final..,
Certificate: (check one)
Fee Submitted: $
A plicant Sign gid'.
Town Hall Annex , Telephone(631)765-1802
54375 Main Road a Fax(631)765-9502
P_ O. Box 1179
co
outh6td, Y 11971-0959 _
,
s
,
BUILDING DEPARTMENT
NOTICE OF UTILIZATION OF TRUSS TYPE CONSTRUCTION PRE-ENGINEERED
WOOD CONSTRUCTION AND/OR TIMBER CONSTRUCTION
DatqI: ®�
Owner:
Location of Properly: 3 6Z ,
Please take notice that the (check applicable line):
New commercial or residential structure
.... Addition to existing commercial or residential structure
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 follo .irlg focation(s) (check pplicabt
Floor framing, including girders and beams (F)
......._. Roof framing (R)
Floor and roof framing (FR)
Signature:.
Name (person submitting this form) µ
Capacity (check applicable line):
Owner
Owner representative
TrussRegl5.docx Effective 1/1/2015
Compliance Certificate
D � D ,
Project
11AY
Energy Code: 2015 IECC
Location: Greenport, New York
Construction Type: Single-family RUMDTNG DEM
Project Type: New Construction TOWN OF SOUTHOLD
Conditioned Floor Area: 2,370 ft2
Glazing Area 11%
Climate Zone: 4 (5572 HDD)
Permit Date:
Permit Number:
Construction Site: Owner/Agent: Designer/Contractor:
su (-f 11-1. lr&tJF Hpw� � �� - �kolJF, � A*4
Compliance: 14.0%Better Than Code Maximum UA: 378 Your UA: 325 Maximum SHGC: 0.40 Your SHGC: 0.39
The q Better or Worse Than Code Index reflects how close to compliance the house is based on code trade-off rules.
It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home.
Ceiling 1: Cathedral Ceiling 2,744 45.0 0.0 0.023 63
Wall 1:Wood Frame, 16" D.C. 2,240 28.0 0.0 0.050 98
Window 1: Wood Frame:Double Pane with Low-E 219 0.310 68
SHGC:0.39
Door 1: Solid 20 0.110 2
Door 2: Glass 30 0.310 9
SHGC: 0.39
Door 3:Solid 18 0.110 2
Basement Wall 1: Solid Concrete or Masonry 1,500 0.0 12.0 0.055 83
Wall height: 8.0'
Depth below grade: 7.3'
Insulation depth: 7.3'
Compliance Statement: The proposed building design described here is consistent with the building plans,specifications, and other
calculations submitted with the permit application.The proposed building has been designed to meet the 2015 IECC requirements in
REScheck Version 4.6.5 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist.
Name-Title _. 5 41 . Dat
,
Project Title: �� �Y Report date: 05/16/18
Pagel of 1
Data filename: Untitled.rck
IS8S9'
Scott A. Russe51F01R1AAWAT1ER
SUPERVISOR MA\NA\.G 1EM1ENT
SOUTHOLD TOWN HALL-P_0.Box I1 T7 �� �ufl f"'', j 1 Z1 2M8
53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of Southold
TOWN OF SOUMOLDI
CHAPTER 236 - STORM"'WATER MANAGEMENT WORK SWEET
( TO BE COMPLETED BY THE APPLIC NIT )
DOES "TPIIS PROJECT hZ'OLVE iVNY OF TI-IE FOLLOWLNG:
G:
CHECK -\LL TH�T -xPPL)
lel\o
A. Clearing, grubbing, grading or stripping of land which affects more
than 5,000
s
square feet of ground surface.
q
B. Excavation or filling involving more than 200 cubic yards of material
within any, parcel or any contiguous area.
o 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.
OK E. Site preparation «-ithin the one-hundred-year floodplain 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 Storm\rater Management
Control Plan NN-as received by the TONj7n 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 s County Tax Map Number? Chapter 236 does not apply to your project.
`�IP you answered YES to one or more of th
_
e above, please submit Two copies of a Stormwater Management Control Plan
and a.completed Check List Form to the Building, Department wil. lir Building Permit Application.
.C. \'I. 11100 Date.
`: ... I
APPLIC-�\T: PrcgMrt� O.nrt-Dc t nt't te__ntu aCrm Crn:nact.n.(khc'r ST. mct �' 6-'vim/ r
ILII CJy
N-\tIE. -
-. ........ � Sed-tonBIoc4, Lot
4-,
d7 C YV4Y %I k� �m+' ..e,,.......... c" l/L^✓/r/./
Re\ie\aed B\-: �\I
_.. ._..._ Date:.. ........-�..
Pra' n \1'( rk:
Location(r�� on;lrucho � Approved for pi`occ sing Building Permit.
oC Slormvvatcr A1k�
— — eqt iced.
��Berly t a q o Z_ t_
Control Plan dot R
_._. Stormaaler\lanagemenl Control Plan)<Requu-e(I.
tFor\\ard to Engineering Department for Re\te\\.i
FORM T SMCP--FOS MAY 2014
W _
xc � a Z a
Cao
_ 6 IAJ
—
M
-
- o
N — 10a
t
i �J, W k
F w LU W
CD
+ -
J J
n
� WJE
w = "
LAJ
�•41
� U
lu
77
to
7,1
L
f
—
�
— � is'.� ^� f / _ _ _ — _ '_J J ✓, .
....,,... ................ ....... 3
inn
q k 0
V' W p Z o �)N V.VIII.wPl S I"
C\2 w
MIT
^� ��
�„+" s
SEA
O�WA
z oJo� -
w _ =3 e 'a
Hsi r J
z aRM 1
3 3r E
#Gy
WK
1
_ >a w o w >
x J hw w
0
r n w J a �Qaw EM,
3w�
}' zp� °=ewmm�wzo
..... m o
aww
pF
< o i
F zz w
� <
�rci= < Q "
�zoo
otos „ a p N 3
o
to p
� o
p
z 8�
soNo
�aaw�
awe �=��wps
W
� o
e z
� a
v
d
} of m O o O
O O
1 f xf
J /
n �
Out
yr
11-
p
m
i m
o,� m n
r
2 �
r
Eno RGA
`L C
qi ���L9 prY 5.
/ 1 i
4�
U`sE'��A7 y1iA�a�6,4
........_._. .. ................. _ -.... ____ ., ---
qua HV i
?y�
w„ o
O R2 w w W O Z r�o N .� '` ~•. ^„, a i„ ";F: E
cj�
wd
a a o r
W U z34 0 aim J S
a o� o
a�oo
o � Q
ew
�f
i�j ^i %uiii
a r i a W 0
o
uu kJ
0
a i
.o) m •.
4YV7fL1.lNe ru a a
O
O O p O
G
y � a
.� Wt�4y
"MI
0 N n
�� }vv
'01
I fay. ✓ 111 1.� ,� l'a, 6
10
60 ta"tiu' ra
o �a
s' as Nm
"al of`'��lF�sucsgeeTso
CJ
au r N
-r 'Ot y.ytSro (Svi
0T
oW��y`C1�Xq�a.
rt a'V',fr1.