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HomeMy WebLinkAbout43397-Z TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL __B-aard of Health SOUTHOLD,NY 11971 �ets of Building Plans TEL: (631)765-1802 Planning Board approval FAX: (631)76S-9502 TE (:�)_ey South oldtownny.gov PERMIT NO. I -Clwck -Septic Form -N_Y.S,D.E.0. . .............................................. C Application r r-i ad Permit 'It, Examined— 20 gle&Separate..._... -T-PAss Identification Form J A�R Jl� ----&Qryh-Water Assessment Form Contact: Approved 20 Mail to: TOWN OF SOUT""OLD �}o 5 Disapproved a/P TC T)g* 9211 )QJ l lq4-7 Phone: g J(Q --70 Z C571'7 Expiration 120 Building Inspector APPLICATION FOR BUILDING PERMIT Date 20 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 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. `--�'Signaiurc of applicant or name,if a corporation) oft)(P)T � O� 214-7 (,M LhIng_idilress of applicant) State whether applicant is owner,lessee,agent thituc ngiiiecr,general contractor,electrician,plumber or builder ....... .............. .............. Name of owner of premises e, ki AE ..... ........................ (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 an on which proposed work will be done: ........... ............ House Number Street Hamlet County Tax Map No. 1000 Section Z04. .........—Block.... © S 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 t ti,y _ -5 b. Intended use and occupancy-- —I,- 3. ,,-3. Nature of work(check which applicable):New Building Addition Alteration —. Repair .. ._... f....... �k (Description) 4. Estimated Cost Removal �� ��tmnr-Kee Other Work g g (To be ii on filing this application) 5. If dwelling,number of dwelling units L Number of dwelling amts n each floor If garage, number of cars -- 6. If business,commercial or mixed occupancy,specify natureand ciient of eah type of use. ....__ . j �r 7. Dimensions of existing structures,if any:Front -11 Rear 111 Depth Zro - Height `3,:q' Number of Stories 12— Dimensions of same structure with alterations or additions: Front l—i I" Rear 4.Zr —i t Depth 2tor-1 b" Height I Number of Stories 7Z-- 8. Dimensions of entire new construction:Front No arj,q- Rear Depth Height Number of Stories 9. Size of lot:Front /03>,91 Rear 101, � � Depth 2_1+5',-,1 ^ 251,20 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 V' 13.Will lot be re-graded?YES_NO v Will excess fill be removed from premises?YES_NO ✓~ 14.Names of Owner of premises CAi63Address Phone No.qt-7-t o 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.C.PERMIJI S MAY BE REQUIRED. b.Is this property within 300 feet of a tical 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 V' *IF YES,PROVIDE A COPY. STATE OF NEW YORK) MS'S: COUNTY OF ' uvt g being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the _ C ct t " ( '. Agent,Corporate 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 it''is t'--'I^ day of 20 l __.- FRAOEI.DWYER NotaryPublic OTAFRly PUBLIC,STATE OF NEW YO Signature of Applicant NO.oIOW63o6Joo QUALIFIED IN SUFFOLK COUNTY COpu MISSYON EXPIRES JUNE 30,2"a 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. FinaI Approval fro Health Dept. of waiter-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. Con niercnal bu'i'lding, industrial building, n wItiple residences and similar buildings and installations, a certificate of Code Connpliance trona architect or engineer responsible for the building. 6. Submil Planning Board Approval a f"connplcted site plan regUircine:nnts. B. For existing buildings(prior to April 9, 1957)non-conforming uses, or buildings and "pre-existing"land uses: 1. Accua;-ate survey of property showing all property lines, streets,building and unusual natural or topographic feawres. 2. A properly coo npleted npplication and consents to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons 41crefor in writing to the applical11. 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. —I/qjjg New Construction: Old or Pre-existing Building: _ LZ (check one) Location of Property: -- _.�Sf�No. ... � Street Hamlet _ ... Owner or Owners of Property: C--4g4!q51, Suffolk County Tax Map No 1000, Section 7 Block Lot Z'Z Subdivision Filed Map Lot: Permit No. Date of Permit Applicant: . Health Dept. Approval:..... Underwriters Approval:................. ,................ .9_..................... ............... Planning Board Approval: �. Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ O Applicant Signature � � CHARLES M. THOMAS R.A. PLLC 206 LINCOLN STREET RIVERHEAD, NY 1 1 901 (631 )727-7993 CDTH❑MAS63 @AOL.COM JANUARY 15, 201 9 Building Department Town of Southold Re: 590 Haywaters Drive Cutchogue, New York SCTM # 1000-104-05-22 Dear Sire/Madam:. This letter shall serve to certify that the alterations proposed at the above referenced residence shall not be substantial with reference to the requirements of FEMA and the 2015 IRC. Thank you for your attention to this matter. Please contact me with any questions you have. Very truly yours, CHARLES M. 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