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Home My WebLink About43403-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 Survey_ Sou tholdtowriny.gov PERMIT NO. Check Septic Form_...__ N.Y. Trustees C.O.ApplioaJon Flood Permit Examined 20 Single&Separate Truss Identification Form Storm-Water Assessment Form Contact- 14� A,/Approved__ K Mailtol-kg�L Disapproved a/c Phone: 734-TS"r n Expiratio '-7-h 11, .2( A Bu l pector OCT 3 1 "018 APPLICATION FOR BUILDING PERMIT U, Date —,20 OF SOUTHOLD 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. ..................... (Signature of applicant or name,if a corporation) (Mailing address of applicant) State whether applicant is owner,lessee,agent hi ;e'ngineer,general contractor,electrician,plumber or builder ........................ .............. Name of owner of premises—e—' -�J JJ A) ........... (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. Locati11 0on of land orl hich proposed work will be dolle: 1 1�-Im -- House Number St eet Hamlet County Tax Map No. 1000 Section 76Bl ) ock �o, I I _ 4__��_ Lot Subdivision Filed Map No. Lot 2. State existing use and occupancy of premitise di t 11dCd Lse and occ ancy 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 ther 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 6. If busine ,cotrint.er ` 1 t° 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 ight� Number for s � 8. Dimensions o entire ne 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 , 6k 12.Does proposed construction violate any zoning law,ordinance or regulation?YES NX 13.Will lot be re-graded?YES NOYWill excess fill be removed from premises?YES NO 14.Names of Owner of premises 9 ' Address Phone No. 57b ev 7 Name of Architect Address Phone No Name of Contractor 1W GIL4LO&LAddress 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 MAYBE SQUIRED. 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—C< *IF YES,PROVIDE A COPY. CONNIE D.BUNCH STATE OF NEW YORK) Notary Public,State of New York SS: No.01 BU6185050 Qualified in Suffolk County COUNTY OF S'U 1 aKCommission Expires April 14,241-)'o I u — � 20�Wft-ri—'..being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the (Contractor,Agee, orpore e 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 belle l' and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this - 12 day of ( i 20 lS Notary Public Signa e 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 properly 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: (check: one) ... ... � . . Location of Pro> rty: House �No. Stre t _m.. Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Block Lot Subdivision w ,. _ Filed Map. . _ _._. .,,Lot: . .. ...... .._._._. . Permit No. „ Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval:, Planning Board Approval:,,__,___, Request for: Temporary Certificate Final Certificate: iie'l Fee Submitted: $ Applicant Slignature r r � r , SIC IRL Scots A. FZussell SUPERVISOR MANAGEMENNI"Ir SOUMOLD TOWN IIAIXF.0.Box 1179 S,W%Main Road-SOUTE10T....-D,NEW YORK 13.971 241 41 Town of'Southold ( To BE COMPLETED BY THEAPPI ICANT ) NV'"' "OLNT' . IAFY OF W HE FOLLOWING: (LRmm'Ix: '0jI, MAT AM T) Ye-allo A. Clearing, griA.king, gradi m -sttipping of land which affect rnor , than 51,000 ,tear feel, of . _ xcavatkx,,i r f iffi g involving more, th.an .200 cubic yards of material within parcel. r any contiguous area_ Vj�' C. Site preparation on slopesi exceed. 10 fvertical l arise to 0 D. Site preparation, 'within 100 feet off" t �� , Ibeach, I:Auff' ons cod.. til erosion hazzird area. E. Site pr -anon within the orte-4-nindred year floo dplains depicted on FIRM,Map (A any watercaume, Installation of new ,,. resurfaced imperviou s surfaces of' 1000 square Feet or more, unleg priorIIC t of a Storrnwater Management C " �r the µ.,rd aid proposal includes in7kind. r � l tram. of impervious- stirfaces. _ µ1,r 236 does nd a IT'to Your PrOject. �"PA.KUIIbtl.:g NA Wm... . C4✓ did tl✓ " ��. .�� P,m�u� Ra LAX Reviewed By. � DaW7 PE .m' C omMb1 � Km ' �, �. _.. _ �N p' r�ovtR ��r �13wg PmW, RMqnua.urmm�o�u� �� ;an5 ammm " ,ramrnaotl Plan Er� Vrr 4a�r� �� .�� Rmw Naa'Rcvoc .b FORM * ,SMC '—TOSMAY 2014 rz -t Telephone epone 631-1802 Town ball Annex ` Fax(631)734-9502 54375 Main Road , R 0. Box 1179 Co Southold, NY 11971-0959 BUILDINGt ., l TI E UTILIZA I US TYRE CONSTR tTI ' PRE-ENGINEERED O cOUST UCTI wl M FI 13ER CONSTRUCTION CT1ON Date: Pal �- Owner__ OHW ,pfldn AJr.ae. Li �� . � o zjn if Property:Location z b a Please take notice that the (phe k a line): New Addition to eA�i reid �1structure ba m ntial Rehab id l® ari wChme 1A to be constructed Or PerfOrMed at applicable i n ctid �. Truss type " ry pre-engineerdd OWE iapplicablei FIocW frai- minor „ inctUdingi W I . 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