HomeMy WebLinkAbout43413-Z TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do yoLi have or need Etre'l'ullowing,kefore applying'
(lardTOWN HALL
SOUTHOLD,NY 11971 setsof li�ilding Pkkns „,
TEL:(631)765-1802 ling Board approval_„
FAX:(631)765-9502 '. ` al Sn:vt y _.,..
Southoldtownny.gov PERMIT NO. "'" -C-heck
fis Form
S.l;h.f
Tq�nSluus
Examined 20 wENE -.4"le&Separate}
(-DT ss Mentification Form mm
Orn-Water Assessment Form
Contact:
Appmed 20 ILt1a 'ic i ` Mail to: . fox.
Di—I.-
sa .,Tdle - TOWN F /i..: n .. a`�® It 10
E.,
Phone:S 116-�A5- ?77?
—1-
APPLICATION
.APPLICATION FOR BUILDING PERMIT p
Date...w &E(L .._, 20 �p
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. n d�
o kae
( C8 ayrpheaknl or name,if a uark-pnr,�ktitri^�y -.
ti LAO
(Mailing address of applicant)
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
Cts PQM
Name of owner of premises4mlm.:�= .. P eL l�(P, P'
(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:
ta�k.. ( ...... T'ii' Ctf I1�
House Number Street Hamlet
County Tax Map No. 1000 Section L4--—Block ..—Lot 1 c�e l 0
Subdivision --Filed Map No.—
2. State existing use and occupancy-of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy kA![ -- - I r+, Q
b. Intended use and occupancy_ _ -Wgt4CL h.Z_
3. Nature of work(check which applicable):New Building l/ Addition Alteration
Repair Removval° Demolition Other Work
o (Description)
4. Estimated Cos 1 u„CxD o to C3 l e t ,g l -,a,
— - ..
d ( � t t1 filing this application)
5. If dwelling,number of dwelling units_ a 'rher of dwelling unrts o , h floor
If garage, number of cars -
�� 1' t,�
6. If business„comniercia_l or mixed occupancy,specify nature and extent of each type of use.
T Diment ic)ns of 3 isting s tniP„tLII-cy: ont __ ��a m`i:w R at ll i"�j5.- Depth (->$
Number ofI r`
Stories ca
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 oflof:Front Perrr i� �,`Z� Depth 3l a. 01
10.Date of Purchase L4d J a 1 13 Name of Former Owner 6-14 iZ8L-Le:
11.Zone or use district in which premises are situated 9
12.Does proposed construction violate any zoning law,ordinance or regulation?YES NO X /
13.Will lot be re-graded?YES--,/—NO—Will excess fill be removed from premises?YES NOOIL-G6 6 V
14.Names of Owner of premises r�' 7 rE'�ti..F AddresspQ ash ltal phone No.5f 6-(A5-`g7?7
Name of Architect moi- 0 V=1 ) E& Address S Phone No_�, i
Name of Contractor p t fir ,n Address Phone No.
15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES NO 1
*IF YES,SOUTHOLD TOWNTRUSTEES&DEC,PERMITS MAY BE REQl11RED.
b.Is this property within 300 feet of a,tidal,wetland?*YES NOS,,,-
*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"covenata:ts and restricti6 is'with respect to this property?*YES NO
*IF YES,PROVIDE A COPY,
STATE OF NEW YORK)
SS:
COUNTY OP
1�G'4�&4e-n- being duly swom,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the_0 0--)0SR- Ijr(2-J!5-re. D F
(Contractor,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 before me tl's
day o,
.. TBACEY L.DVV`( _ . . _�
atatry Ptnbli NOTARY PUBWC,STATE OF K Signature of Applicant
NO.01 D W 6306900
QUALIFIED IN SUFFOLK COUNTY
COMMISSION EXPIRES JUNE
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 I% 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$1(5.00
Date. F Z'S A
New Construction: Old or Pre-existing Building: (check one)
Location of Property:. ��"' �� (ZO �-'C-r1"" "t� �,. �M��
House No, Street Hamlet
Owner or Owners of Property: OIL-lab� LP
..
Suffolk County Tax Map No 1000, Section Block Lot
Subdivision ------
-. --- Filed Map. Lot:
Permit No.—I .. Date of Permit.. � �.... .........Applicant: .r�.....�.. R a , j w ',��,
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate ... - .._ Final Certificate; (check one)
Fee Submitted: $
41
Applicant Sa���a ,a�
iwn Hall Annex *�` Telephone(631)765-1802
Fax(631)765-9502
,4375 Main Road
P. O. Box 1179
Southold, NY 11971-0959
NOTICE OF UTILIZATION OF TRUSS TYPE CONSTRUCTION PRF-FNt I'NFI=RIND
. WOOb CONSTRIJCTIO I ANWOR TIMBER CONSTRUCTION
Date:
Owner;
Locat:I`brt of Property: �..:...
Please take notice that the ( b pk applicable line.):
New commer is r;N,"residOiltiat structure
a .;
_ -, ddition to"ea s N-commer ial or-residential structure
k9babilit ton .an existing commercial or resi erg, truct re,
,. ,.
to be.,,c nstrucled`:Ij' r performed at the subject property reference above i t utll e
(check applicable Ilne): ,
Truss type on.,*traction (TT)
Pre-englnedlx + ° nt 'cow;�tr cti®n. (PW) .
m
M .
Timber construdtion (,W
in the following location(s) (check'applicable line):
Floor framing, including girders and beams (F)
Roof framing (R)
Floor and roof framing.(FR)
W
aignat re:
Nam
/ ,, G-- "
Name (person submitting this form): L..-�t gmj
Capacity(check applicable line):
l/ Owner
Owner representative
TrussRegl5.docx Effective 1/1/2015
Scott A. Russell 5� � ST�O>]KIM[WA\T]E]k
��
SUPERVISOR hWA NAG]ENHEN T
SOUTHOL53095 ain Road O 9
d-SOU HOLD NEW YORK 11971
ss
Town of Southold
CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET
( TO
BE COMPLETED BY THE APPLICANT )
DOES THIS PROJF'C;"I INVOLVE ANY OF THE FOLLOWING-
Yes
°OLLO ING-Yes No (CHECK ALL THAT APPLY)
❑' A. Clearing, grubbing, grading or radin stripping of land which affects more
PA g
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.
j ❑ E. Site preparation within 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 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 ivitli your Building Permit Application.
APPLICANT: (Property Owner,Design Professional,Agent,Contractor,Other) S'C'T'M' #' 1 0QQ Date
District
NAME: .� �" � � �� _.._.....� .._......_.....
spetfon Block Lot
FOR BUILDING DEPARTNIENT USE ONLY"'Y
Contact Information - L 77-7
f ........
Reviewed By:
Pro c)�t Address/ Location of Constructioll —
Work:vn Approved for processinga_.. ._ T — — ._�
Building Permit.
Aft4, S
Stormwater Management Control Plan Not Required.
..1..:_M l - .Stormwater
Management
Control
Plan
for Review-)Required. ..
(Forward Engineering g g pr?rtm
FORM $ SMCP-TOS MAY 2014
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