HomeMy WebLinkAbout36944-Z o�sU o��co TOWN OF SOUTHOLD
,� ay BUILDING DEPARTMENT
' TOWN CLERK'S OFFICE
o . SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 36944 Date: 1/26/2012
Permission is hereby granted to:
Burns, Roseann
PO BOX 261
New Suffolk, NY 11956
To: Construction of an Accessory Building;
Shed, 10' X 12', as applied for.
At premises located at:
4370 New Suffolk Rd, New Suffolk
SCTM # 473889
Sec/Block/Lot# 110.-8-29
Pursuant to application dated 1/18/2012 and approved by the Building Inspector.
To expire on 7/27/2013.
Fees:
CO -ACCESSORY BUILDING $50.00
ALTERATION OF ACCESSORY BUILDINGS $148.00
Total: $198.00
Building Inspector
FIELD INSPE ON REPORT DDATE COMMENTS
FOUNDATION(IST)
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FOUNDATION(2ND)
ROUGH FRAMNG&
PLUMBING
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INSULATION PER N.Y.
STATE ENERGY CODE
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FINAL
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ADDITIONAL COMMENTS
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HOLD BUILDING PERMIT APPLICATION CHECKLIST
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'` } EPARTMENT Do you have or need the following,before applying?
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ALL Board of Health
,� TTHOLD,NY 11971 4 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Survey
SoutholdTown.NorthFork.net PERMIT NO. Check
Septic Form .
N.Y.S.D.E.C.
Trustees
Flood Permit
Examined ' ,20 Storm-Water Assessment Form
J Contact:
Approved ( i 120 , �' Mail to: 1 LL
lais��c l fo q 2
Phone:
Expiration / ,201_3
Building Inspector
D A ATION FOR BUILDING PERMIT
J AN 17 2012 ,
Date , 20 12
BLDG.DEFT. INSTRUCTIONS
F s0U1H00
a. Thi a 0W e 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 sha-ll ex-pir-e-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,anew 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.
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(Signature of a'pNicad or name,if a corporation)
k b1i 2 M PE 1y c.r—
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
Name of owner of premises t-i
(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. Ft5,�01Nc,
Plumbers License No. ►�
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
House Number Street Hamlet
County Tax Map No. 1000 Section O ,,M,,.>. 010ck .' g Lot
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 rz:> Ly (--)Vytp- -k(J C.
b. Intended use and occupancy f7As(Yl iG
3. Nature of work(check which applicable): New Building Addition ✓ Alteration
Repair Removal Demolition Other Work N-_ N S{: _
(Description)
4. Estimated Cost 150000 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.
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7. Dimensions of existing structures, if any: Front `4 Rear 5+ Depth
Height 115 Number of Stories 1
Dimensions of same structure with alterations or additions: Front 'Rear _
Depth Height 1 S Number of Stories 1
8. Dimensions of entire new construction: Front Rear. 1 �} Depth
Height Number of Stories. 1
9. Size of lot: Front WO Rear �� �J Depth Iq-2
10. Date of Purchase 2c off' Name of Former Owner 1 o t66 1 1V5
11. Zone or use district in which premises are situated
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 7• NO
14. Names of Owner of premises�� U(yNS Address t2fb Nos -SOAO Phone No. _
Name of Architect LZP, Address �C_r_ Phone No Z`tv — �Z
Name of Contractor Address Phone No..
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO x
* 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 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 K
* 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,
(S)He is the t TfrC. 1
(.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.
Swo to before me this
o c/ 20
IA J. KESSL
Notary P li Notary Public, State of New York Signature of Applicant
No.01KE5006684
qualified in Suffolk Cc y';O�D
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B. P. # 36 9 + =ate a
/^f BUILDING PERMIT EXAMINER CHECKLIST *Date Submitted: I°2 Date Reviewed.-
Applicant: Owner:
Architect/€: Estimated Cost: ��
SCTM# 1000 - f 0 s Subdivision: Zone: Conforming? /1/0
Property Address: 4-3 7 0 7 1 City: Al Pre C.Os?
Building Permits (Open/Expired): BP -Z/Go Z- ,Info: BP -Z/C/O Z- ,Info:
BP -Z/00 Z- , Info: BP -Z/C/0 Z- ,Info: BP -Z MO Z- ,Info:
Single& Separate Search Required? Y ot�Determination: TRi"1w7 :.R�4D/�.FF:
REQ. Lot Size: ACT. Lot Size: l�>-5-0 0 REQ. Lot Cov. o1y7c ACT. Lot Cov.
REQ.Front ACT. Front REQ Side ACT. Side_REQ. Rear PROP. Rear
REQ. Height. 3 5 ACT. Height Re a. S*TH. St Dcs A C T
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Project Description:
Waterfront? Y or ��/� /Ce
If yes, water body: Panel# Flood Zone: B..ulkhead/Bluff Distance:
ADDITIONAL APPROVALS REQUIRED PLAN S(4f) SIGNEp, S��LED SITE PLAN
Suffolk County Health: Y or N- If yes, *Bed#: _ *Date: _/ / *Permit#f: Town Septic: Y-N
- If no, certification required: Y or N Received: Y or N By:
NYS DEC: PRF-oEC9i1/75 Y or N - Date: / /_ Permit#: or NJ Letter-Notes:
Southold Trustees: Y or N- Date: / / Permit#: or NJ Letter_Notes:
Southold ZBA: Y or N- Date: / / Permit#: -Notes:
Southold Planning: Y or N- bate: '/ /_ Permit#: -Notes:
Town Landmark C of A: Y or N DTE: _I /_ *NYS CODE.Compliance-(page 2): Y or N
CQNTA&CTIoR 0CENSt DISABILITY 1-11ML4TY 11�Ql11 IMAIS CoMp��S.97-/0�/
Notes:
Fee Structure: Calculation:
D'V)LL-/alb: sy� C4�X Ja
Foundation: SF X$ , =$
First Floor: SF J -° WELLIi1 + Initial Fee: $ P 00 , 00
Second Floor: SF +Additional Fee ( �: $
Other: SF la-O SF X$ , f0 010
Total: SF ., h'E2) +Initial Fee: $ f o• c00
C of o FEE) S0, 00 X t-
A 5 B to I L T FEE --&- 1. TOTAL: $ (�ulfl L l NG�
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NEW.YORK STATE &TOWN CODES
AS REQUIRED .
.. �. , .. ( C7 � . }-� OLD TOWN ZBA
SOUTHO LANNING BOARD
SOUT D TOWN T c
N. S DEC �
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-APPROVED AS NOTED --
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i �. I �T B.P.#00 BY
CL10 _- -=Y-BUILDING DEPARTMENT AT
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L- / —=2 AN1 TO 4 PM FOR THII
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- \ !NG INSPECTIONS:
'NDA_:ION -TWO REQUIREDY_'..__. 3
-)P POURED CONCRETE I
i-FRAMING,PLUMBING,
l P, 2[c �o„ -
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q" F NAL-CONSTRUCTION&ELECTRIC +,
- L MUST BE COMPLETE FOR C.O.
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ALL CONSTRUCTION SHALL MEET THE
0 _ �T/ATNO H COgES,�N
f I/ ---BE-SIf Rf�ARS.
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