HomeMy WebLinkAboutMarch submission Locke Rd. PermitTOWN OF GROTON BUILDING PERMIT APPLICATION
Rick Fritz, Code Enforcement Officer - 607-898-4428 or 607-591-9898
No Construction shall begin until a permit has been issued.
Check documents you are supplying:
Vi ADDlication Form & Fee- to Groton Town Clerk at 101 Conger Blvd. (Po Box 36) Groton, NY 13073
6 Plot Dian of the lot with dimensions for new and existing structures, septic and wells.
Construction specification drawings (professional stamped drawings may be required) or ADDliance specifications
^ ComDleted Affidavit of Exemption for owner occupied residences
❑ If you have a contractor, proof of Workers Compensation or a signed CE-200 Exemption form.
A CE-200 can be applied for @ httr)s://www.wcb.nv.aov/icexeMDt/index.isD
❑ Sewaae Svstem Construction Permit issued by the Tompkins County Department of Health, 607-274-6688 55 Brown
Rd., Ithaca, NY 14850. Applications are on their web site www.tomokinscountvnv.aov/health/eh/owts/index
Name Adolphe Alexander & Michele Judge Date01/02/2021
Mailing 101 E Cortland St, BOX 278, Groton NY 13073-0278 Phone2679189255
Address
Project Address451 Locke Rd, Groton NY, 13073
Description Of Work: Small Shed
Building Use
Storage
Check applicable:❑Residential Commercial
Tax Map # Flood Zone No
15.-1-27.21
Serial Number of Manufactured Home Cost
Estimate $5,000
Total Acreage Total Floor
of lot : 5.64 Area — sq ft 80
Will any part of the building be a place used by the
Public? No
Will any part of the buildinq be used for human Will any part of the building be a place of employment
habitation? No where agricultural products are processed, treated
Builder / Contractor Self or packaged? No
Name & Phone Other Builder / Contractor
Name & Phone Self
PROJECT COMPLETION or OCCUPANCY PROCESS
1. Permit will be issued upon approval of a completed application with fee and all paperwork as above.
Construction can begin with permit prominently displayed. Permit is good for a one year.
2. Once passing all required inspections including the installation of the E911 sign, the permit will be closed and a
Certificate of Occupancy or Completion will be issued.
NO OCCUPANCY OR USE IS ALLOWED UNTIL PERMIT IS CLOSEDM
I hereby affirm under penalty of perjury that all information provided in this application is complete, correct, and
contains no misleading statements. I understand that any false or inaccurate information contained in the
application or attachments; any construction changes made after the issuance of a building permit; or failure to
schedule required inspections, may invalidate all permits issued under this application. I will not remove any
buildings, structures, or other construction started or completed. I certify that I have read and understand the permit
process and all requirements.
I hereby license, permit and give privilege to the Town of Groton, or a designee, to enter the premises or land to
conduct any onsite inspections by owner confirmed appointment only. Such license is revoked upon completion of
the building project. I understand that no building shall be occupied, used in part or in whole for any purpose, until
first obtaining the Certificate of Occupancy or Com tion.
Land Owner(s) Signature: �� r7 �� Date: 03/20/2021
[ ] APPROVED
Comment:
Signed
Code Enforcement Officer
APj
Date [ ] DENIED
Reason:
Signed
Code Enforcement Officer
VARIANCE [ ]GRANTED
[ ] DENIED
Date Date Received 3v 03�
Permit Fee
Receipt #
Activation Date
Date PERMIT #
Date Truss Decal
PLOT PLAN
❑For Interior work only
Check box & skip to Name.
MAP SHOWING THE STRUCTURE IS THE REQUIRED DISTANCE AWAY
FROM PROPERTY LINES AND OTHER STRUCTURES:
Using a survey map (or draw on the line below as the road) sketch your lot including the following :
4 Property Lines + Location/(or proposed) well & septic with distances to lot lines.
4. Other structures
a Location of new structure/addition with distances to lot lines.
+ Center of driveway or right-of-ways a. Location of reflective house number sign
N
74
Indicate
North
- NAME -Or ROAD-0R-STRM--------------------------------------------------------------------------------------------------- 1
Owner Name Michele Judge & Adolphe Alexander
Lot Size Tax Map # Amount of Road Frontage
( Acres) 5.64 15.-1-27.21 183'
CERTIFICATION:
I herby affirm under penalty of perjury that all information provided in this application is complete, correct, and contains
no misleading statements. I understand that any false or inaccurate information contained in the application or
attachments; any construction changes made after the issuance of a building permit; or failure to schedule required
inspections, may invalidate all permits issued under this application. I will not remove any buildings, structures, or
other construction started or completed as a result. I certify that I have read and understand the permit process and all
requirements. I hereby authorize the Code Enforcement Officer of the Town of Groton, or a designee, to conduct all
onsite inspections by owner confirmed appointment only. I understand that no building shall be occupied or used in part
or in whole for any purpose until obtaining the Certificate of Occupancy or Completion.
Owner(s) Signature: Date:
Affidavit of Exemption to Show Specific Proof of Workers' Compensation Insurance
Coverage for a 1, 2, 3 or 4 Family, Owner -occupied Residence
**Thu form cannot be used to waive the workers' compensation rights or obligations of any party. **
Under penalty of perjury, i certify that 1 am the owner of the 1, 2, 3 or 4 family, owner -occupied residence
(including condominiums) listed on the building permit that I am applying for, and I am not required to show
specific proof of workers' compensation insurance coverage for such residence because (please check the
appropriate box):
® I am performing all the work for which the building permit was issued.
❑ 1 am not hiring, paying or compensating in any way, the individual(s) that is(are) performing all the work
for which the building permit was issued or helping me perform such work.
❑ I have a homeowners insurance policy that is currently in effect and covers the property listed on the
attached building permit AND am hiring or paying individuals a total of less than 40 hours per week
(aggregate hours for all paid individuals on the jobsite) for which the building permit was issued.
I also agree to either:
♦ acquire appropriate workers' compensation coverage and provide appropriate proof of that coverage on
forms approved by the Chair of the NYS Workers' Compensation Board to the government entity issuing
the building permit if 1 need to hire or pay individuals a total of 40 hours or more per week (aggregate hours
for all paid individuals on the jobsite) for work indicated on the building permit, or if appropriate, file a CE-
200 exemption form; OR
♦ have the general contractor, performing the work on the 1, 2, 3 or 4 family, owner -occupied residence
(including condominiums) listed on the building permit that I am applying for, provide appropriate proof of
workers' compensation coverage or proof of exemption from that coverage on forms approved by the Chair
of the NYS Workers' Compensation Board to the government entity issuing the building permit if the
project takes a total of 40 hours or more per week (aggregate hours for all paid individuals on the jobsite) for
work indicated on the building permit.
(Signature of.. meowne
Adolphe Alexander & Michele Judge
(Homeowner's Name Printed)
Property Address that requires the building permit:
451 Locke Rd
Groton NY 13073
03/20/2021
(Date Signed)
Home Telephone Number 267-918-9255
r
Sworn to before me tJ
(County Clerk or Not,
o;
Once notarized, this BP-1 form serves as an exemption for both workers' compensation and disability benefits insurance coverage.
BP-1 (12/08) NY-WCB
C Ground Floor- Phase 1
Namagasta
www.namagasta.com
BACKFILL 48" TRENCH WITH
MEDIUM AND
) W/ SMALL
451 LOCKE RD, GROTON NY
STRAWBALE SHED SM
C Ground Floor - Phase 2
No. Descrlptlon Date 3 D VIEWS
Project number Project Number
Date Issue Date
Drawn by Author
II Checked by Checker
CAP INFILL WITH
Scale
A101
BUILD UP HAY BALES TO
TOP OF WINDOW & DOOR.
BUILD STEM WALL W/
BLOCK WALL. FILL
SPACE W/SAND, CAP
W/3"CONCRETE
O Ground Floor - Phase 3 n Ground Floor- Phase 4
No.
451 LOCKE RD, GROTON NY
Description
Date
a
3D VIEWS N
Namagasta
Project number Project NumberIssue o
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STRAWBALE SHED SM
IDrae Author ate A102
� Drawn by Author
Checked by Checker Scale
ADD ANOTHER
COURSE OF
HAY BALES
I
,, � Illllh�r
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® Ground Floor - Phase 5
�t
I III�I'
IIIIIIIIII.I.IIIIII�IIII'
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C Loft - Phase 5
No. Description Date
451 LOCKE RD, GROTON NY 3D VIEWS ry
I Project number Project Number � o
Date Issue Date I Al03
STRAWBALE SHED SM ;Drawn flyby Checker Scale
C Loft - Phase 7
Namagasta
www.namagasta.com
=F
OPE
GABLE
CAP
451 LOCKE RD, GROTON NY
STRAWBALE SHED SM
CONCRETE
FLOOR
L.L.I.0
q) Loft - Phase 9
No. Description Date 3D VIEWS
Project number Project Number
Date Issue Date
Drawn by Author
Checked by Checker
Scale
Al 04
DRRUGATED PIPE
JE GRAVEL
42"DEEP W/FRENCH
DRAIN AT LOWEST POINT
Foundation
1� 3/8" = 1'-0"
Namagasta 451 LOCKE RD, GROTON NY
www.namagasta.com STRAWBALE SHED SM
BLOCK
SAND
...........
CSupport Wall
3/8" =1'-01
I No.
Dacdptlon I Drb
I
I I FOUNDATION PLAN ?�
I Project number Project Number tl
Date Issue Date A201
Drawn by Author
Checked by Checker Scale 3 8" = 1-0
%r 10' - 101,
ERS OF COB
RTH, SAND,
AW & CLAY)
C
STORAGE
m
—�-- WASH
BASIN
e
I
CONCRETE
..AND FLOOR
HAY BALE _
CFinish Floor - Phase 4
3/8" = 1'-0"
Hama aSta 451 LOCKS MU, GROTON NY I "° o. l�
Q
www.namagasta.com STRAWBALE SHED SM -
OFinish Floor - Phase 9
3/8" = 1'-0"
o,u
FLOOR PLANS - ARCH
Project number Project Number
Date Issue Date
AZ 02
b
Drawn by Author
i Checked by Checker i Scala 3/8" = T.0"
I
I Fir IIIr
liillLiLitiii li
CNorthern Section - ARCH
3/8" = 1'-0"
Namagasta 451 LOCKE RD, GROTON NY
www.namagasta.com STRAWBALE SHED SM
c
No. Description
Date -
i
I ARCH SECTION
- Project number Project Number
Issue Date A301
(Date
Drawn by Author
Chocked by Checker Scale 3,8 = 1 -0
Namagasta
www.namagasta.com
OWestern Section - ARCH
3/8" = 1'-0"
451 LOCKE RD, GROTON NY
STRAWBALE SHED SM
0
N0. 'n oa ARCH SECTION
Project number Project Number
Date Issue Date
- Drawn by Author
Checked by Checker
A302
Scale 3/8" _ 1-0
A302
1 / �
i
i
CSouthern Elevation
3/8" = 1.-T
451 LOCKE RD, GROTON NY i No. Descrtptlon
Namagasta
www.namagasta.com STRAWBALE SHED SM
Data
Southern Elevation
Project number Project Number
Date Issue Date
Drawn by Author
Checked by Checker
A304
Scale 318" = T•0"
TOWN OF GROTON BUILDING PERMIT APPLICATION
Rick Fritz, Code Enforcement Officer - 607-898-4428 or 607-591-9898
No Construction shall begin until a permit has been issued.
Check documents you are supplying:
Application Form & Fee- to Groton Town Clerk at 101 Conger Blvd. (Po Box 36) Groton, NY 13073
pr, Plot plan of the lot with dimensions for new and existing structures, septic and wells.
Construction specification drawings (professional stamped drawings may be required) or Appliance specifications
tf- Completed Affidavit of Exemption for owner occupied residences
❑ If you have a contractor, proof of Workers Compensation or a signed CE-200 Exemption form.
A CE-200 can be applied for @ httos://www.wcb.nv.aov/icexemr)t/index.isr)
❑ Sewaae Svstem Construction Permit issued by the Tompkins County Department of Health, 607-274-6688 55 Brown
Rd., Ithaca, NY 14850. Applications are on their web site www.tomDkinscountvnv.gov/health/eh/owts/index
Owner e
Adolphe Alexander & Michele Judge
Name P 9
Mailing Address 101 E Cortland St, BOX 278, Groton NY 13073-0278
Project 451 Locke Rd, Groton NY, 13073 I Tax lMap2 7.21
Address
Description Large Shed
Of Work: g
Building Use
Storage
Check applicable:F-]Residential FICommercial
Serial Number of Manufactured Home
Date 01 /02/2021
Phone 2679189255
Flood Zone No
Cost $10,000
Estimate
Total Acreage Total Floor
of lot : 5.64 Area — sq ft 250
Will any part of the building be a place used by the
Public? No
Will any part of the buildinq be used for human Will any part of the building be a place of employment
habitation? No where agricultural products are processed, treated
Builder / Contractor Self or packaged? No
Name & Phone Other Builder / Contractor
Name & Phone Self
PROJECT COMPLETION or OCCUPANCY PROCESS
1. Permit will be issued upon approval of a completed application with fee and all paperwork as above.
Construction can begin with permit prominently displayed. Permit is good for a one year.
2. Once passing all required inspections including the installation of the E911 sign, the permit will be closed and a
Certificate of Occupancy or Completion will be issued.
NO OCCUPANCY OR USE IS ALLOWED UNTIL PERMIT IS CLOSEDM
I hereby affirm under penalty of perjury that all information provided in this application is complete, correct, and
contains no misleading statements. 1 understand that any false or inaccurate information contained in the
application or attachments; any construction changes made after the issuance of a building permit; or failure to
schedule required inspections, may invalidate all permits issued under this application. 1 will not remove any
buildings, structures, or other construction started or completed. I certify that 1 have read and understand the permit
process and all requirements.
I hereby license, permit and give privilege to the Town of Groton, or a designee, to enter the premises or land to
conduct any onsite inspections by owner confirmed appointment only. Such license is revoked upon completion of
the building project. I understand that no building shall be occupied, used in part or in whole for any purpose, until
first obtaining the Certificate of Om-jpancy or Completion.
Land Owner(s) Signature: Date: 03i20i2021
[ ] APPROVED
Comment:
Signed
Code Enforcement Officer
Date [ ] DENIED
Reason:
Signed
Code Enforcement Officer
VARIANCE [ ]GRANTED
[ ] DENIED
Date Date Received 5 36/1� " `4
Permit Fee
Receipt #
Activation Date
Date PERMIT #
Date Truss Decal
PLOT PLAN
❑For Interior work only
Check box & skip to Name.
MAP SHOWING THE STRUCTURE IS THE REQUIRED DISTANCE AWAY
FROM PROPERTY LINES AND OTHER STRUCTURES:
Using a survey map (or draw on the line below as the road) sketch your lot including the following :
4 Property Lines
+ Location/(or proposed) well & septic with distances to lot lines.
+ Other structures + Location of new structure/addition with distances to lot lines.
+ Center of driveway or right-of-ways 46 Location of reflective house number sign
�o
N
Indicate
North
11
- NAME -OF ROAD-0RSTRE4ET---------------------------------------------------------------------------------------------------
I
Owner Name Michele Judge & Adolphe Alexander
Lot Size Tax Map # Amount of Road Frontage
( Acres) 5.64 15.-1-27.21 183'
CERTIFICATION:
I herby affirm under penalty of perjury that all information provided in this application is complete, correct, and contains
no misleading statements. I understand that any false or inaccurate information contained in the application or
attachments; any construction changes made after the issuance of a building permit; or failure to schedule required
inspections, may invalidate all permits issued under this application. I will not remove any buildings, structures, or
other construction started or completed as a result. I certify that I have read and understand the permit process and all
requirements. I hereby authorize the Code Enforcement Officer of the Town of Groton, or a designee, to conduct all
onsite inspections by owner confirmed appointment only. I understand that no building shall be occupied or used in
part or in whole for any purpose until obtaining the Certificate of Occupancy or Completion.
Owner(s) Signature:, Date: �� �7 -Zo'Z0 2. I
Affidavit of Exemption to Show Specific Proof of Workers' Compensation Insurance
Coverage for a 1, 2, 3 or 4 Family, Owner -occupied Residence
"This form cannot be used to waive the workers' compensation rights or obligations of any party."
Under penalty of perjury, I certify that I am the owner of the 1, 2, 3 or 4 family, owner -occupied residence
(including condominiums) listed on the building permit that I am applying for, and I am not required to show
specific proof of workers' compensation insurance coverage for such residence because (please check the
appropriate box):
® I am performing all the work for which the building permit was issued.
❑ I am not hiring, paying or compensating in any way, the individual(s) that is(are) performing all the work
for which the building permit was issued or helping me perform such work.
❑ 1 have a homeowners insurance policy that is currently in effect and covers the property listed on the
attached building permit AND am hiring or paying individuals a total of less than 40 hours per week
(aggregate hours for all paid individuals on the jobsite) for which the building permit was issued.
I also agree to either:
♦ acquire appropriate workers' compensation coverage and provide appropriate proof of that coverage on
forms approved by the Chair of the NYS Workers' Compensation Board to the government entity issuing
the building permit if 1 need to hire or pay individuals a total of 40 hours or more per week (aggregate hours
for all paid individuals on the jobsite) for work indicated on the building permit, or if appropriate, file a CE-
200 exemption form; OR
♦ have the general contractor, performing the work on the 1, 2, 3 or 4 family, owner -occupied residence
(including condominiums) listed on the building permit that 1 am applying for, provide appropriate proof of
workers' compensation coverage or proof of exemption from that coverage on forms approved by the Chair
of the NYS Workers' Compensation Board to the government entity issuing the building permit if the
project takes a total of 40 hours or more per week (aggregate hours for all paid individuals on the jobsite) for
work indicated on the building permit.
03/20/2021
(Signature of HHomo`meo� (Date Signed)
Adolphe Alexander & Michele Judge
(Homeowner's Name Printed)
Property Address that requires the building permit:
451 Locke Rd
Groton NY 13073
Home Telephone Number 267-918-9255
1rSworn to before me this
County Clerk or Notary Public)
day of
Once notarized, this BP-1 form serves as an exemption for both workers' compensation and disability benefits insurance coverage.
BP-1 (12/08) NY-WCB
BACKFILL WITH
�— LARGE STONES
CGround Floor - Phase 1
C Ground Floor - Phase 2
CAP INFILL WITH
CONCRETE
CGround Floor- Phase 3
BUILD SUPPORT
WALL. FILL SPACE
W/SAND
BUILD UP HAY BALES ADD ANOTHER
TO HEIGHT OF / COURSE OF HAY BALES
/ WINDOWS 8 DOOR.
Ll-
L�y4 I t6
1.11 J�.1 Illlll 11111 tl
'.f� II I Itlt.
C Ground Floor - Phase 4 C Ground Floor - Phase 5
No. Deecriptlon Date
451 LOCKE RD, GROTON NY I 3D VIEWS
NamagastaProject number Project Number
LG STRAWBALE SHED ' Date ate Al1
Author Q
www.namagasta.com I Drawn by Author �
I Checked by Checker Scale
M
Namagasta
www.namagasta.com
O Loft - Phase 6
451 LOCKE RD, GROTON NY
LG STRAWBALE SHED
C Loft - Phase 7
C Loft - Phase 9
C Loft - Phase 8
No. Description Date a
3D VIEWS a
a
Project number Project Number
Date Issue Date Al 02
Drawn by Author
Checked by Checker Scale
BACKFILL 48" TRENCH WITH
LARGE, MEDIUM AND
CFoundation
1/4" = 1'-0"
Namagasta
www.namagasta.com
0:-4" 1:_8::
,
BLOCK
SAND
/ 1-
C SUPPort Wall
1/4' = 1'-0"
No. Description Date
451 LOCKE RD, GROTON NY FOUNDATION PLAN
Project number Project Number o
Date Issue Date i A201
LG STRAWBALE SHED
N
Drawn by Author
Checked by Checker Scale 1/4" = T-9' �v
19' - 10"
�IA
1
/r
y t1' - 01 /4" B' - 7"
Finish Floor
Q 1/4" = V-011
Namagasta
www.namagasta.com
1(
LAYERS OF COB
(EARTH, SAND, STRAW & CLAY)
WIRE BOUND HAY BALE
451 LOCKE RD, GROTON NY
LG STRAWBALE SHED
I%
/- LADDER
C Loft
1/4" = 1'-0"
No. Description Date FLOOR PLANS - ARCH
N
0
Project number Project Number di
Date Issue Date A202
Drawn by Author I
Checked by Checker I Scale 114' = Tug' q
A3D2
30' - 3 112'
CRoof
1/4" = -01, NOTES
1. INSTALL METAL ROOF PANELS, EVES, RAKES
AND CAP WITH 1 1/2" SELF DRILLING SCREWS,
451 LOCKE RD, GROTON NY No. Description Date ROOF PLAN
Nam agasta Project number Project Number
LG STRAWBALE SHED Date AuthorIssue ete A203
www.namagasta.com Drawn by Author
Checked by Checker Scale 114" = 1'-0"
R
CNorthem Section - ARCH
3/8" = 1'-0"
No. Description Date
Namaasta 451 LOCKE RD, GROTON NY ARCH SECTION
Project number Project Number
Issue
www.namagasta.com LG STRAWBALE SHED Date Drawn by Author Author ate
Checked by Checker
A301
Scale 3/6' = T-0"
I I FIT
CWestem Section - ARCH
3/8" = 1'-0"
No. Description Date
Namaasta 451 LOCKE RD, GROTON NY ARCH SECTION
Project number Project Number
9 LG STRAWBALE SHED Date AuthorIssue ate
www.namagasta.com I Drawn by Author
Checked by Checker
A302
Scale 3/6' = 1'-0"
G