HomeMy WebLinkAbout44953-Z .gfv!,- at TOWN OF SOUTHOLD
BUILDING DEPARTMENT
C, !A1-1 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#: 44953 Date: 7/7/2020
Permission is hereby granted to:
Stern, Arnold
363 Ambrose Ln Unit L-104
Bainbridge Island, WA 98110
To: install a deer fence as applied for.
At premises located at:
3080 Bay Shore Rd., Greenport
S'CTM # 473889
Sec/Block/Lot# 53.-6-39
Pursuant to application dated 6/29/2020 and approved by the Building Inspector.
To expire on 7/7/2021.
Fees:
DEER FENCE $75.00
$75.00
Building Inspector
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applymg9
TOWN HALL Board of Health
SOUTHOLD,NY 11971 4 sets of Building Plans
TEL:(631)765-1802 g Board approval
FAX: (631)765-9502 rvey � d �(�r
Southoldtownny.gov
PERMIT NO. heck
Septic Form
NYSDEC
Trustees
C 0 Application
Flood Permit
Examined 20 Single&Separate
Truss Identification Form
Storm-Water Assessment Form
ontact:
Approved 20 Mail to
Disapproved aic
Phone
Expiration 20
- -
g Inspector
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1
.JUN 2 9 2020 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
Y 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 interum,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 herem 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)
Al i Y, Al,, 1 0 0 (Mailing address of applicant)
State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder
Name of owner of premises 4 rim p�G� � i-ek'l ew G{ kc,&, I PSV! a Vail 2a4l+e ki
(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. Locationcyon whi proposedSo will be do
-30o p- m a/
or ?1. 11 of
House Number Str oe / Hamlet .l
County Tax Map No. 1000 Section��00 Block O q . 0 Lot 0 .3 !q ,# Q 0O
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 D
b. Intended use and occupancy y" aI.h
' 3. Nature of work(check which applicable):New Building Addition Alteration
Repair Removal Demolition Other Work -
(Description)
4. Estimated Cost 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.
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 Height Number of Stories
8. Dimensions of entire new 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
12.Does proposed construction violate any zoning law,ordinance or regulation?YES NO
13.Will lot be re-graded?YES NO Will excess fill be removed from premises?YES NO -
14.Names of Owner of premises Address Phone No.
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 j
NO
*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
* 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
*IF YES,PROVIDE A COPY.
STATE OF NEW YORK)
_� SS At-lvo1� Ehelve1ti
COUNTY OF /r/ 1 )
being duly swom,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the
(Contractor,Agent,Corporate Officer,etc)
FS'NH U-IM
of said owner or owners,and is duly authorized to perform or have performed the said work and to make and hJ&0A,,apVbEji$i}ATE OF NEW Y0R
that all statements contained in this application are true to the best of his knowledge and belief,and that the work will bolo 01 LA6108641
performed in the manner set forth in the application filed therewith Qualified in Kings County ;
My Commission Expires April 20� `If
Sworn �b,�fore me this n 0
day t1`(/-'C 20
Notary Pubhc pplicant
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SITE PLAN
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FOR INSTALLATION OF DRAINAGE STRUCTURES THE CONTRACTOR SHALL EXCAVATE THROUGH THE CLAY LAYER TO CLEAN SAND.
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