HomeMy WebLinkAbout46756-Z �5�FQj�,co TOWN OF SOUTHOLD
ay BUILDING DEPARTMENT
y x 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#: 46756 Date: 8/30/2021
Permission is hereby granted to:
Smith, Gregory
200 Shipyard Ln
East Marion, NY 11939
To: Install deer fencing at existing single family dwelling as applied for.
At premises located at:
9330 N Bayview Rd, Southold
SCTM #473889
Sec/Block/Lot# 79.-8-12.4
Pursuant to application dated 8/6/2021 and approved by the Building Inspector.
To expire on 8/30/2022.
Fees:
DEER FENCE $75.00
Total: $75.00
Building Inspector
gtlff0l� TOWN OF SOUTHOLD-BUILDING DEPARTMENT
z Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959
�y�o• �ao�� Telephone (631) 765-1802 Fax (631) 765-9502 https://www.southoldtomLnny.gov
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Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. Building Inspector: �
9
Applications and forms'.,must�be filled out in their.entirety.-Incomplete
applications will not be accepted: Where the Applicant is not the owner,an ��� I ��' I ►_ � �}�� i V
Owner's Authorization form(Page 2)shall be completed. -"—�-
Date: ,�f/'!6 / 2,o--L(
OWNER(t)OF PROPERTY:
Name: � ear S CTM#1000-
ProjectAddress: 9330 A/, /2A-`1VIC--W R6 _ c u i Il`! --
Phone#: w_ T �Z® 6 ��-� Email_ _S_f�
Mailing Address:
CONTACT PERSON
Name: ---
Mailing Address:
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION: 21T . .
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:, ' 1 ;
Name: j�n
Mailing Address: 7
Phone#: ( 7GS'' S4'7( Email: 5S LAW Al (2 A0 ( � C-0 V1/\
,DESCRIPTION OF PROPOSED'CONSTRLICTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
Other_ IFGN C.E 4- 66�- -une,6 $ ®00
Will the lot be re-graded? ❑Yes Woo Will excess fill be removed from premises? ❑Yes
1
PROPERTY INFORMATION `
Existing use of property: Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? []Yes Cho IF YES, PROVIDE A COPY.
Check Box After'Reading: The-owner/contractor/design professionaLis responsible fdrall drainage and storm water issues as provided by
Chapter'236 of the Town,Code. 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,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 oh premises and in building(s)for necessary inspections.False statements made herein are
punishable as a Class"A misdemeanor pursuant to Section 230.45 of the New York State Penal Law.
Application Submitted By(print na )• �AL 114, 5/;!//7'A]Authorized Agent 12(Owner
Signature of Applicant: Date: 2i�
STATE OF NEW YORK)
SS:
COUNTY OF )
L/ /!/f '
+� / ny being duly sworn, 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.)
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/her knowledge and belief; and
that the work will be performed in the manner set forth in the application file therewith.
Sworn before me this
day of 120
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
I, residing at
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signature Date
Print Owner's Name
2
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OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE'
APPROVED AS NOTED OF OCCUPANCY
DATE: F'30 2 B.P.#
FEE. - -�Zw�
5 BY:
NOTIFY BUILDING DEPARTMENT AT
�35-1802 8 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS
t FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATION COMPLY ,
4. FINAL - CONSTRUCTION MUST
WITH �+-� C,���
BE:COMPLETE FOR C.O. NEW YORK STATE & TO-
WN
ALL CONSTRUCTION SHALL MEET THE AS REQUIRED AND CONDITIONS•
REQUIREMENTS OF THE CODES OF NEW
YORK STATE. NOT RESPONSIBLE FOR SOUTHOLDTO4NNZBA
DESIGN OR CONSTRUCTION ERRORS. SOUTHOLD TOWN PLANNING 804;�
SOUTHOLD TOWN TRUSTEES
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EN LASE P6OL TO r_,
UPON COMPLET'r,t,
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