HomeMy WebLinkAbout47210-Z �o�g�4fD1K�G TOWN OF SOUTHOLD
j Gyp BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
eg 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* 47210 Date: 12/9/2021
Permission is hereby granted to:
Daley, Sylvia
PO BOX 574
East Marion, NY 11939
To: legalize "as built" deer fence as applied for.
At premises located at:
975 Tucker Ln., Southold
SCTM #473889
Sec/Block/Lot# 59.-10-13
Pursuant to application dated 11/9/2021 and approved by the Building Inspector.
To expire on 6/9/2022.
Fees:
DEERFENCE $150.00
Total: $150.00
Buil ng nspector
�av
�rrot� TOWN ON'SOUL'HOLD—BUILDING J)EPAR1'MEN'1'
1'ownHall Annex 54375 Main Road P. U.Box 1179 Southold, NY 11971-0959
Telephone(631) 765-1802 Fax(631) 765-9502 hfts://www.southoldtownny.gov
Date Received
APPLICATION FAR BUILDING PERMIT nn
,/� croffice use only D E C E n� U
PERMIT NO.��� Building Inspector: NOV O 9 2021 D
Applications and forms must be filled out In their entirety.Incomplete BUILDING DEPT.
applications will not be accepted. Where the Applicant Isnot the owner,an TOWN OF SOUTHOLD
Owner's Authorization form(Page 2)shall be completed.
Date: OvrvB, +
OWNER(S)OF PROPERTY:
Name: _S\ V( A tC SCiM#1000- 5 Gi
Project Address: U5T /X),-./
Phone#: ( 6 6 Email: t(E AcAA&
Mailing Address: po
CONTACT PERSON:
Name: �.
Mailing Address: j
Phone#: 6 l b g Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#s: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone##: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structqe ❑Additi ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
)1�6ther d-eer 't�YY�, $
Will the
lot be re-graded?
❑Yess 0 N WIII excess fill be removed from premises? ❑Yes ❑No
l PWS � P Q
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 ❑No IF YES, PROVIDE A COPY.
Cheek Box After Reading: The owner/contractor/design professional is responsible for all drainage and stone 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 Perm!t pursuant to the Building Zone
Ordinance of the Town of Southold,Suffolk,county,New York and other applicable Laws,Ordinances of Regulations,for the construction of buildings,
additiow,alterations or for removal or demolition as herein described.The epplicent agrees to comply with all app0ceble laws,ordinances,building code,
housing code and regulations and to Wmlt authorized Inspectors on premises and In building(s)for necessary Inspection.False statements made herein am
punishable as a Class A misdemeanor pursuant to Section 220.45 of the New York State Penal Law.
Application Submitted By krint name): ` V( A I�L ❑Authorized Agent Owner
- - --- ---- --- -
Signature of Applicant: — Date: n _Rct _ 21
STATE OF NEW YORK) f
COUNTY OF ,
%I V f a being duly sworn, deposes and says that(s)he is the applicant
(Nam of individual contra,&)above named,
(S)he is the l w n-C r
(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
��
a:h—day of—� r . i7 P-� 20 2 �—
Notary Public
TRACEY L.UNYER
NOTARY PUBLIC,STATE OF NEW YORK
PROPERTY OWNER AUTHORIZATION IED IN SUFFOLK C
QUALIFIED IN SUFFOLK COUNTY
(Where the applicant is not the owner) COMMISSION EXPIRES JUNE 30,2oa a
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
S.C.T.M.N0. DISTRICT: 1000 SECTION:59 BLOCK: 10 LOT(S):iJ
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suRKY M:OESCRIBED PROPERTY CERTIFIED TO. SYLVIA DALEY',
YAP M, NJ LENDERS CORP.:
IDELNY NATIONAL TITLE INSURANCE COMPANY, LONG ISLAND
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