HomeMy WebLinkAbout49293-Z r
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�o�SUFFo�,��oTOWN OF SOUTHOLD.
BUILDING DEPARTMENT
y, TOWN CLERK'S OFFICE
• 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#: 49293 Date: 5/22/2023
Permission is hereby granted to:
Latham, Stephen
PO BOX 595
Southold, NY 11971
To: install deer fence as applied for.
At premises located at:
60 Rogers Rd, Southold
SCTM # 473889
Sec/Block/Lot# 66.-2-19.1
Pursuant to application dated 4/21/2023 and approved by the Building Inspector.
To expire on 11/21/2024.
Fees:
DEER FENCE $75.00
Total: $75.00
Building Inspector
o�g�FFO(,t�G TOWN OF SOUTHOLD—BUILDING DEPARTMENT
y�
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959
oy�0 ail Telephone (631) 765-1802 Fax (631) 765-9502 hqps://www.southoldtownny.gov
Date Received
APPLICATION FOR BUILDING PERMIT
24 ,1
For Office Use Only -
1� IL, I� II M I�
PERMIT NO. Building Inspector:
HAPR 2 1 2023
Applications and forms must be filled out in their entirety.Incomplete
8UIapplications will not be accepted. Where the Applicant is not the owner,an V Ub-l.
T®WN OpsDu 6Tc-9DB n
Owner's Authorization form(Page.2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: QTc 4 IV L-197-- g/Y SCTM # 1000-
Project Address: O P_OC F P_S E04-C> -')o 07-40 Z-7 y 11q71
Phone#: ��I- /.lD 5 .�(� O/ TTM11. M6 F_IL_17%+x/7" Doll
Mailing Address: P 0 .gOx 5q6' SOv*6LlZ) I/ /1,x/7
CONTACT-PERSON:
Name: ,/O,+A/
Mailing Address: Ra, &X 6 JC S U7-*jL-D y //�7/
Phone#: 76-6-- 36 6( Email:
DESIGN PROFESSIONAL INFORMATION:
Name: C,1-6
Mailing Address:d. &X �T ������,� 0-16&rU
Phone#:f, '76.5 44(o l Email:��f2/SMD/�.��iVT�,eI>�1
CONTRACTOR INFORMATION: ti
Name:
MailingAddress:
P�
Phone#: ���`�� _ / Email �S�d����t1EP�/SSS /I/U Caf/
DESCRIPTION'OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration El Repair El Demolition Estimated Cost of Project:
❑Other }S� ,P /=�N<�� $ 2000 , Oa
Will the lot be re-graded? ❑YesXNo Will excess fill be removed from premises? ❑YesxNo
1 (2ec- ioLi6 o (
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PROPERTY INFORMATION
Existinguse ofproperty: Intended use of property: /�5 ID FAJ77141-
��S�7J.E-�/,�Z_
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑YesNo IF YES, PROVIDE A COPY.
VChdck Box After Reading: The owner/contractor/design'professional is responsible for all 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 on'premises and in building(s)for necessary inspections:False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 210,AS of the.New York State Penal Law.
Application Submitted B (print name)- ❑Authorized Agent ❑Owner
Signature-of Applicant: �l O Date:
Marilyn Daly
STATE OF NEW YORK) NOTARY PUBLIC,STATE OF NEW YORK
SS: Registration No.01DA6113067
Suffolk County
COUNTY OF YN r-11-C.14-IC- ) Commission Expires July 19 2024
/)l4 Vje.j A—V being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing co tract) 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
jday of A An-1 L , 20��
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
AW 4
AP R UED AS SNOT D
"t-T,
•. -DATE.
p.
- 5
FEE: BY:
� _j NOTIFY BUILDING. DEPARTMENT- 'fi , .�!x°z . n -T
765.1802 BEAM. TO 4 PM FOR THE � r� •
AFOLLOWING INSPECTIONS: ;
l: FOUNDATION..-,TWO REQUIRED
f FOR,,POURED CONCRETE
2• ROUGH t=:.FRAMING'& PLUMBING � -
'3. INSULATIONJ.
r ;
.4: FINAL CONST^..�''T!0N MUST
BE.COMPLETE Y r. {
f
ALL CONSTRUCT!.".,
r � .-
.�.., ..'-ALL MEET'.THE
_REQUIREMENTS OF 1 Nt CODES CSF NEW
YORK STATE. NOT RESPONSIBLE FO „
DESIGN.OR`. CON,STRUCTION='ERRORS.
Zr '; - � xd`: _ - __. qtr,. 93 •_ � - .. ."
COMPLY WITI+ALL CODES OF
NEW.YORK,STATE &:TOWN-COD ES�",`J`
AS.REQUIRED ND.CONDITIONS
' �-�'ef
t ar
L NG BOARD?:
Srnrn n TnwN TRUSTEES �- a
RETAIN STORM WATER RUNOFF { a
>>' PURSUANT TO CHAPTER 236,
g. OF THE TOWN CODE.
bd
+ unaatfmraedIx"
aeration orilddlt(att' _ _ ?
to this survey is a violation of f
Seotion 7�8 of 0b New York State q �, ? i _`
Educat+on Lew
4, -a
Copies of this survey map`rioi bearing R f 'd" K 'y^�3„ r �
r fie far,d'surveyo inked"seal or >.
g
em 's shall not be cans+derad _�' -- ..._-.,_ - O _
7 to b a valid tiue'copy •.--
C1i ra+ahtees ditGaated he'son strati rtin .,sy r - +t r j
fspretR?Jlepepared andorrhishbehaUlotheeY .L�
tdie.Comparry.governmental agency and
P7 tenifing u,stuuuon iisted i on and
3 totheassgneesofthelendufgiristt- �,.. ix
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tu8otr.Guaranteesarenattiansferabf9, _
i,fo add�ional kstiiutions o[ tuequeid'
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