HomeMy WebLinkAbout49478-Z X�gUffQlKTOWN OF SOUTHOLD
BUILDING DEPARTMENT
go 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#: 49478 Date: 7/14/2023
Permission is hereby granted to:
Baker, Charles
PO BOX 394
Orient, NY 11957
To: install deer fence as applied for.
At premises located at:
33000 Route 25, Orient
SCTM #473889
Sec/Block/Lot# 19.-1-14.5
Pursuant to application dated 6/8/2023 and approved by the Building Inspector.
To expire on 1/13/2025.
Fees:
DEER FENCE $75.00
Total: $75.00
Building Inspector
=oy�SOFFO�RCob TOWN OF SOUTHOLD—BUILDING DEPARTMENT
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,southoldtownny_gov
Date Received
APPLICATION FOR BUILDING PERMIT
7
`' ` 1
For Office Use Only '"� �-�'LI V/
PERMIT NO. Building Inspector: J JUN _ 8 2023
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the-owner,an' f�'
Owner's Authorization form(Page 2)shall be completed. ' '
Date: ce1.Lnt 1R- Jba 8
OWNER(S)OF PROPERTY:
Name: LAoA bz/ ak-p-A SCTM #1000-
Project Address: 83&op Mat/'1 2d Orl'�e } 7? . 11467
Phone#: (D31- SDS tv,) Email:_,p
Mailing Address: P.6. &1
CONTACT PERSON:
Name: C
Mailing Address:
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name: n Q
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Ja
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
00ther , m6c ED 8f
Will the lot be re-graded? ❑Yes Ao Will excess fill be removed from premises? ❑Yes ❑No
1
PROPERTY INFORMATION
Existing use of property: Intended use of property: cJG J
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes ONO IF YES, PROVIDE A COPY.
❑ Check 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 210.45 of the New York State Penal Law.
Application Submitted By(print name): C/4A42LLS &hfEf-2 ❑Authorized Agent Elbwner
Signature of Applicant: L�JI(�. �` V Date: (O/ef a3 �
STATE OF NEW YORK)
SS:
COUNTY OF SU"I c)l K )
-bo K p, being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the l Il lmP,
(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 ,T n� , 20
o ary Public
TfiA EY L. OWYER
NOTARY PUBLIC,STATE OF NEW YORK
PROPERTY OWNER AUTHORIZATION NO.01 DW6306900
(Where the applicant is not the owner) QUALIFIED IN SUFFOLK COUNTY
COMMSSION EXPIRES JUNE 30,2P-(p
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
1qw
'FOLK CO. HEAL rb 1 E*'?. AMk.
H. S NO'.
-
APPRO ED AS NOTED
STATEMENT OF INTENT_
DATE: B.P. THE WATER SUPPLY AND SEWAGE DISPO'Sgi._
FEE: B`r:� � a �Qk�l SYSTEMS FOR THIS RESIDENCE W(l,'L
NOTIN BUILDING -FFARTMENT AT 96 ruo matA pc I CONFORM TO THE STANDARDS OF T4
7651802 8AM TG 4rMi FOR THE RCrr pr,Q�- I SUFFOLK CO. DEPT. OF HEALTH SERVICEca
FOLLOWING INSPECTIONS:
l51
1. FOUNDATION - TWO REQUIRED /Ct S I APPLICANT
FOR POURED CONCRETE 1.
2. ROUGH - FPAM;'1G & PLUMBING I SUFFOLK COUNTY DEPT. OF HEALTH
3. INSULATION
SERVICES - FOR APPROVAL OF
;. FINAL - CCN'� MUST
BE COMP:.E" \ _ F CONSTRUCTION ONLY
ALL CONSTRUL r:HLL MEET THE
)EQUIREMENTS 'r �:ODESOFNE�r J� \ f � H. S- REF. NO _
YORK STATE. NOT RESPONSIBLE FOP. � i �j{vC� \ � 'p
APPROVED
)ESIGN OR CONSTRUCTION ERRORS.
>� . _ "� SUFFOLK CO. TAX MAP DESIGNATION
COMPLY WITH ALL CODES OF -� \ KCAL� I + DIST. SECT BLOCK PCL
NEW YORK STATE & TOWN CODES AP—CA_f ,:,
AS REQUIRED AND CONDITIONS OF t --
OWNERS ADDRESS:
v BOARD
0,,i D � TEES _
s d r \ DEED: L. P.
TEST HOLE STAMP
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,,.:TAtN STORM WATER RUNOFF `�(jl ------- RODER ICK VANJUYL."P.C.`" -` ;" `a4•IAY:' � ?w� h�{
PURSUANT TO CHAPTER 236
OF THE •_W.i CDD �fI i_��
r PJ� LICENSED LAND SURVEYORS
GREENPORT NEW YORK ,
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