HomeMy WebLinkAbout52177-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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#: 52177 Date: 08/12/2025
Permission is hereby granted to:
William Nystrom
79 Pine St
Dover, MA 02037
To:
Construct a deer fence to an existing single-family dwelling as applied for.
Premises Located at:
1815 King St, Orient, NY 11957
SCTM#26.-2-43.6
Pursuant to application dated 07/15/2025 and approved by the Building Inspector.
To expire on 08/12/2027.
Contractors:
Required Inspections:
Fees:
DEER FENCE $100.00
Total S.100.00
Building Inspector
40
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 htt s://www.southoldtownn . ov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only � 8 VErm
L
PERMIT NO-0 Q\ Building Inspector:,
U0
A,) JUI 2025 U
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an Building Department
Owner's Authorization form(Page 2)shall be completed. Town of Southold
Date:
OWNER(S)OF PROPERTY:
Names. , Q SCTM# 1000-
Project Address:
Phone#: S'6 g Email: s�f-rc�MS t �1V N a ,
Mailing Address: 0 3 f Q T E5 N T
CONTACT PERSON: a
Name: S,, 2-,,Pt h n L
Mailing Address: 'P, d . Q Gq- fVI+ Jv
Phone#: �v Sr '�!! �5� Email: N S' �✓l53 2if.R'm,l rIgM
DESIGN PROFESSIONAL INFORMATION:
Name:
TA-u
w
Mailing Address: Z�rJ a e�c 1 QP O l3
Phone#: 21 Z 2 1 - U! d p Email:
CONTRACTOR INFORMATION:
Name:
LSLrL q.
Mailing Address: '"` ✓1 P �- ,
Phone#: / 7 2 2 b Email: d co t 'n o!21 / 1 -,L
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑ p
Re air ❑Demolition EstimatedCo
st of Project:
Other DE� 6& F- E AJ C $ e) D
Will the lot be re-graded? ❑Yes.�Vo Will excess fill be removed from premises? ❑Yes k.N0
1
PROPERTY INFORMATION
Existing use of property: Intended use of property: y
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
26 VLA-- O this property? ❑YesVNo 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.ad raft authorized Inspectors on premises and In building(s)for necessary Inspections,False statements made herein are
punishable�a,Class A misdemeanor pursuant to Section 210AS of the New York State Penal Law.
Application Submitted By riint name): z ! U l/S+>�o/jl []Authorized Agent MOwner
Signature of Applicant: Date: j U �, 2 0 Z5
STATE OF NEW YORK)
--' SS:
COUNTY OF r-FOL L )
i
/V__w S 7 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 knowled n bli f
that the work will be performed in the manner set forth in the application file therewith, CAROLINE M MACARTHUR
tars Public-State of New York
NO.01MA6384635
Sworn before me this ' uauhed in Suffolk County
My.omission Expdres Dec 17,2026
.
day of JULY .2D
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