HomeMy WebLinkAbout37677-ZTOWN 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 #: 37677
Date: 12/10/2012
Permission is hereby granted to:
Billinghay, Justin & Scavone, Melissa
4505 Vanston Rd
Cutchogue, NY 11935
To;
construct a Deer Fence as applied for
At premises located at:
4505 Vanston Rd, Cutchogue
SCTM # 473889
Sec/Block/Lot # 111.-14-5.2
Pursuant to application dated
To expire on 6/1112014.
Fees:
11/28/2012 and approved by the Building Inspector.
ALTERATION OF ACCESSORY BUILDINGS
Total:
$75.00
$75.00
Building Inspector
TOWN OF SOUTHOLD
BUILI~ING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
SoutholdTown. NorthFork.net
Examined
PERMIT NO.
707
7
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
4 sets of BuiLding Plans
Planning Board approval
Survey.
Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O. Application
Flood Permit
Single & Separate
Storm-Water Assessment Form
Approved
Disapproved a'c
Contact:
Phone:Ct \-~
/~,~/.~' ,, ~, PPLICATION FOR BUILDING PERMIT
., , INSTRUCTIONS
a. This ap~ npletely filled in by ~pewriter or in ink and submitted to the Building Inspector with 4
sets of plans, accurate plot plan to scale. Fee accordiag to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or
areas, and waterways.
c. The work covered by this application may not be commenced betbre issuauce of Building Permit.
d. Upon approval of tiffs application, the Building Iospector will issue a Building Permit to the applicant. Such a permit
shall be kept on the premises available lbr inspection throughout the work.
e. No building shall be occupied or used in whole or in pail for any purpose what so ever until the Building Inspector
isstles a Ce~ificate of Occupancy.
[ Every building permit shall expire if the work autborized bas not commenced within 12 mouths after the date of
issuance or has not been completed withiu 18 months from sach date. If no zoning amendments or other regulations affecting the
prope~y have been enacted in the interim, the Buildiog Inspector may authorize, in writing, the extension of the permit for an
addition six months. Thereafter, a new permit shall be required.
APPLICATION IS HEREBY MADE to the Building Department for the issuance ora Building Permit pursuant to the
Boilding Zoue Ordiuance of the Town of Southold. Sufl¥lk County. New York. and other applicable Laws, Ordinances or
Regolations, for the construction of buildings, additioos, or alterations or fbr removal or demolition as hereiu described. The
applicant agrees to comply with all applicable laws. ordinances, building code. housiug code, aud regulations, and to admit
authorized inspectors on premises and in building lbr necessary inspections.
(Signature of applic~t or ~me, if a corporation)
(Mailing address orapplicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises ~ \,~>~ ~' ~-~,..)'"~V~ G ~_~\(\ rk6¥N~"-'~C
_~6~xJ o ~ (As on the tax roll or latest deed)
If applicant is a corporation, signature of doly authorized officer
(Nmne and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
Location of land on which proposed work will be done:
ttouse Number Street
Hamlet
CountyTax MapNo. 1000 Section { I~ Block lq Lot ~', ~2, .
Subdivision Filed Map No. Lot
State existing use and occupancy of premises and intended nde and occupaucy of proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy ~'eJlCe-
Nature of work (check which applicable): New Building
Repair Removal Demolition
Estimated Cost I)/~,?'Dt3 %Ot~-~-:-- --- -- Fee
If dwelling, number of dwelling units
If garage, number of cars _~,
Addition X Alteration
Other Work
(Description)
(To be paid on filing this application)
Number of dwelling units on each floor
If business, commercial or mixed occupancy, specify nature and extent of each type of use.""~
Dimensions of existing structures, if any: Front
Height. Number of Stories
Rear Depth
Dimensions of same structure with alterations or additions: Front Rear
Depth_ Height. Number of Stories
Dimensions of entire new' construction: Front Rear ~p~h~ ~0~
Height Number of Stories
9. Size of lot: Front Rear Depth
10. DateofPurchase Ptt,(v 15 ~q.011, Namc of Former Owner M¢~x/
l 1. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law. ordinance or regulation? YES NO
13. Will lot be re-graded? YES NO__ Will excess fill be removed from premises? YES NO
14. Names of Owner of premises
Name of Architect
Name of Contractor
Address Phone No.
Address Phone No
Address Phone No.
15 a. Is this property within 100 feet cfa tidal wetland or a fi'eshwater wetland'? *YES__ * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES NO ~
* IF YES, D.E.C. PERMITS MAY BE REQUIRED. "-
NO, X.
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at l 0 feet or below, must provide topographical data on survey.
18. Are there any covenants and restrictions with respect to this property? * YES NO ~N~
· IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF )
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.)
CONNIE D.
Nott~/Public, State
No rllgt
Qualified [r~ ~'
Commission
of said owner or owners, and is duly autborized to perform or bare performed the said work and to make and file tiffs application;
that all statements contained in this application are true to the best of bis knowledge and belief: and that the work will be
performed in the manner set forth in the application filed therewith.
Sworn to before me this ~
_~'"~ctq day o f~CD~]~w~.~-O~ 20/c~
Notary Public
Signa~uT~e o f A pplica,k3 ~'