HomeMy WebLinkAbout37931-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 #: 37931
Date: 4/11/2013
Permission is hereby granted to:
Grigonis, William & Grigonis, Joyce
470 Columbia Rd
Southold, NY 11971
To:
install a deer fence per Town Code #280-105-C as applied for
At premises located at:
470 Columbia Rd, Southold
SCTM # 473889
Sec/Block/Lot # 79.-6-10
Pursuant to application dated
To expire on 4/1112014.
Fees:
4/4/2013
and approved by the Building Inspector.
DEER FENCE $75.00
Total: $75.00
Building Inspector
TOWN OF SOUTHOLD
BUIJjDIi~G DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
SoutholdTown. NorthFork. net
Examined
Approved
Disapproved a/c
Expiration
APR - 4
PERMIT NO.
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
Septic Form
N.Y.S.D.E.C.
Trustees
C.O. Application
Flood ?enuit
Single & Separate
Storm-Water Assessment Form
Contact:
Mail to:
Phone:
Building Inspector
PPLICATION FOR BUILDING PERMIT
Date
INSTRUCTIONS
,20
a. This application MUST be completely filled in by typewriter or in inls and submitted to the Building Inspector with 4
sets of plans, accurate plot plan to scale. Fee according 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 applicatiou may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building luspector will issue a Building Permit to the applicant. Such a permit
shall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whOle or in part for any purpose what so ever until the Building Inspector
issues a Certificate of Occupancy.
f. Every building permit shall expire if the work authorized bas not commenced within 12 months after the date of
issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the
property have been enacted in the interim, the Building 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 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, or alterations or for removal or demolition as herein described. The
applicant agrees to comply with all applicable laws, ordioances, building code, housing code, and regulations, and to admit
authorized inspectors on premises and in buildiug for necessary inspections.
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Nameofownerofpremises IA~;II',-~ ~q. ck ~---OtAf~.o._
(As on th~ tax roll or la~est deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
70 Cc luonb',a g oac4
House Number Street
County Tax Map No. 1000 Section
Hamlet
¥73?8?
Block
Lot
Subdivision
Filed Map No./000 -O~.-~-~°ot
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy P6U--~ic-~e,-')c~ ~ _~ ~'-~ ~e>~l,~-
b. Intended use and occupancy_ ~ Ir
Nature of work (check which applicable): New Building.
Repair Removal Demolition
4. Estimated Cost ~ }, OoO. oo
5.
If dwelling, number of dwelling units
If garage, number of cars ~
Addition Alteration
Other Work
(Description)
Fee '~7~-' oo
(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 Oil l~xisting structures, if any: Front Rear
Height ~/~" Number of Stories
DD;~hnsions b/~/me structure ~Veitihgh~lterations or additions: Front
Number of Stories
Dimensions of entir~ ~ew construction: Front Rear
Height /{,//~ Number o~ Stories
Size of lot: Front '[ //7, lot t//5
Rear /~/, Depth
11. Zone or use district in which premises are situated
Depth
Rear
Depth
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__ ?,tPr
14. Names of Owner of premises/,d~mt~e J'~ e ~/0'oO-t,~ddress ¢70 ~/, ~,b~/ Phone No. '~ 5"-~'26; 7
Name of Architect Address Phone No
Name of Contractor Address Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO x~
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED.
b. is this property within 300 feet ora tidal wetland? * YES NO__
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below', must provide topographical data on survey.
18. Are there any covenants and restrictions with respect to this property? * YES NO >{
· IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF
~ MF---~-~ ~:::'t~ 0 ¢3 t~ being duly sworn, deposes and says that (s)he is the applicant
(Namelof individual sig~g contract) above named, ,;ONN!E i3. BUNO~4
(S)He is the
(Contractor, Agent, Corporate Ofl'icer, etc.)
of said owner or owners, and is duly atttborized 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 knowledge and belief; and that the work will be
performed in the manner set forth in the application filed therewith.
Notary Public
67'
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Z~70 COLLIMDIA 12.0AP..f~IJTLIOLD