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Home My WebLink About39381-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#: 39381 Date: 11/24/2014 Permission is hereby granted to: Koubek, Stanley 2495 Rocky Point Rd East Marion, NY 11939 To: Construct a deer fence in the required rear yard as applied for At premises located at: 2495 Rocky Point Rd, East Marion SCTM # 473889 Sec/Block/Lot# 30.-3-4 Pursuant to application dated 11/13/2014 and approved by the Building Inspector. To expire on 11/24/2015. Fees: DEER FENCE $75.00 Total: $75.00 ' 1 ��--CSC-- - Building Inspector TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD, NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 n Survey Sou tholdTown.NorthFork.net PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined / 20 I 1 Single&Separate 13 2014 Stone-Water Assessment Form I� Contact: Approved //k-v20, � q;n;; i. Mail to:"--Lf q-1 t S R g e�Zc�1 �� Disapproved a/c T� -i''I D Phone: Al—7"� —3-5'?f Expiration I ,20_4kn T'—fruilifing Inspector APPLICATION FOR BUILDING PERMIT Date 14 , 204 INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink 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 application may not be commenced before issuance of Building Permit. d. Upon approval of this application,the Building Inspector 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 has 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, ordinances,building code,housing code,and regulations,and to admit authorized inspectors on premises and in building for necessary inspections. (Signage of applicant or name,if a corporation) '2-4(1 Qa&V_�-t Pc,/Wr /� IIci3q (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder aW/JL.RZ Name of owner of premises STH tJ 4-.I—= D U �K (As on the tax roll or latest 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 whichroposed work will be done: '2-g9S R6e-ky ijo to R _ C-05 i Mi RioN 3C, House Number Street 3 Hamlet County Tax Map No. 1000 Section 3 Block Lot Subdivision Filed Map No. R-75"i Lot 2. State existing use and occupancy of premises and i tended use and occupancy of proposed construction: a. Existing use and occupancy e.g ,2 n CLQ b. Intended use and occupancy P 2 S t a-eh C P_ 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work V- Pjprj(P j via (Description 4. Estimated Cost ;k-'s-00166 Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units Number•o f dwaijing units on each floor If garage, number of cars "2- 6. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. I 7. Dimensions of existing structures, if any: Front Rear 15 - , S Depth 3 (o -2- Height Number of Stories I Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories l 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front 140.0 6 I Rear l 34 ,5 S Depth nJ 3 I r 2Z- S 3 o a,6a 10. Date of Purchase o O`er Name of Former Owner S C l-t L_M R ( CO/J TR AC'T/Aj G_ 11. Zone or use district in which premises are situated 9(go 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO/Will 13. Will lot be re-graded? YES NO excess fill be removed from premises? YES NO 14.Names of Owner of premises S'�A_ yaat ddressa.-/QS R�,et�.,pf Phone No. (��1 -4 7`1 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 * 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. 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? * YESNO * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF SfOY1 (A�k- being duly sworn,deposes and says that(s)he is the applicant (Name of individual igning contract)above named, (S)He is the mnakz (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 knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. S V4 before me thi f-� day ofh2tM20 Notar' lic MELANIE DOROSKI Sign ure of Applicant NOTARY PUBLIC,State of New York No.01 D04634870 Qualified in Suffolk County Commission Expires September 30, Scott A. Russell 41 Si]FOIKIAWA SUPERVISOR a � AN.A�(G]EMI]ENT to I��l[A SOUTHOLD TOWN HALL-P.O.Box 1179 p 53095 Main Road-SOUTHOLD,NEW YORK 11971 y�'�� Town of,Sou th o l d CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) ---------- ---- ------ -- - .. _. .. .._ ........_ .__..- DOES THIS PROjECr INVOLVE ANY OF THE FOLLOWING: F Yes 5/A. (CHECK ALL THAT APPLY) t Clearing, grubbing, grading or stripping of land which affects more han 5,000 square feet of ground surface. ❑ B. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area.-- which exceed 10 feet vertical rise to 100 feet of horizontal distance. Fj[3"/D. Site preparation within 100 feet of wetlands, beach, bluff or coastal I erosion hazard area. E Ef"E. Site preparation within the one-hundred-year f loodplain as depicted /.on FIRM..Map of any watercourse. �, Installation of new or-resurfaced impervious surfaces of 1,000 square feet or more, unless prior approval of a Stormwater Management Control Plan was received by the Town and the proposal includes in-kind.replacement of.impervious.sur-f..aces.. _. ...._._.__..__. If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name, Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project. If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan and a completed Check List Form to the Building Department with your Building Permit Application. - S.C.T.M. a: 1000 Date. APPLICANT: (Property Owner,Design Professional,Agent,Contractor,Other) ( � District / NAME 0 U t Section Block Lot FOR BUILDING DEP:;R-rN_jLNT USE ONLY Contact Information l —4—1 Reviewed By: — — — — — — — — — — — — — — — — — — Date: Property Address/ Location of Construction Work: — — — — — — — — — — — — — — — — Approved for processing Building Permit. rJ q S R0(,—k L4 O i/J T ''RA P. _ — — Stormwater Management Control Plan Not Required- E�S j A4AR 1p� , 04 1 1 e(,3q Stormwater Management Control Plan is Required. (Forward io Engineering Department for Review-) FORM ' SMCP -TOS MAY 2014 I' . 41 inp. p MT �i'�« d i e ' Al ! 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