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Home My WebLink About40015-Z TOWN OF SOUTHOLD ,�'gUFFDL ��o�° 414 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#: 40015 Date: 8/18/2015 Permission is hereby granted to: Lesica, Jerry & Lesica, Mirjana 1670 Wells Ave Southold, NY 11971 To: install a deer fence as applied for. At premises located at: 1670 Wells Ave, Southold SCTM # 473889 Sec/Block/Lot# 70.-3-13 Pursuant to application dated 8/13/2015 and approved by the Building Inspector. To expire on 8/17/2016. Fees: DEER FENCE $75.00 tal: $75.00 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 "700/S� Survey 1 .1ci A3f (\CQ SoutholdTown.NorthFork.net PERMIT NO. Check ' '? 6 , co Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined ,20 Single&Separate Storm-Water Assessment Form ji <' Contact: Approved ,20 Mail to: Disapproved a/c G Phone: s-1 6- �,)U Expiration ,20 / 4 Lr' _ ceding ns:: for 1 AUG 1 3 NI§ �1 PPLICATION FOR BUILDING PERMIT J Date , 20 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. APPROVED AS Nle QEDX - DATE: .-,.,-,_-._, L,P.4....w.-------------.- (S:nature//applicant or e,if a corporation) NOTIFY,..R;„�p -i'„ -i--d. r 'EINT A, /670 RIF' 1 ATE SOU ' 765-1802 8 AM i`: ,'M FOR (Mailing address of applicant) if 77/ FOLLOWING INSFEC,TIOT:.: State yvlri�upplipantfilsmw, el+, E lee, agent, architect, engineer, general contractor, electrician, plumber or builder FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION Name'!oilWher 6 UFO ION ML!!1Ej2RV M 1 g3-4,✓.¢9 ESiG4- BE COMPLETE FOR C:O. (As on the tax roll or latest deed) If appfi arCinATc it � .t�oiSil-! i ' duly authorized officer REQUIREMENT OF THE C �b Y K TATE NOT 3E3I'ONSIQL C, Builders-LMeCgicense c#WReerT MPtEf�P far Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed wok will be done: House Number Street Hamlet i_.i",' .A ?:1'_% 1. County Tax Map No. 1000 Section °'®' 06 '4iBlockk '6:3';.:DO' r ' ' Lot 013 d 0 00 ,, -. „'+r..,, JI, : 'J .,3 Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. ntended use and occupancy I/V d-1- 1EEJ F i.d,SE./FENS-67 {cy_,ANT E 6 (W. 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work ✓ (Description) 4. Estimated Cost Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear _ Depth ," Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase (3—/7— 20(3 Name of Former Owner P4-77t Ldp)c- AL/ AfEY 11. 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 zik-g s1C13- 1670 VkL-c "livE 14. Names of Owner of premises Mt#S7N4 i- St CA-Address Soc htoLP1AU:7s Phone No. /- 3/ 5Q 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 F 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? * YES NO * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF SUp K ,.J aE J > S;C4 being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)He is the O w f t°r- (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. Sworn to before me this 12 day of / U IGS , 20 )5 TRACEY L. DWYER 0 Notary Publi NOTARY PUBLIC,STATE OF NEW YOR //signature of Applicant NO.01 DW6306900 l/ QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,20Iii Lo 'T 20 a _ 14 ' >14 8' 'DEER1 >1- 11 ‹ C4AiN 1-41.1K (b a' -o�C—) 151 CVLDN6-) LO E R L N 2D' LoNG- 0 I 61 emt fA a ua< T C. 0 301 to ¢¢ r't/ 0-)Ao 1-INi< U v ( 3& ' LoNc. ) 1 w V d L. X dE. 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