HomeMy WebLinkAbout41270-Z �SUFw���oTOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
oma. . SOUTHOLD, NY
.ljo1 � �a0
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#: 41270 Date: 1/4/2017
Permission is hereby granted to:
Bredemeyer III, John & Beverly
PO BOX 245
Orient, NY 11957
To: construct deer fence as applied for.
At premises located at:
425 Old Farm Rd, Orient
SCTM #473889
Sec/Block/Lot# 25.-5-7
Pursuant to application dated 1/4/2017 and approved by the Building Inspector.
To expire on 7/6/2018.
Fees:
DEER FENCE $75.00
Total: $75.00
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Buildi
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL IBoard of Health
SOUTHOLD, NY 11971 4 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Survey
SoutholdTown.NorthFork.net PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
Flood Permit
ExaminedJ ,4 20J Single&Separate
Storm-Water Assessment Form
Contact:
Approved20_q Mail to:
Disapprov4a/c
Phone:
Expiration ,20
MB nspector
DPPLICATION FOR BUILDING PERMIT
LAK 4 201`i Date )'a)IVd-1f , 20
INSTRUCTIONS
a. T . . T be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of p ' ���ale.Fee according to schedule.
"R—tlan 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'.J, h In 0/-e zIe))q e y e,,. ;
4?eJeVI I re�l�'rII 2r
ignature o o a
��X awls, 00&,4 ,11Vy /10
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
0-w h e
Bahr m. �rede�e�e. � � �e✓eye /-�� .�ie�e�e e/'
Name of owner of premises
(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 which proposed work will be done:
!J�C)ld F-11)n
House Number Street Hamlet
County Tax Map No. 1000 Section -2 S Block s Lot 7
Subdivision FR y V i ew �.yam �f ��'h� Filed Map No. 7 c Y5'
Lot / S
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy S-J
b. Intended use and occupancy SG�r-e- Q r ��U✓L'
3. Nature of work(check which applicable):New Building Addition Alteration
Repair Removal Demolition Other Work L;'--ev'�
(Description)
4. Estimated Cost JOU Fee
(To be paid on filing this application)
5. If dwelling, number of dwelling units / Number of dwelling units on each floor A14
If garage, number of cars �-
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. n 4
7. Dimensions of existing structures, if any: Front n eA Rear /Vk Depth 41
Height Number of Stories 4�
Dimensions of same structure with alterations or additions: Front ✓plc 'Rear
Depth /11* Height Ak Number of Stpoes .
8. Dimensions of entire new construction: Front Rear /V r i e--be�� Qt=--
Height Number of Stories iv
9. Size of lot: Front `LA's ��I�L� Rear 5� Croz/�) Depth
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated �` el0
I '
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO v",,
i
13. Will lot be re-graded? YES NO'44 Will excess fill be removed from premises? YES NOAM
JdAh-gaLx?V41
14. Names of Owner of premises T✓e sem Address °AU6 X �yS (J) Pfi+'ione No. 6 -3-2 -,;2 0 o
Name of Architect Address q R Phone No a c
Name of Contractor Address Phone No. "
15 a. Is this property within 160 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 onisurvey.
18. Are there any covenants and restrictions with respect to this property? * YES NO w-' j
* 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.)
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
YA day of��1 LA 201
CONNIE D.
- Public81
Notary Public Notary"No.01'SU6185050 e df Applicant 9V®.01
Qualified in Suffolk County
Commission Expires April 14,2 T,
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COMPLY WITF(AL(,1(;OD $O
NEW YORK STAI`E & 'OWN CO6ES
AS REQUIRED AND CONDITIONS OF
AP P VED ATNOTED
r_ Il Tf1WA17RA
DATE B.P.# d - %�'� *C>` pIn
FEE: V BY:
o n x4 C Z) i•1ICr Fi ,
NOT.FY 6UCLDING DEPAI;TlNT A s<
765-1802 8.AM TO 4 PM FOR THE/'
FOLLQth<<vG INSPF-TIGNS:
r' 1, OUNCIATION - -VwlQ EQUI DT
FOh'POURED
2. ROUGH - FRANkliNt,33; BING
3. INSULATION V
i 4. FINAL - CtC'�BTR' N MUST ` d•f., .u`t,+ t:� s r �7y�; `' l
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BE COMPLETI�="�J , 0,0•
ALL CON TRU�,WN SHALL MEET T c
REQUfw4wAENTS OF THE CODES 0� �( (� �. �' �� ,,�CLyS?
YORK STAT1y. NOT RESPGNSIBI�ER �C \ � .', ,; ! 3
DESIGN OR. CaCONSTRUCTIONRROR �
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