HomeMy WebLinkAbout42348-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
'$ y SOUTHOLD, NY
490 '
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#: 42348 Date: 2/7/2018
Permission is hereby granted to:
Dean, Charles
295 Village Ln
PO BOX 307
Orient, NY 11957
To: construct a deer fence as applied for.
At premises located at:
295 Village Ln, Orient
SCTM #473889
Sec/Block/Lot# 25.-2-4.10
Pursuant to application dated 1/26/2018 and approved by the Building Inspector.
To expire on 2/7/2019.
Fees:
DEER FENCE $75.00
Total: $75.00
Building spector
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD, NY 11971 4 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-950223�$,� Survey
Southoldtownny.gov PERMIT NO. R, , Check t'"7 Q
�y Septic Form
D 6TC'?— '1 r lN.Y.S.D.E.C.
Trustees
, Q C.O.Application
Flood Permit
Examined 20 j, Single& Separate
F"= Truss Identification Form
Storm-Water Assessment Form
(� 3. 1!- "ntact:
Approved 20 1"i>; Mail to:
� , 4 F ,,
i/.L
Disapproved a/c E
ALL CJ' i F;F; C 1
t i!:. Phone:
Expiration \ ,20_ <fE r,
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Building Inspector
2D f� CATION FOR BUILDING PERMIT
JAN 2 6 2018 Date , 20AL
INSTRUCTIONS
a. This appileation,MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of plans, acCTQ"(QFWX11MQ1Ae according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or
aGeas, 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.
1�1
(Signature of applicant or name, if a corporation)
P &� , '- o-7 ) 9�,%e1i ) WY ��C)—b
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Ownec—
n C\
Name of owner of premises L a C':t S, �5 � e 6\q
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer) -�,1vc Soo" �-
Builders License No. � Rc SA t�
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
House Number Street Hamlet
County Tax Map No. 1000 Section Block 2. Lot 1 U
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
D. ,
tended use and occupancy
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. y.
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 Name of Former Owner
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
14. Names of Owner of premises Address Phone No.
Name of Architect Address Phone No
Name of Contractor Address Phone No. /
(:
51F
Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO 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 )
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named, CONNIE D.BUNCH
Notary Public,State of New York
(S)He is the No.01BU6185050
un
(Contractor, Agent, Corporate Officer, etc.) Commission Expires April 14,2
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. r
Sworn to before me this
day 20 �S i
Notary Public Signature of Applicant
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