HomeMy WebLinkAbout52227-Z OfSoly 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#: 52227 Date: 09/02/2025
Permission is hereby granted to:
Font!Trust
70-36 Kessel St
Forest Hills, NY 11375
To:
install deer fence as applied for.
Premises Located at:
522 S Harbor Rd, Southold, NY 11971
SCTM#75:4-27
Pursuant to application dated 07/28/2025 and approved by the Building Inspector.
To expire on 09/02/2027.
Contractors:
Required Inspections:
Fees:
DEER FENCE $100.00
Total $100.00
N Building Inspector
FIELD INSPECTION REPORT I DATE COMMENTS C
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�o��guFF01 y�OG TOWN OF SOUTHOLD—BUILDING DEPARTMENT
y �z Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
oy • a�� Telephone(631) 765-1802 Fax(631) 765-9502 https://www.southoldtownny.gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only D E ' E O V
PERMIT NO. r Building Inspector: w
JUL 2 5 2025
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed. Building Department
Town of Southold
Date:
OWNER(S)OF PROPERTY:
Name: �G�f/y`G _ C,/ SCTM#1000-
Project Address:
�O/,5Z- ----
Phone# - / //7' � Email: 73"�-O GA'5*4 _
Mailing Address: �__-_...5__ v.77 ..__ f! /�f3d2.___!?a.i_._S_ov% Gib
CONTACT PERSON: ,
Name:
Mailing Address:
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
lew Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
/❑Other
Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises? ❑Yes No
1
S
PROPERTY INFORMATION
Existing use of property: Intended use of property:
Zone or use district in which premises is situated: Are there any covens is and restrictions with respect to
this property? ❑Yes No IF YES, PROVIDE A COPY.
❑ Check Box After Reading: The owner/contractor/design professional is responsible for allxdrainage and storm water issues as provided by
Chapter 236 of the Town,Code. APPLICATION IS HEREBY MAD E'to the BuildingOepartment for the is 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,alterations or for removal or demolition as.herein described.The applicant agree"sto comply with all applicable laws,ordinances,building code,
.housing code and'regulatio'ns and to admitauthorized inspectors,on premises and in building(s)for necessary inspections.False statements made herein,are.
punishable as a Class A misdemeanor pursuant to Section 210.45 of the New'York State Penal Law.'
Application Submitted By(print name): �/T/,r//G ❑Authorized Agent Owner
?- _ .
Signature of Applicant: , Date:
STATE OF NEW YORK)
SS:
COUNTY OF-51L .
T)ty^A I n I G �1 being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the C9GtI Y�`ems
(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/her knowledge and belief;and
that the work will be performed in the manner set forth in the application file therewith.
Sworn before me this
f day of�V�y�mI'}('r .20�
Notary Public
TREY L. Q M
NOTARY PUBLIC,STATE OF NEW YORK
NO.01 DW6306900
PROPERTY OWNER AUTHORIZATIONhWLIr=IED iN slf;=FOLK COUNTY
(Where the applicant is not the ownerf o"3S10N EX
PIREs DUNE 30,2M&
I, residing at
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
r
Owner's Signature Date
Print Owner's Name
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