HomeMy WebLinkAbout52646-Z oF Soul Tyo TOWN OF SOUTHOLD
BUILDING DEPARTMENT
N Y
' 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#: 52646 Date: 02/04/2026
Permission is hereby granted to:
George Kombogiannis
605 Clark Rd
Southold, NY 11971
To:
Install deer fence at existing single family dwelling as applied for.
Premises Located at:
605 Clark Rd, Southold, NY 11971
SCTM#51.-3-18
Pursuant to application dated 12/11/2025 and approved by the Building Inspector.
To expire on 02/04/2028.
Contractors:
Required Inspections:
Fees:
DEER FENCE $100.00
Tota I S100.00
Building Inspector
FIELD INSPECTION REPORT I DATE COMMENTS
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FOUNDATION (1ST)
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FOUNDATION (2ND) -�
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ROUGH FRAMING&
PLUMBING
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INSULATION PER N.Y.
STATE ENERGY CODE
FINAL
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ADDITIONAL COMMENTS
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TOWN OF SOUTHOLD-BUILDING DEPARTMENT
y Town Hall Annex 54375 Main Road P. O. Box.1179 Southold, NY 11971-0959
oy�0 ao� Telephone (631) 765-1802 Fax (631) 765-9502 https://www.southoldtownny.gov
Date Received
APPLICATION FOR BUILDING PERMIT
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For Office Use Only •';i
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PERMIT NO. 210
? Building Inspector: {`, DEC zO25 '
_ �.
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an nt
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY: .
Name: /� ��CT"
1000-
Project Address: -
Phone#: �. .. ,.s.��,_.. a.i.a__C Email: UEl�I !4 .C.. . -_.
Mailing Address:
CONTACT PERSON: "
Name:
Mailing Address:
Email.
E Phone#: ma
- - - _ e...- -
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address: ��--
Phone#__..� ��_.D-fD.� Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition �j Estimated Cost of Project:
Other C-- PrA(05 — /�L�57�'L (1 r $
--.__.._.. - - - --......_..._...._....--- .. — - - -- - - ------ - -- ---
Will the lot be re-graded? ❑YesyNO Will excess fill be removed from premises? ❑Yes No
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PROPERTY INFORMATION .
Existing use of property: Intended use of property:
Zone or use district in which premises is situated: Are there any covenants 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 all.drainage and storm water issues as provided by
Chapter 236 of the Town Code. 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,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(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) ? ❑Authorized Agent ❑Owner
Signature of Applicant. ate:
CONNI B
STATE OF NEW YORK) Notary Public,State of New York
SS: No.01 BU6185050
Qualified in Suffolk County
COUNTY OF ) Commission Expires April 14,2tb�b
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/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 �j�n �(
day ofleMM � 1 , 20
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
I, � ( f/art-l� siding atpy
1197/
do hereby authorize r-x I�O�V1 // lyjS to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
1 z fib, ZDZ�
wner's Signature Date
Print Owner's Name
2
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COMPLY WITH ALL CODES OF
DA .� B.R f (P 5L NEW YORK STATE&TOWN CODES
�O , ,�, AS REQUIRE AND CONDITIONS OF
FEE__1_��BY: TOWN Z8A
NOTIFY BUILDING DEPARTMENT AT SOMM$(�}IQtQ TOWN PLANNING 8ORR0
631-765-1802 8AM TO 4PM FOR THE
FOLLOWING INSPECTIONS: 50U1NOLDTOWNTRUSTEES
1. FOUNDATION-TWO REQUIRED N.YS,Dm
FOR POURFD CONCRETE
2. k(�I iH- r,'aAMING & PLUMBING
3. INSULATION S
4. FINAL-CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE RETAIN STORM WATER RUNOFF
PEQUIREMENTS OF THE CODES OF NEW
YORK STATE. NOT RESPONSIBLE FOR PURSUANT TO CHAPTER 236
DESIGN OR CONSTRUCTON ERRORS OF THE TOWN CODE.