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HomeMy WebLinkAbout53169-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT `� .�0 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#: 53169 Date: 08/04/2026 Permission is hereby granted to: Ellen Hagerman PO BOX 278 Mattituck, NY 11952 To: install a deer fence in the side and rear yards as applied for. Premises Located at: 6980 New Suffolk Ave, Mattituck, NY 11952 5CTM# 115:16-27 Pursuant to application dated 07/13/2026 and approved by the Building Inspector. To expire on 08/03/2028. Contractors: Required Inspections: Fees: DEER FENCE $100.00 Total ioo.oa Build' g Inspector " TOWN OF SOUTHOLD--BUILDING DEPARTMENT �' � Town Hail Annex 54375 Main Road P. 0. Box 1179 Southold,NY 11971-4959 Airmro Telephone (631) 7+6`�-1 02 Fax +631 7 � rov , Date Received FC` R BU LO NG PERMITAPPLICATION -z'r E 9 V E rz tr For Office Use Only PERMIT" NOO ,� ct rrX 2026 ..................... J U L ,Of ApplicationS and forms must be filled out in their entirety. incomplete applications will not be accepted. where the Applicant is not the owner any Oeartn Owner's ALithoriaation form(Page 2)shall be completed. Town of v ���old Date: OWNER(S) PROPERTY Name. .��L L � SCTl1lI#1000-- 115"' o�7 Project /Y) Address: Phone #. �- -� `.. .` Em ail /' t1 w ��c.-�' �r� �I C' Mailing Address: 6C) 4, /< N 8qE CONTACT pIERSON$ Name: lYl l Mailing Address: ...................... Phone#: t Email: 0,/,1,0,qet, F M DESIGN PROFESSIONAL INFORMATION: Name: a l thg Add es,s, u ,W. Phone # Email: CONTRACTOR/,[N FORMATION. Name: � �,� -- � � ��� �� . � CLWO Mailing Address: + -- - Phone#: r - 1 ' _ Email-, DESCRIPTION OF PROPOSED CONSTRICTION []New Structure ❑Addition ❑Alteration ❑Repair F71Demolition Estimated Cost of Project: VOther t7k�M $ will the lot be re-graded? ❑Yes C_1No Will excess fill be removed from premises? C]Yes ❑No 1 PROPERTY INFORMATION Existing use of property: Intended use of property: Existing Zone or use district in which premises is situated.- Are there any covenants and restrictions with respect to this property? E]Yes 7No IF YES., PROVIDE A CCPY, er issues,"as provitfbd b)o El Check Box,After,Reading'." "T heowner/cootractor/doss gn professional is,responsible,for alb drainagre and storm w,at g Permit Pursuant to the Wtdir%g Zone ,C,hapte,r 236 of,theTbiqn,C g Department for�the,issuance of a Buildin ode APPLICATION IS HEREBY MADE to the,Buildin ructio of 10 Ordi nance,ofthe T own of$0ut601d,,'S'uffo1'k`,,county New,York and other applicabte Laws,,Otdina nces or Regulations,for the const ft buildl ngs ibed.The,�applicant,ag-rees tol compl'y with all appkable law's ordinantes buildinlg co,�,gje# 'aiions""*6rfd`* addft1'on,s,,allter r,rein "ons and to admit authoriled Inspectors on premises and in building(s)for,notessavy inspe, OU1,115"Ing,tode,and regulati an t�to,Section 210.45 of the New,'York State Penal Low. punbh'able aisa Class.A misdernean,or pursu If A 7AUthorized Agent 21(!rcaner 'T. L� Application Submitted By(print name). ALI / o C? e-fn Ir ,roe�, Date: 13 c), Signature of Applicant: "1 AlJ4 STATE OF NEW YORK) COUNTY OF being duly sworn, deposes and says that(s)he is the applicant (Name of individual signmgy 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 thew will be performed in the manner set forth in the application file therewith. Sworn before me this 3_day of 20_ N o,-t,ary P u b I i c 'AWL EMMA LEADED! Notary Publk-State Of Now York NO.01LE0049174 PROPERTY OWNER AUTHORIZATION Qualiflad,in Suftk county my commission Expim�,4r 22,,,2.030 F— my— (Where the applicant is not the owner) residing at do hereby authorize to apply on my be to the Town of Southold Building Department for approval as described herein. 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