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HomeMy WebLinkAbout37931-Z zr TOWN OF SOUTHOLD o�SUFFo�,r�oG BUILDING DEPARTMENT y 2 TOWN CLERK'S OFFICE , . o� 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#: 37931 Date: 4/11/2013 Permission is hereby granted to: Grigonis, William & Grigonis, Joyce 470 Columbia Rd Southold, NY 11971 To: install a deer fence per Town Code #280-105-C as applied for At premises located at: 470 Columbia Rd, Southold SCTM # 473889 Sec/Block/Lot# 79.-6-10 Pursuant to application dated 4/4/2013 and approved by the Building Inspector. To expire on 4/11/2014. Fees: . DEER FENCE $75.00 Total: $75.00 AA- Building Inspector TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUII;;.D>�i(�G DEPARTMENT Do you have or need the following,before applying? I TOWN HALL Board 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. 3 Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined ,20 Single&Separate Storm-Water Assessment Form - Contact: Contact: Approved 20 I �/ Mail to: Disapproved a/c Phone: Expiration ,20 3 ® E C E y E Building Inspector APR _ 4 2013 PPLICATION FOR BUILDING PERMIT Date , 20 BLDG. DEPT. INSTRUCTIONS TOWN OF SOUTHOLD a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan 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 Pen-nit. 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 Pen-nit 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. (Si ature of a pli ant or h4e, if a corporation) y70 Co for bia Pcj. S00)410 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises l end Z C) r-% o rl L-5 (As on th 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: f �f70 Colymb',a Roach Souk-h©(�1 House Number Street Hamlet County Tax Map No. 1000 Section Block Lot Subdivision 2Q a Filed Map No./&D—0_/91%—Ieot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy J. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work (Description) 4. Estimated Cost M (YoD•oo Fee 7s', 0 0 (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. 7. Dimensions Fisting structures, if any: Front Rear Depth Height Number of Stories Dimensions of ame structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entirqjnew construction: Front Rear rM Depth Height Number of Stories 9. Size of lot: Front o is ® Rear Depth l 3 7QS-0 10. Date of Purchase .S a7 ,2C Name of Former Owner r -eh i e p f GL1 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 NA- 14. Names of Owner of premises d ic"1mi,Te;t e CiC o#a Address 7 70(°D/��„�Y42d1 Phone No. cl Name of Architect Address Phone No Name of Contractor Address Phone No. 15 a. Is this property within 100 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 on survey. 18. Are there any covenants and restrictions with respect to this property? * YES NO x IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF 5LA I �Jp yC-e e ►vle(0►'1 S being duly sworn, deposes and says that(s)he is the applicant (Name f individual sigrrflig contract) above named, CONNIE D.BUNCH Notarj,Public,State of New York (S)He is the No.OiSU6185050 (Contractor, Agent, Corporate Officer, etc.) Quaftied in susto ,Counq Combnissaon Expires April 14.1 e�P of said owner or owners, and is duly authorized to perform or have performed the said wort: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. Sw4Utbefore me tl day of 201 C�y� ►vim ���l..l,�,C� ', �. 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