HomeMy WebLinkAbout46748-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
7.
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#: 46748�m� M Date: 8/26/2021
Permission is hereby granted to:
Riesterer CH Rev
210 Bedell T. . ._.___.. w�....... ......
Famil Trt
West Heng s
1k�ar�, NY 1er
1552 w�__.._w._n. �._w...�.__.._...._�...w�.............__..____�,^.. _.
To: install generator as applied for.
At premises located at:
9Rd.,
..... 45 Calves Neck ..
Southold.....�.w..._._. ..., .__._....�..�..��a.._.....�.�.�..w_..w_..wa..__.��.M...... ..... ._..��...._..
SCTM #473889
Sec/Block/Lot# 70.4-47
Pursuant to application dated 8/17/2021 and approved by the Building Inspector.
To expire on 2/25/2023.
Fees:
ACCESSORY $100.00
ELECTRIC $85.00
CERTIFICATE OF OCCUPANCY $50.00
Total: $235.00
Building nspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
,t Town Hall Annex 54375 Main Road P. O. Box 1179 Southold NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 ➢ gl �u ioklto% i„unao:v
Date Received
air Office Use Only
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PERMIT N0. Building insrctsr;, .. AUG 17 2021
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant Is not the owner,an 1
Owner's Authorization farm(Page 2)shall be completed.
Date: 1
OWNER(S)OF PROPERTY:
Name: SCTM#1000- -
Project Address: "A5 DA, of
Phone#: G `J-- «1Z— Email: � p zNd U C- A-01„
Mailing Address: " q� FZo C5
CONTACT PERSON:
Name: I Z5TPC
Mailing Address: K �'{
d
Phone#: - �� A ��--� Email: �» ""' � �5S M
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Te
Mailing Address:
Phone#: 3)r - "�-r`-� Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Othertructur $ 16 K
Will the lot be re-graded? ❑Yes W Will excess fill be removed from premises? ❑Yes S&IO
1
PROPERTY 1, FPR TIo
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
property?. _ _
,JPR _
this ❑Yes o 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
hapter 236 of than"town Coale. APPUCAMON 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 taws,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 aippilcable laws,ordinances,building code,
housing code and regulations and to admit authorized Inspectors on premises and In bultding(s)for necessary inspections.False statements made herein are
penis )e cfa A,bra ,,, rrf r pawrsua to Section z11 FIs o fl r ,ry„yawl S nal rad e, ra a j F
j
Application Submitted By(pri name): 1��� ❑Authorized Agent l6owner
Signature of Applicant: Date: --i 2 1
f
STATE OF NEW YORK)
SS: mm
COUNTY'01" Sui4d
being duly sworn,deposes and says that s)he is the applicant
(Name of individual signing contract)above named,
i
(S)he is the GzvcsbTL
(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 manrier set forth in the application file therewith.
t
Sworn before me this_Ir " 1
day of �iJL�{ Zp 21'
Nota L.
L McDONALD
Notary ry � blic-
State of New York
No. 01 MC6224291
PROPERTY OWNER AUTHORIZATION Qual i erj in Suffolk County
My Cor'nrnisE,uo,', Expires June 28,20 Z2--
(Where the applicant is ilei:the owner)
I,C'14.4 A z.c5 ���',�'; '�„ 2� 2 residing at �� °� lv �o D
0 iE� OLo do hereby authorize —to apply on
my tae f to the To n f Southold Building Department for approval as described herein.
Owner's Signature Date
Print Owner's Name
2
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**7042-2&7043-2 specifications
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