HomeMy WebLinkAbout46780-Z 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#: 46780 Date: 9/7/2021
Permission is hereby granted to:
Stocker, Christopher
3375 Depot Ln
Cutchogue, NY 11935
To: Construct enclosed accessory carport at existing single family dwelling as applied for.
At premises located at:
3375 Depot Ln., Cutchogue
SCTM # 473889
Sec/Block/Lot# 102.-1-6.1
Pursuant to application dated 8/23/2021 and approved by the Building Inspector.
To expire on 3/9/2023.
Fees:
ACCESSORY $580.00
CO-ACCESSORY BUILDING $50.00
Total: $630.00
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Y` Telephone(631)765-1802 Fax (631) 765-9502 h , wov,sot _ ' nny,gov
AII)PLICATION FOR BUILDING INS ER I -
Forteonly
PERMIT NO. nspecton
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.
Date:
OWNER(S)OF PROPERTY:
Name: SCTM#1000- 10 2
o J
b.
Project Address:
Phone#: 1 � f Email:
Mailing Address: C 1j
po
CONTACT PERSON:
Name: - J
�brrS � � - k r
Mailin Address: -
Phone#: 0 2— � 0 Email:
L
DESIGN PROFESSIONAL INFORMATION:
Name: -k _
Mailing Address: a 3
Phone#: Email
CONTRACTOR INFORMATION:
Name _
Mailing Address:
_,
It
Phone#: 73 Email:
- Com-
DESCRIPTION OF PROPOSED CONSTRUCTION
likNew Structure ❑Addition ❑Alteration ❑Repair ❑Oemol tin Estimated Cost of Project:
❑Other P�'?G� dLY r L � ce ,- - $
Will the lot be re-graded? ❑Yes RNo Will excess fill be removed from premises? ❑Yes O No
1
PROPERTY INFORMATION
Existing use of property: rc�iIntended use of prope • - -
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
— Y`e-,� , J zvi c, this property? ®Yes RNo IF YES, PROVIDE COPY.
Checkx After Reading: The owner/contractor/design prof ional Is responsible for all drainage and storm ter Issues as provided b
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 applible Laws,OrdinancesRegulations, r the construction of buildings,
additions,alterations or for removal or demolition as herein described. applicant agrees h all applicable law,ordinances,buildin e,
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 210.4S of the New York State Penal Law.
Application i (print : ;,' �0C�e V- OAuthorized Agent Nowner
Signature lig t: y Date:
STATE OF NEW YORK)
S - J
COU OF a 1
' r t Q.
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being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the O W V),Y—
(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 tree this
3 $ P
day of 2 1
Notary Public
DARLENE K RRU5f1
Tia,v Public-State of New York
> `}ze t1R631S051
N
_ _... _ —
N0.01Qualffle in Suffolk County
(Where the applicant is not the own My Commission Expires Jan 20, 2023
1,
residing at
do hereby authorize to apply on
tray behalf tot e Town of Southold Building Department for approval as described herein.
Owner's Signature Date
PrintOwner's Name
2
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