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HomeMy WebLinkAbout47295-Z t� 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 #: 47295 Date: 1/5/2022 Permission is hereby granted to: Country House by Bay LLC 12680 Route 25 East Marion, NY 11939 To: Construct alterations and new covered porch to existing accessory structure at single family dwelling as applied for. At premises located at: 12680 Route 25, East Marion SCTM # 473889 Sec/Block/Lot# 31.-14-13 Pursuant to application dated 11/30/2021 and approved by the Building Inspector. To expire on 7/7/2023. Fees: ALTERATION OF ACCESSORY BUILDINGS $216.40 CO-ACCESSORY BUILDING $50.00 Total: $266.40 Building Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT Z Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 AIDDLICATION FOR BOUILDING PERMIT Date Received For Office Use Only PERMIT NO. Building Inspector: � 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: /1-:3) ._ �'i OWNER(S)OF PROPERTY: Name: L'G�l,';�ITP,�/ WVSE 'PSY T14E 9.4y SCTM#1000- 31 _ I q — J.3 Project Address: /2(ot�p IM 1+1� �� S ( 25-) I-AS: I�1A(2 O►�( N Y 11939 Phone#: �Y6 - 2�1 3<S 60 Email• RCS T W Et=T�`� A O 1-, C©t"1 Mailing Address: CONTACT PERSON: 4 Name: SCE 11L tSESIq N f}SSO L LL-C . Mailing Address: 2(p.5 —TASM!N P L-ANiGSo%1T-H X—tN _ NY 117/71 Phone#: (-5(_ q33-go8q Email: SS(&N 1oS`f cc p�oN- �jy� r DESIGN PROFESSIONAL INFORMATION: Name: ��t� NESlct-K As'soL LLC' Mailing Address: 265 �'F}51�1�N,� LANA SOJ7 +OL�, NY //77( Phone#: J' t9�� ' �3.3 '�V�J�{ Email* CONTRACTOR INFORMATION: Name: �(� �}T TN c`S i/MF Mailing Address: Phone#: Email: DESCRIPTION OF PROPOSED CONSTRUCTION New Structure NAddition KAlteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $ sK Will the lot be re-graded? ❑Yes KNO Will excess fill be removed from premises? ❑Yes KNo 1 PROPERTY INFORMATION Existing use of property: RES I QE;tirlA l_ Intended use of property: _i�F—S Ips t-t T i AQ_ Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes f—D(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): tAt- ®Authorized Agent ❑Owner Signature of Applicant: Date: fir' STATE OF NEW YORK) SS: COUNTY OF SUPP04 4— t qt--- being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the (ContractC(.ZD Corporate Officer,etc.) of said owner or owners, and is duly authorized to orrn 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 5} day of ,202 Notary Public TRACEY L. DWYER NOTARY PUBLIC,STATE OF NEW YORK P PERTHOWN- 0ALIT R- A N NO.01DWOWg00 QUALIFIED IN SUFFOLK COUNTY (Where the applicant is not the owner) COMMISSION EXPIRES JUNE 30,222 SF_� SF P A-''irz- PA,(3 I, residing at do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date Print.Owrier's Natiiie 2