HomeMy WebLinkAbout47680-Z t TOWN OF SOUTHOLD
� .a BUILDING DEPARTMENT
o 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#: 47680 Date: 4/15/2022
Permission is hereby granted to:
Engguist,_Erik ..
44 8th Ave #4 _........_a._... _._.__ _. ._
.. .... .................. _..
Brookman, NY 11217
To: Remove existing covered porch and construct new screen porch addition to existing
single family dwelling as applied for.
At premises located at:
6895 Route 25, East Marion
SCTM #473889
Sec/Block/Lot# 31.-1-2
Pursuant to application dated 3/16/2022 and approved by the Building Inspector.
To expire on 10/15/2023.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $305.60
CO-ADDITION TO DWELLING $50.00
Total:
.............................................................
_._.w.__._w.........................$.3.5.5...�.o
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Am Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
W Telephone(631)765-1802 Fax(631)765-9502 lutes:// w wL 1, 110 (itn
Date Received
]CATION FDR Bt JILDING PERMIT
For Office Use Only E lin 1:- Il Y 6.`.-:a
PERMIT NO. Building Inspector:� NVAR
Applications and forms must be filled out in their entirety.Incomplete BUILDING DEPT.
applications will not be accepted. Where the Applicant is not the owner,an TOWN OF SOUTHOLD
Owners Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PR PERTY:
Name: SCTM#1000-
Project Address:
Phone#: 3 4 2Z �tEmail:
Mailing Address:
CONTACT PERSON:
Name: 14I
Mailing Address:
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
, I AL�AA e- �c
Mailing Address:
Phone#: �,�,, Email: IM r+O
DESCRIPTION OF PROPOSED CONSTRUCTION
El New Structure KAddition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $
Will the lot be re-graded? ❑Yes o Will excess fill be removed from premises? Yes ONO
1
Existing use of property: , le 45f Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes o IF YES,PROVIDE A COPY.
4-0
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.
App
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 appru�ble laws,ordinances or Regulations,for the construction of buildings,
additions,aiterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,buildurg code,
housing code and regulations and to admit authorized inspectors on premises and in buikling(s)for necessary inspections.False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 21OA5 of the New York State Penal law.
Application Submitted By(print name W Ate�.f� I�Atlthorized Agent ❑Owner
Signature of Applicant: Date: 4— —
STATE OF NEW YORK)
SS:
COUNTY OF � �)
t ,& " being duly s rn,deposes and says that(s)he is the applicant
(Name of individual signing c tract)above named,
(S)he is the t t/AyZ T7
(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 me this
nl
tfay of 20_aj (,UA
( otary Public
TRACE "L DWYER
NOTARYU&J� 10,S`i' TE 'NEW" YORK
PROPERTY OWNER AUTHORIZATION ° "' ��`� �`'�'
I ALWI iN ,,, : A.Pti °C I„9 "I Y
(Where the applicant is not the owner) COWNSSM I XPH-'iES JU E-3 , �)2;i,,.
I, Erik Engqulst residing at 6895 Main Road, EaSt Marion
do hereby authorize Mark K. Schwartz, architect to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
3/13/2022
Owners Signature Date
Erik Engquist
Print Owners Name
2