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HomeMy WebLinkAbout48320-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE 09 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#: 48320 Date: 9/22/2022 Permission is hereby granted to: Rasani, Mohammad 450 Eastward Ct Mattituck, NY 11952 To: legalize "as built" conversion from electric to oil hot water heater & boiler to existing single-family dwelling as applied for. At premises located at: 450 Eastward Ct., Mattituck SCTM # 473889 Sec/Block/Lot# 115.-7-4 Pursuant to application dated 8/8/2022 and approved by the Building Inspector. To expire on 3/23/2024. Fees: AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $400.00 CO-ALTERATION TO DWELLING $50.00 Total: $450.00 B `ding Inspector sup ' TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O, Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 htt s://www.sotitholdto,lynnv. ,, v Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only a PERMIT NO. � Building Inspector: u Q�NN..�iDRG I.) P Applications and forms must be filled out in their entirety. Incomplete V is")II 01i1 H applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date: U' OWNER(S) OF PROPERTY: Name: kh6me"-4d - SCTM# 1000- 5— — Project Address: qSD &571�)OeW LY Phone#: '� r ` ��� Email: M/�S C94 find Address: CONTACT PERSON: Name: Mailing Address: Ak[A/ r, �WZ3 Phone#: 91 —L?'1q Email: � ��� �� �Ct✓/� DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: Mailing Address: Phone#: Email:. DESCRIPTION OF PROPOSED CONSTRUCTION V0therC# ew Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: hG dlr V $ Will the lot be re-graded? ❑Yes 96 Will excess fill be removed from premises? ❑Yes o a 1 PROPERTY INFORMATION Existing use of property: Intended use of property: Zone or use district in which premises is situated: Are there any covenaVO restrictions with respect to this property? ❑Yes F 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. w Application Submitted By(print na + , , �""' []Authorized Agent 2/owner Date: Signature of Applicant- Alvin Gong STATE OF NEW YORK) Notaryublii�S� T Of N8W 9 York SS:, / Qualified in Yjng CountY CO U NTY O F VALLA�'ly ) MyCommission Expires Nov 13.2025 o ;gip ri 949sar, I being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)he is the ©� (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly authoriz6d 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 day of , 20 22 tar+ Public PROPERTY TATIO (Where the applicant is not the owner) 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 Owner's Name 2