HomeMy WebLinkAbout48575-Z TOWN OF SOUTHOLD
N BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
..G"" 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 #: 48575 Date: 12/8/2022
Permission is hereby granted to:
Allcock Thomas
117W123rdStApt 1B
New York NY 10027
To: Construct accessory garage and workshop at existing single family dwelling as applied
for.
At premises located at:
55 Crown Land Ln. Cutcho ue
SCTM #473889
Sec/Block/Lot# 109.-2-12.1
Pursuant to application dated 6/29/2022 and approved by the Building Inspector.
To expire on 6/8/2024.
Fees:
ACCESSORY $734.00
CO-ACCESSORY BUILDING $50.00
Total: $784.00
Building Inspector
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) ://www.sotitliold own �o
Date Received
APPLICATION
v
For Office Use Only
PERMIT NO. Building Inspector. � ,'
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Applications and forms must be filled out in the il
entirety. Incomplete i BU .. b ! h��P
applications will not be accepp
ted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: 4�LiIES�f C� �NC3til SCTM # 1000- QG,a a
Project Address: ��. C(20-u�J L-" L. J L
Phone#: &Ijv?L-3. gqZ) Email: �ibC- IL�o
Mailing Address: &3;- CA3W h1 i' Aa zW C',J�{f06'LIA— t4l 1 1VS—
CONTACT PERSON:
Name: CC oop>�
Mailing Address:
11-3-- W
Phone#: ��� -q-ES 9 2 Email:
DESIGN PROFESSIONAL INFORMATION:
Name: -C!
��4=6r��
Mailing Address: 291415- Cvnff06-ur
Phone#: 1i�-3e/ y / � Email: M K /r�uEhTbCi' 6 �tt�€. -
CONTRACTOR INFORMATION:
Name:
Mailing Address:.
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other
Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises?Pes ❑No
1
PROPERTY INFORMATION
Existing use of property: 4Q i,e S Intended use of property: 5Me
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
P-444this property? E]YesKNo 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 na �: �K SG{ 1�r2 rz 2AUthorized Agent ❑Owner
Signature of Applicant: "'` { Date: G(p I O(p 12 2
STATE OF NEW YORK)
SS:
COUNTY OF K
. being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract)Aove named,
(S)he is the ARcq "" `CA-0L1
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
41nwau
day of ��1 `)oe , 20
Notary Public
TRACE:Y L. WYER
NOTARY PUBLIC,STATE OF NEW YORK
„ ,,,, , , OWNER IZATINO.Oi DW6301i900
.�, QUALIFIED IN SUFFOLK COUNTY
(Where the applicant is not the owner) COMMISSION EXPIRES JUNE SCifi4�\
4011v— /1111 1
1, AAll � residing at
do hereby authorize �� to apply on
my b alf to the Town of Southold Building Department for approval as described herein.
wner's Signature Date
Print Owner's Name
2