HomeMy WebLinkAbout48647-Z ° TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
�ea 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#: 48647 Date: 12/22/2022
Permission is hereby granted to:
Cunningham TJ Liv Trt
1105 Ka lei hs Ct
East Marion, NY 11939
To: construct additions and alterations to existing single-family dwelling as applied for.
At premises located at:
1105 Ka lei hs Ct, East Marion
SCTM # 473889
Sec/Block/Lot# 22.-3-5.4
Pursuant to application dated 10/31/2022 and approved by the Building Inspector.
To expire on 6/22/2024.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $577.20
CO-ADDITION TO DWELLING $50.00
Total: $627.20
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 631 765-95021st � w�w . a Itloldl' nn .
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Date Received
APPLICATION FDR IBUILIDING PERMIT
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For Office Use Only
PERMIT N0. Building Inspector:,
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13liiLDING P,
Applications and forms must be filled out in their entirety. Incomplete TOWN OF SOLD. .,II'..1 '
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date:2/28/2022
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OWNER(S)OF PROPERTY:
Name:JANE MULLIKIN &THOMAS CUNNINGHAM SCTM #1000-22-03-5.4
Physical Address:1105 We x/15 COURT, EAST MARION, NY W9 'SC)
Phone#:631-333-2310 Email:JMULLIKIN@OPTONLINE.NET
Mailing Address:SAME AS ABOVE
CONTACT PERSON:
Name:EILEEN WINGATE
Mailing Address:2805 WEST MILL RD.
Phone#:516-818-9754 Email:EILEEN@QUIETMANSTUDIO.COM
DESIGN PROFESSIONAL INFORMATION:
Name:CONDON ENGINEERING
Mailing Address: 1755 SIGSBEERD. MATTITUCK, NY
Phone#:631-734-7250 Email:CONDONENG@OPTONLINE.NET
CONTRACTOR INFORMATION:
Name:TBD
Mailing Address:
Phone#: Email:.
DESCRIPTION OF PROPOSED CONSTRUCTION
LJNew Structure FgAddition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $
Will the lot be re-graded? ❑Yes RNo Will excess fill be removed from premises? ❑Yes ❑No
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PROPERTY INFORMATION
Existing use of property:single family home Intended use of property:Same With addition
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes ®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): �/ l��r] vv k uthorized Agent ❑Owner
Signature of Applicant: "I " Date:
STATE OF NEW YORK)
SS:
COUNTY OF SlISI K )
Eileen Wingate being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the agent for owner
(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
�-� day of M (AV-ch 200��
N r Public
CEY,L. DYW ER
NOTARY PUBLIC, TATE OF NEW YORK
NO,01d"�w;Py��-Nwy0�g00
�" ua f '� �l l '� ��� P N,? ' ' ��"'9 ALINED IN SUFFOLK COUNTY
(Where the applicant is not the owner� ISGON ExPIttES�rNE a
Jane Mullikin residing at 1105 Kayleighs Ct., East Marion
I,
do hereby authorize Eileen Wingate to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
/a a
Owner's Signature Date
Print Owner's Name
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