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Home My WebLink About48667-Z TOWN OF SOUTHOLD �' � rtat 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 #: 48667 Date: 12/29/2022 Permission is hereby granted to: Spitzenberg, Robert 344 Terry Ct Southold, NY 11971 To: Construct interior alterations to an existing single family dwelling as applied for. At premises located at: 375 Elizabeth Ln Southold ......_.._ .... .............. ........... SCTM # 473889 Sec/Block/Lot# 78.-5-4 Pursuant to application dated 10/1 pp 2/2022 and approved by the Building Inspector. ._._ .. ........ To expire on 6/29/2024. Fees: CO-RESIDENTIAL $50.00 SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $529.60 ..... . .... Total: $579.60 . ............... Building Inspector �Fft rrr v 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 lett s:/—/Www.so tth ldtown . Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only b ,. Or"T 6, 443�P(O-1 Building Inspector:PERMITN0, i TOS Applications and forms must be filled out in their entirety. Incomplete applications will not be accepted. Where the Applicant is not the owner,an OWners Authorization form(Page 2)shall be completed. Date: OWNER(S)OF PROPERTY: Name: 10 SCTM# 1000 Project Address: f� 04';xa- Phone#: ��. �'! �3�� Email: Mailing Address: 3 (xfc!; L)V/!/6 LA 0 -Ino CONTACT PERSON: Name: 7— Mailing Address: 07 ,� NV Phone#: ,10 n Email: DESIGN PROFESSIONAL INFORMATION: Name: OL LCOTT. Mailing Address: Phone#: (13� d Email: P& A11<d meott1 CONTIRAC,T, NFDRMAT10r#11'`A Name: Mailing Address: f' < s, . Phone#: 516 4Y e-1,2 � 3 c/S Email: DESCRIPTION OF PROPOSED CONSTRUCTION El New Structure ❑Addition ❑Alteration ZIR`epair 06emolition Estimated Cost of Project: ❑Other $ 000 — W,00a Will the lot be re-graded? ❑Yes AO Will excess fill be removed from premises? ❑Yes ZlNo 1 PROPERTY INFORMATION Existing use of property: SiiUG�/� � IIID)0,� Intended use of property: , 'r Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to Q this property? ❑Yes�c Ivo 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 inbuilding(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): ` 7emg" ❑Authorized Agent 26wner Signature of Applicant: � t Date: STATE OF NEW YORK) COUNTY OF �i� ) being duly sworn, deposes and says that(s)he is the applicant (Name of individua signing contraM above named, (S)he is the (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 Notary Public PROPERTY OWNER AUTHORIZATION CHARLES R. CUDDY Notary Public, State of Niew%York (Where the applicant is not the owner) Na.02CU „ 7 a 25 Qttalifd'ed in Suffolk County CO on 1~zplres Decem e!r 31,�� 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 �Ww^ Mp1'N Tf'r "w1°4 Wy.1�&, y "�W k�, .4,$M1� W1� M.,^,. ''° ri.tom^�'� e"" �4 „",so-✓ 'lld.Nrh i- w� 'M "`h rt 1 r F ' , w VA m " 77 777 �R�$(� �rLa � �"+ � °� W � � 1'Y roar �'� rya✓ ��: ��"��m},��aa��r+�,, „ { � y,p �� + � k „t✓a / Y "q" Y-. Bas.F`� r pr" �Jn y bfA rNs � y _ ] � k.1 .. 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