HomeMy WebLinkAbout48837-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
y N AUa
01 ...
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 #: 48837 Date: 2/1/2023
Permission is hereby granted to:
Kin , Lindse
131 Maple St
Brooklyn, NY 11225
To: construct accessory garage with outdoor shower as applied for.
At premises located at:
890 Arrowhead Ln, Peconic
SCTM #473889
Sec/Block/Lot# 98.-2-6.1
Pursuant to application dated 11/30/2022 and approved by the Building Inspector,.
To expire on 8/2/2024.
Fees:
ACCESSORY $501.20
CO-ACCESSORY BUILDING $50.00
Total: $551.20
Building Inspector
� TOWN OF SOUTHOLD—BUILDING DEPARTMENT
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Town Hall Annex 54375 Main Road P, 0. Box 1179 Southold, NY 11971-0959
�r Telephone(63 1)765-1802 Fax (63 1) 765-9502 BIt :ifsw �, i:rou&B:o9�jtewnm .
Date Received
APPLICATION FOR BUILDING PERMIT
FOfrce Use Onlyy
tltltl
PERMIT NO. Building Impettcr;,
IIIIII
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Applications and forms must be filled out in their entirety.InI I W9
complete
applications will not be accepted. Where the Applicant is not the owner,an BUILDING DEPT.
Owner's Authorization form(Page 2)shall be completed. TOWN OFSOUTHOLD
Date:11/30/22
OWNER(S)OF PROPERTY:
Name:KEVIN AND LINDSEY KING :[SCfM#1000 098.00-02.00-006.001
Project Address:890 ARROWHEAD LN PECONIC NY, 11958
Phone#:(646) 322-2441 Email:LKINGCRESTVIEW.COM/sticknyc@gmail.com
Mailing Address:131 MAPLE STREET BROOKLYN, NY 11225
CONTACT PERSON:
Name:KATE SAMUELS
Mailing Address:25235 MAIN ROAD CUTCHOGUE NY 11935
Phone#:631-235-1177 Email:KATE@SAMUELSANDSTEELMAN.COM
DESIGN PROFESSIONAL INFORMATION:
Name:KATE SAMUELS G
Mailing Address:" 5 AGOVE
Phone#:" Spm (a,(�prf Email:"
CONTRACTOR INFORMATION:
Name:TBD
Mallin Address:
Mailing Adr
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
a New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $200,ODO
Will the lot be re-graded? ❑Yes ii No Will excess fill be removed from premises? ❑Yes iiNo
1
PROPERTY INFORMATION
Existing use of property:RESIDENTIAL Intended use of property:RESIDENTIAL
Zone or use district in which premises is situated. Are there any covenants and restrictions with respect to
R-4 thisproperty? Eyes �No IF YES,PROVIDE A COPY.
0
8 Check Box Aft er Reading: The owner/contractor/design profess lona I is responsible for all drainage and storm water issues as provided by
Chapter 236 of the.Town cove.APPLICATION IS HERESYNIAM to the Building Department for the Issuance of a Building permit pursuant to the Budding Zone
Ordirtanc+e of the Town of Southold,Suffolk,County,New York and other appllcafale haws,,Ordinances or Regulations,for the construction of buildings„
additions,alterations or for removal or demolition as herein destritted.The applicant agrees to comply with all applicable laws,ordinances,building code,
housing code and regulations and to admit authonzed inspectors on premises and in building(s)for necessary inspettlord.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' e). nS BAuthorized Agent ❑Owner
Signature of Applicant„ Date:
STATE OF NEW YORK)
SS.
C'OUNTLF
/ � � ' 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 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
Aday of Ve f"t�j ZB .
Notary Public .
NEREIDAA..BAE
NOTARY PUBLIC,State of New York
PROPERTY OWNER AUTHORIZATIONNo.01BA6079116
(Where the applicant is not the owner) Qualifled in Queens County
Co mission Expires August 12,Zd
I, L t el f« 9-k'V Y Ivy K, eliding at f1to '�1 ?t c0✓ ,L
do hereby authorize kAtc_. sa,,\,i' .( to apply on
my half to th To n of Southold Building Department for approval as described herein.
"Owne 6gn ire Date
t t
(�
Print Owne Name
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