HomeMy WebLinkAbout48844-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
� ori
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#: 48844 Date: 2/1/2023
Permission is hereby granted to:
7355 Main Road Cor
PO BOX 649
New Suffolk, NY 11956
To: Install window replacements at existing single family dwelling as applied for.
At premises located at:
7355 Route 25, Laurel
SCTM # 473889
Sec/Block/Lot# 122.-6-33
Pursuant to application dated 1/11/2023 and approved by the Building Inspector.
To expire on 8/2/2024.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00
CO-ALTERATION TO DWELLING $50.00
Total: $250.00
V)Q—.
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 haps://www.southoldtownny.gov
Date Received
APPLICATIONR BUILDING PERMIT
For Office Use Only , ['D
ddu
PERMIT NO. Building Inspector;_
Applications and forms must be filled out in their entirety.Incomplete JAN 2023
will not be accepted. where the Applicant is not the owner,an
l 'UILOIN!DDEIN;
applications
P PP � �O �O ,0 ,
Owner's Authorization form lPaee 21 shall be completed.
Own „- .
Date: 1/10/2023
OWNER(S)OF PROPERTY:
Name:TERRY WOODHULL scrM# 1000- U .
Project Address:a 55 RT 25 MATTITUCK, NY 11952
Phone#:631-680-0982 :[E.ail::1—:C:WOODHULL@-YAHOO.COM
Mailing Address: 7255 RT 25 MATTITUCK, NY 11952
CONTACT PERSON:
Name:TERRY WOODHULL
Mailing Address: 7255 RT 25, MATTITUCK, NY 11952
Phone#:631-680-0982 Email: TCWOODHULL@YAHOO.COM
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name: TERRY WOODHULL
RA-:1:__ RJJ_ -lAl-r SIT Ar \ A A TTI T! 1/!1J 61X/ A AAt 0-
ivlalnl lg reuul Cay. /LOO K 1 LO IVI/A I I i I lJl..iti, 114 T I I`J'OL
Phone#:631-680-0982 Email: TCWOODHULL@YAHOO.COM
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration -WRepair ❑Demolition Estimated Cost of Project:
❑Other $ 25000
iivili the lot be re-graded? ❑'res ®iso Will excess fill be removed from premises? ❑res 'MNo
1
PROPERTY INFORMATION
Existing use of property:BUSINESS&RESIDENTIAL Intended use of property: BUSINESS &RESIDENTIAL
Zone or use district in which premises is situated: Are there any covenantsandrestrictions with respect to
❑Yes OPdo IF YES PROVIDE A COPY.
BUSINESS
this property? ,
M Qheck 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 buildingls)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.
ZT Y 0®HULLent ®Owner
Application Submitted By(print me). ❑Authorized Ag
Signature of Applicant: Date: 1/10/2023
STATE OF NEW YORK)
SS:
COUNTY OF tk:l.
f I being duly sworn, deposes and says that(s)he is the applicant
(Name of in ividua signing contract)above named,
She 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 t
p
day of 2D
l id ublic
Deborah Orlowski
NOTARY Notary Public,State of New York
* Pueuc F* No.0IOR6280392
PROPERTY NES UTA ) IOC , = Q'Willediriswrolkcrty
.•., ya , , Coflurdsslonftimi)511�2
r„....
(Where the applicant is not the owner) fWWWpW4AM
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