HomeMy WebLinkAbout48858-Z " fat TOWN OF SOUTHOLD
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 #: 48858 Date: 2/6/2023
Permission is hereby granted to:
Stulsk , Christine
PO BOX 114
New Suffolk, NY 11956
To: construct repairs and alterations to existing single-family dwelling as applied for.
At premises located at:
515 Orchard St New Suffolk
SCTM # 473889
Sec/Block/Lot# 117.-5-35
Pursuant to application dated 1/17/2023 and approved by the Building Inspector.
To expire on 8/7/2024.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00
CO-ALTERATION TO DWELLING $50.00
Total: $250.00
Building Inspector
7 Y+r
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 s://www.,southoldtowiiiiy.gov
Date Received
APPLICATION
For Office Use Only E E � W
PERMIT NO. � Building Inspector: R JAN 17 1023
Applications and forms must be filled out in their entirety.Incomplete BUIll3ll' GDEP,.
applications will not be accepted. Where the Applicant is not the owner,an 7OWNOFSODMOLD
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: Clk_ SCTM#1000-
Project Address: f � ,G j�C.�i �✓-e�-✓ �(,c��OTk
Phone#:
Mailing Address: ��
CONTACT PERSON:
Name:
we
Mailing Address: �� ' ��� %70e
Phone#: ( Email; ����,. 'S
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address-
Phone =mail-
CONTRACTOR
INFORMATION:
Name:
Mailing Address: .7
Phone#: _ g� Email,Loll -
�•—
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition 4p!AIteration>4epair ❑Demolition Estimated Cost of Project:
❑Other f90
Willthe lot be re-graded? ❑Ye o Will excess fill be removed from premises? Dyes P<o
1
FFZonPROPERTY INFORMATION
���� Intended use of property: Z "
e
use of property: l'�>1/�
use district in which premises is situated: this property?Are there any c❑PesWo IF YI S, PROVIDE A COpy respect to
❑ C.1veck Box After I emfgr : 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
ction of buildings,
ordinance of the Town of Southold,Suffolk,County,New York and other applicable taws,Ordinances orRegulations,all applicable flaws,ordinancebuilding code,
additions,alterations or for removal or demolition as herein described.The applicant agrees to comply PP
In building(s)s for necessary Inspections.False statements made herein are
actors
on re
mises
andl g 1
hor4ed
Ins P
housing code and regulations and to admit aut P
punishable as a Class A misdemeanor pursuant to Section 210AS of the New York State Penal Law.
uthorized Agent ❑Owner
Application Submitted By(print name): /'/���"v�—
r
Date:
Signature of Applicants �—
STATE OF NEW YORK)
COUNTY OF )
' being duly sworn,deposes and says that(s)he is the applicant
141111
(Name of indivi ual signing contract)above named,
I---
(S)he is the
(Contractor Agen ,Corporate Officer,etc.)
of said owner or owners,and is duly authorized to rm 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.
h
Sworn before me this
J day of I' I` ,20.
tary Public
TI✓RACEY L. DWYER
NOTARY PUBLI STATE OF NEW YORK
PROPEh�"( !i T �� w R NO.ol DW6� 6900
(Where the applicant is not the owvner lv l I DIED IN SUFFOLK JUNE
E30,COUNT
�i� aBION EI�iFiEB JUNG 3�ti,
WP
residing at_ 1,S s
do hereby authorize �.. .. 4,wi V i" . . to apply on
my behalf to the Tovrn Southold Building Department for approval as described herein.
Date
Owner's Signature
Print Owner's Name
2
C
H&C ONE CORP CONSTRUCTION
8305 Cox LN #6
Cutchogue, NY 11935
Office- 631 856 0066
Cell- 631 953 1386
hconecorp@mail.com
Insurance information;
General Liability
Policy Number L068026874
05/07/2022- 05/07/2023
Worker' Compensation
NYSIF
Policy Number I2473019-4
05/08/2022- 05/08/2023
Suffolk County License
HI-62286
Expires 05/01/2023