HomeMy WebLinkAbout48935-Z 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 #: 48935Date: 2/17/2023
Permission is hereby granted to:
Boucher, Diane.
8 Windmill Ct
.... ...._ _ ._..
Smithtown, NY 11787
To: Remove existing deck (CO z-20356) and construct additions and alterations to an
existing single family dwelling as applied for.
At premises located at:
5645 Pequash Ave, Cutchoguee__ITIT _mm
SCTM #473889
Sec/Block/Lot# 110.-6-2
Pursuant to application dated 2/7/2023 and approved by the Building Inspector.
To expire on /18/2024.
.......................................................
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $536.00
CERTIFICATE OF OCCUPANCY $50.00
Total: $586.00
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
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Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 lit :1/www. oLitltoldto iin .IoNI
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Date Received
APPLICATION FOR BUILDINGPERMIT
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For Office Use Only u
PERMIT NO. I Building Inspector:4� - �� � �'
Applications and forms must be filled out in their entirety.Incomplete It or-st trrpi 'l.i::
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date: 6th February, 2023
OWNER(S)OF PROPERTY:
Name: Mrs. Diane M. Boucher SCTM #1000- 110.00 - 06.00 - 002.000
Project Address: 5645 Pequash Avenue, Cutchogue, N.Y. 11935
Phone#: 516.356.3100 1 Email:Butterflysisters5@yahoo.com
Mailing Address: 8 Windmill Court, Smithtown, N.Y. 11787
CONTACT PERSON:
Name: Nigel Robert Williamson
Mailing Address: P.O. Box 1758, Southold, N.Y. 11971
Phone#: 631 .834.9740 Email: nigel_architect@hotmai1.com
DESIGN PROFESSIONAL INFORMATION:
Name: Nigel Robert Williamson R.A.
Mailing Address: P.O. Box 1758, Southold, N.Y. 11971
Phone#: 631 .834.9740 Email: nigel_architect@hotmail.com
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ®Addition RAlteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other
Will the lot be re-graded? Dyes RNo Will excess fill be removed from premises? gYes 0N
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,_, � �) a�I + II(rg Intended use of property. Single family dwelling
Zone or use district in w
is premises is situated: Are thereany
y covenants and restrictions with respect to
property? Dyes iONo IF YES PROVIDE A COPY
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Application Submitted BY(print name): Nigel Robert Williamson
BAuthorized Agent Own r
Signature of Applicant Date: �,��
STATE OF NEW YORK)
SS:
COUNTY OF,
Nigeli RobertWilliamson _ being duly sworn,deposes and says that(s)he is the applicant
(IVarde of individual signing contract)above named,
r (5)hej''sthe Agent
(Contractor,Agent,Corporate Officer,etc_)'
of said owner or ownefs',and is duly authorized to perform or have performed the said work and to make and filet his
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/��� / a'ppftca��on,that alllstatemehts contained in this application are true to the best of his/her knowledge and belief;and
/I thatthe work will be performed in the manner set fo""rth"in"the,applicationfile therewith.
won before me this
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NOtary Public
BRIAN
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1.Copyright 2019,Alphonse Pesos Jr.,Co.,YnC,Land Surveying,All Rights Reserved.
2,Unauthorized alteration or addition to a survey map bearing a licensed land surveyors i
,�1�? A Yi 8 P PS rP, J r. the New York state Education Law.
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3.Only boundary survey maps with the surveyors embossed seal are genuine true and a
V YORK Professional 11a»b 3urt egor
A =}., opinion.
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Y CORP. " `. 4.Certifications on this boundary survey map signify that the map was prepared in accord
} :, Land Surveys adopted by the New York State Association of Professional Land Surveyor.,
t � the boundary survey map is prepared,to the title company,to the governmental agency,
N.Y.S.Lic.No.048365 i 1 survey map.
)9 ' x k--` 5.The osriifications herein are not transferable.