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HomeMy WebLinkAbout48942-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT p TOWN CLERK'S OFFICE w � 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#: 48942Date: 2/22/2023_......_...._... Permission is hereby granted to: Mrvica, Darinko ...... w....ww.............. . ..........................m___. ........ ___. .. ........ 16-03 150th St Whitestone, NY 11357 To: Relocate and legalize a 12 x 16 accessory shed to an existing single family dwelling as applied for. Minimum setback of 5 feet is required from property lines. At premises located at: 300 Dolphin Dr., GreenportITITmmmmm SCTM # 473889 Sec/Block/Lot# 56.-7-8 Pursuant to application dated 6/17/2022 and approved by the Building Inspector. To expire on 8/23/2024. Fees: AS BUILT-ACCESSORY $353.60 CO -ACCESSORY BUILDING $50.00 ...................... Total: $403.60 ..........._ ,� ..... ..... 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 httt)s://www.southoldtownny.gov Date Received APPLICATION For Office Use Only PERMIT NO. U-I I Building Inspecton, Applications and forms must be filled out in their entirety. Incomplete BUILDING DEPT. applications will not be accepted. Where the Applicant is not the owner,an TOWN OF SOU OLD Owner's Authorization form(Page 2)shall be completed. Date: 67 ©ate OWNER(S)OF PROPERTY: Name: ���r rU OGi4 SCTM#1000 6 --7-9 Project Address: Phone#: 0 C4(o — 30a —3aFV Email: m i�2�c bqqqo�6) Mailing Address: �00 DoL?FktJ Vide— e5o U CONTACT PERSON:f - Name: zkrl✓1. Mailing Address: Phone#: 6 6 � 3��- 3� (� Email: U-k2X ��-�a� G(�l✓ki I � ► DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: Mailing Address: Phone#: Email; DESCRIPTION OF PROPOSED CONSTRUCTION ra�ti rr ❑Repair ❑ t of Project: ❑NeyweStructure I❑Ad Ition ,❑�Alte. � Demolition Estimated Cosi I Will the lot be re-graded? ❑Yes 54<0 Will excess fill be removed from premises? ❑Yes F110, 1 PROPERTY INFORMATION Existing use of property: Intended Intended use of property: 49 Zone or use district in which premises is situated: Are there any covenants a� restrictions with respect to this property? ❑Yes L�Ko IF YES, PROVIDE A COPY. 09"C'Sheck 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 15 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 buildings)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 : acrl"l /�rtllL,4 ❑Authorized Agent M Wner Signature of Applicant: Date: 611-714R--2— STATE 1'7/a„ZSTATE OF NEW YORK) SS: COUNTY OF Skffi( ) r 4b Mr V I ca being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the Vwnc—r (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 1-7 day of 20� G Notary Publi TRACEY L. DWYER NOTARY PUBLIC,STATE OF NEW YORK NO.01 DW6306900 P11-0- PEIRTY OWNERII 110RIZATION QUALIFIED IN SUFFOLK COUNTY (Where the applicant is not the owner) COMMISSION EXPIRES JUNE 30, 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 I. LOT t _ 1- _.. 0— --- , I J ,:is' •. r ARES _ - :: - -- _ - - 1 tor-7I , ►9; Z ...._. 9 �o -- L � . cr :L _. 66 Q Q + - -7.9-� � :, 5.x.7 2 I O �l .. 16 5.0 � • � ` __.. 2,8 1 s CF I3) fl 4JH . M i H GUS n. Pt i l -o - c U 2.V EY E FC • A i •�r� r• i r }� 1 a i � f I I I , I I I ' i i I _ ' i r - --' --•`-.�iJ-'-COO - • I SIU I I _ , , . II , r I , . I 1 . I II ------ ------- At - , r I I I , 1_7 J ' r , I ' , i I i -- , I , r I , I � 1 , a