HomeMy WebLinkAbout49141-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
9 SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PIANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit #: 49141 Date: 4/19/2023
Permission is hereby granted to:
Edwards Jr, David
PO BOX 696
Fishers Island, NY 06390
To: construct accessory garage as applied for.
At premises located at:
WinthropDr, Fishers Island
SCTM #473889
Sec/Block/Lot# 9.-10-7
Pursuant to application dated 3/20/2023 and approved by the Building Inspector.
To expire on 10/18/2024.
Fees:
ACCESSORY $253.60
CO-ACCESSORY BUILDING $50.00
Total: $303.60
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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 https://www.southoldtowtiny.gov
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Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. Building Inspector: MAR 2
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Applications and forms must be filled out in their entirety. Incomplete °^
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date:16 February 2023
OWNER(S)OF PROPERTY:
Name: David and Gail Edwards SCTM# 1000-9.-10-7
Project Address: 484 Winthrop Drive, Fishers Island,NY
Phone#:631-788-7382 Email:
Mailing Address:484 Winthrop Drive, Fishers Island, NY 06390 #696
CONTACT PERSON:
Name:Sam Fitzgerald
Mailing Address:15 E. Putnam Avenue, #234, Greenwich, CT 06830
Phone#:8601-287-3808 =Email:sam@sfapc.net
DESIGN'PRO FESSIONAL INFORMATION:
Name:Samuel W. Fitzgerald Architect PC
oMailing Address:15 E. Putnam Avenue, #234, Greenwich, CT 06830
Phone#:860-287-3808 =Email:sam@sfapc.net
CONTRACTOR INFORMATION:
Name:C/O Owner
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
WNew Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project
❑Other $
Will the lot be re-graded? ❑Yes @No Will excess fill be removed from premises? IWYes 0 N
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PROPERTY INFORMATION
Existing use of property:Single-Family Residence Intended use of property:Single-Family Residence
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R-40 this property? ❑Yes @No IF YES, PROVIDE A COPY.
19 Check Box After Reading: The owner/contrActor/design professional is respo "rnsible for a�idrainage and storm r issues a's vided proby
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 fork anti other applicable Laws,Ordinances or Regulations,for the construction of buildings,--
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additions,alterations or for removal or slemobtfonas hereihdescnbed The applicant agrees to comply Mrlth ali�pphcable laws,ordinances building cotle
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housing cote and regulabons'and to admitauthonzed inspectors on premises and"in building(s)for necessary inspections/JaMse statermgnts made herein are
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punishable asa Class A misdemeanor pursuant W fiction 730.45 of the New York-State Penal,La .
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Application Submitted By(pri t name:S muel W. Fitzgerald RAuthorized Agent ❑Owner
Signature of Applicant: Date:
STATE OF NEW YORK)
SS:
COUNTY OF SUFFOLK
<>0.YAM In- A being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the A t
(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 b lief-arid,.,,f
that the work will be performed in the manner set forth in the application file therewith. .�'w ° l: .....,.CAVI
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Sworn before me this
day of a* 1� ,, , 20 a�� • >
Na, P ubrue A ,
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_.-•`j .- .� .."„_.../ .i1I� J,:131]I II INI III,Ix
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
I, GL.v) +L residing at
do hereby authorize Samuel W. Fitzgerald to apply on
my behaff,p the Town of Southold Building Department for approval as described herein.
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Owner's Signature Date
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Print Owner's Name
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