HomeMy WebLinkAbout49185-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#: 49185 Date: 5/1/2023
Permission is hereby granted to:
Osvaldo Landvik LLC
167 Bowery #4� . _.... _. . . . _...._ .. ...... __..............__
New York, NY 10002
To: Alterations and second story deck addition to an existing accessory garage as applied
for. Use to remain as storage.
At premises located at:
16109 Route 25, East Marion
SCTM # 473889
Sec/Block/Lot# 23.-1-10.1
Pursuant to application dated 3/24/202w3mmmm and approved by the Building Inspector,
p10/30/2024..............._...................................
To expire on mmm
Fees:
ALTERATION OF ACCESSORY BUILDINGS $262.00
CO-ADDITIONS TO ACCESSORY BUILDINGS $50.00
Total: $312.00
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 https://ivww.soutlioldtomiov
Date Received
APPLICATION FOR IDING II r
L '
For Office Use Only
PERMIT NO. ✓ Building Inspector:
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:
OWNERS)OF PROPERTY:
Name: 115S\/Otic) K L/L61 SCTM#1000- a3' 1� ►�,
Project Address: 0 AAI (A[ P—Q- tASr IWO( 2d 11737
Phone#: 11 Email:
Mailing Address. /P/04
Pt/04 IR&irti V/Kr- MAP toAf N I 3
CONTACT PERSON:!
Name: J �D ��'ll/ S S
Mailing Address: �b lu0y-
Phone#: 631 2w - lb � Email: I�E��I?2 QST- WIN4IL. C VAt
DESIGN PROFESSIONAL INFORMATION:
Name: AIL 0 G N G�� r
Mailing Address: 4W (/�. N loot 3
Phone#: LL /Zr- Z 0 Email: (\10L � KAA-C� crFtr• 60/q
CONTRACTOR INFORMATION:
Name: V*7iTVt V*-J f
Mailing Address: Pp 8o1C14 OIt
Phone#: 4 Email: vzoy— Sr Q /vl�/(.,•�0/t-t
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
[]Other $ 2-0od o
Will the lot be re-graded? ❑Yes o Will excess fill be removed from premises? ❑Yes dNo
1
PROPERTY INFORMATION
Existing use of property: Intended use of property:
Zone or use district in which premises is situated: Are there any covena;N"o
d restrictions with respect to
this property" ❑Yes IF YES, PROVIDE A COPY.
❑ wck U A tear I
VIII' .. � + dh�iThe 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 building(s)for necessary inspections.False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 220.45 of the New York State Penal Law.
Application Submitted By(print n me;): JAf7R 1—V�S S EIAuthorized Agent ❑Owner
Signature of Applicant: Date:
I 111
CONNIE D.BUNCH
STATE OF NEW YORK) Notary Public,State of New York
No.01 BU6185050
SS: Qualified in Suffolk County
COUNTY OF ) Commission Expires April 14, 2 0�1,
JA.V Lover,t�-4 s being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the C-0L1T-1L"
(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
04
3
ay of ,20
Notary Public
11110FIER'T OWNER lI1JOIII Z III 014
(Where the applicant is not the owner)
I6 1
I, v� 40 IV residing at 14kiv f�P- M
�s� �'�2(r'N
7 "7 do hereby authorize J f0 s to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
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