HomeMy WebLinkAbout49197-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
;r 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#: 49197 Date: 5/3/2023
Permission is hereby granted to:
Courtien, Eileen
................................................................_........................._......._...__................._...........m_....__........................ ..
1375 Belleview Ave
_...._......._..._....._............�.�._.......................�........................................... .............. . .............................. ..........
Plainfield, NJ 07060
To: Construct an 8' x 14' accessory shed to an existing single family dwelling as applied for.
Shed requires a minimum of 10 foot setbacks.
At premises located at:
10006 New Suffolk Ave, Cutchogue
SCTM w#473889mmm
Sec/Block/Lot# 116.-6-1.1
Pursuant to application dated 3/22/2023 and approved by the Building Inspector.
To expire on 11/1/2024.
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Fees:
CO-ACCESSORY BUILDING $50.00
ACCESSORY $144.80
............................... ... w....
Total: $194.80
Building Inspector
TOWN OF SOUTHOLD-BUILDING DEPARTMENT
` Town Hall Annex 54375 Main Road P. O. Box 1179 Southold NY 11971-0959
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Telephone (631) 765-1802 Fax(631) 765-9502 1 1t. yr . o tl c 9clto rrazz .60V
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only pq ,
m t,i
6_
PERMIT NO. � Building InspectoMIAr ' I
I A ,
Applications and forms must be filled out in their entirety. Incomplete i
applications will not be accepted. Where the Applicant is not the owner,an : oFsdll`« i"ul,
Owner's Authorization form(Page 2)shall be completed.
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Date:
OWNER(S)OF PROPERTY:
Name: " 1e-e-0 Coup SCTM#1000-
Le LO_ l
Project Address: � boo L- 1JQ't-J 6 ; v C- c-QA +C( U� s
Phone#: _ � 'J—1 Email:
Mailing Address: t 3-� � `�V i e 1 U'f- -4C w 07- t) Go
CONTACT PERSON:
Name:
Mailing Address: l-� J Ra lcu l Vk PIR 1'�J i VA�
Phone#: ()4; 0� — l �� Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address„
Phone#: Email:
CONTRACTOR INFORMATION:
Name: KV S N f-3
Mailing Address: �/ aS L �q�n 0t Mi4 ff[ t0 L1.
Phone#:fo3 l _ 76S 3010
Email: N\Ic�4cp Co qmwlo C D w"
DESCRIPTION OF PROPOSED CONSTRUCTION
p
l�NewStructure ❑Addition ❑Alteration []Repair ❑Demolition Estimated Cost of Project:
❑Other $5, OO D
Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ❑Yes 9No
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PROPERTY INFORMATION
Existing use of property: Res, �,a,•, Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes t4o IF YES, PROVIDE A COPY,
L29 Check 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 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 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 210AS of the New York State Penal Law.
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Application Submitted BY(p�t ffme): 06Q a--Tl � 13AUth, rite A ent
Owner
Signature of Applicant: �.�M �:� �r - Dater
C'7
STATE OF NEW YORK)
SS:
COUNTY OF Sy �612(— )
,bei.ng,.d.uly sworn,cl .. ;
.i eposesanCl-says-Haat(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the �e
(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
�Lday CAA.
Notary Public
�PPi°��;.1"iPER N .., "�Y"N n !i ��i 1 1 !OlG,12A i41("I�1
(Where the applicant is not the owner)
1, 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
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