HomeMy WebLinkAbout49251-Z TOWN OF SOUTHOLD
14, BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
y 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#: 49251 Date: 5/15/2023
Permission is hereby granted to:
Sadik, Elizabeth
103-19 68th Rd
Forest Hills NY 11375
To: legalize "as built" alterations to existing single-family dwelling as applied for.
Additional certification will be required.
At premises located at:
2300 Sound Dr, Greenport
SCTM #473889
Sec/Block/Lot# 33.-1-15
Pursuant to application dated 4/12/2023 and approved by the Building Inspector„
To expire on 11/13/2024.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $1,400.00
CO-ALTERATION TO DWELLING $50.00
Total: $1,450.00
4111 -e:�--�—I
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 hap gwwwsoutho toN it Y
Date Received
APP11 ICA'rm FOR 'IIIDI '
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For Office Use OnlyAlll::)R 12 2023
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PERMIT NO. Building Inspector 0
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:
OWNER(S)OF PROPERTY:
Name: f r L C � �K� kSCT(�A# 1000- 3�
Project Address: c:> �v •:tG�
Phone#: Email: r �^
Mailing Address:
CONTACT PERSON:
Name:
Mailing Address: C) 1 rimes-(--
Phone#: 04 °� `� �j [� Email: r ( A, e'fo I' '
DESIGN PROFESSIONAL INFORMATION:
Name: 5 P SG heIt
�
Mailing Address: '
2 s
i ,
.....Phone#: 6 31 X16 S- - z �.SST- Email-. �« 1•vi � Q nP
CONTRACTOR INFORMATION:
Name:.
Mailing Address:
Phone#: Jimail:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition Iteration ❑Repair ❑Demolition Estimated Cost of Prje�t:
❑Other $ "
Will the lot be re-graded? ❑Yes No Will excess fill.be removed from premises? ❑Yes No
1
PROPERTY INFORMATION
Existing use of property: k $ / Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? es ❑No IF YES, PROVIDE A COPY.
Chapter 436 of the Town Code. ')I go The owner/tt Wactor/�deatgn professional is responsible for all drainage and storm water issues as provided by
n B��A/ �"1'" ��feat
Z LICATIDN IS HEREBY MADE to the BLdkMg 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 asherein described.The applicant agrees to comply with all applicable laws,ordinances,building code,
housing code and regulations and to admit authorized Inspectors on promises and in buildingls)for necessary inspections.False statements made herein are
punishable as a Class A misdemeanor pursuant t to Section YA.O
45 of the New York State Penal Law.
_5'4VL
Application Submitted By(print name): ❑Authorized Agent gowner
Signature of Applicant: Date: l Z Z3.
STATE OF NEIN YORK)
SS:
COUNTY OF
being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the
(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/filer knowledge and belief;and
that the work will be performed in the manner set forth in the application file therewith.
Sworn before me this
day of 20, ''
Notary Public
CONNIE D.BUNCH
Notary Public,State of New York
No. 01 BU6185050
nPROPERTY" ,m"ry " ) ) Qualified in Suffolk County
(Where the applicant is not the owner) Commission Expires April 14,2 �y
residing a
dao eby authorize to apply on
fry behalf to the Town of Southold Building Depa 1t for approval as describe rein.
Owner's Signature Date
Print Owner's Name
2