HomeMy WebLinkAbout49256-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 #: 49256 Date: 5/16/2023
Permission is hereby granted to:
Menendez, Gabriel
585 10th St
Brooklyn, NY 11215
To: legalize "as built" finished basement to existing single-family dwelling as applied for.
Additional certification may be required.
At premises located at:
450 Stirling Woods Ln, Southold
SCTM # 473889
Sec/Block/Lot# 88.-2-15.4
Pursuant to application dated 4/12/2023 and approved by the Building Inspector.
To expire on 11/14/2024.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $1,117.60
CO-ALTERATION TO DWELLING $50.00
Total: $1,167.60
Building Insp oar
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 littpsa/wwwsou,tlioldtowiiny.gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Onl
Y
PERMIT NO, Building Inspector:
WR 12 2023
Applications and forms must be filled out in their entirety.Incomplete ~bPI�Pi� III�, i
applications will not be accepted. Where the Applicant is not the owner,an "ChM 0V s0ii c "'I D
Owner's Authorization form(Page 2)shall be completed.
Date: Febrary 13, 2023
OWNER(S)OF PROPERTY:
Name: Emily Medina, Gabriel Menendez SCTM#1000-088-02-15.4
Project Address: 450 Sterling Woods Lane, Southold, NY 11971
Phone#: 646-896-4930 Email: medina.emily@gmail.com
Mailing Address: 450 Sterling Woods Lane, Southold, NY 11971
CONTACT PERSON:
Name: Emily Medina
Mailing Address: 450 Sterling Woods Lane, Southold, NY 11971
Phone#: 646-896-4930 Email: medina.emily@gmail.com
DESIGN PROFESSIONAL INFORMATION:
Name: not applicable
Mailing Address:
Phone M. Email:
CONTRACTOR INFORMATION:
Name: not applicable
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
DOther As-Built existing basement n/ap
Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? Dyes �No
1
PROPERTY INFORMATION
Existing use of property: Single family Intended use of property: Sin lle family
zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
AC this property? ❑Yes RNo IF YES, PROVIDE A COPY.
VCheck Box After Reading: The owner/contractor/design profess lonal 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.
Application Submitted By(print name):Gabriel Menendez ❑Authorized Agent WOwner
Signature of Applicant: Date: `� ! L� 23
STATE OF NEW YORK) CAROLINE M MMACARTHLIit
SS: Notary Public-State Of New Yorlw
NE1.Oi Afr384635
COUNTY OF SUP�aL.4 ) Qualified in Suffolk Lounty
My commission Expires DOC 17,20'25
(;A 1-,121 C-j- rn C-1/C--/V 1>6- 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/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
Z. day of 4P(24c- ,20_0 r
Notary Public
PROPERTY OWN:ER AUTHORIZATION
(Where the applicant is not the owner)
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