HomeMy WebLinkAbout49265-Z ,- TOWN OF SOUTHOLD
; ^ BUILDING DEPARTMENT
F „^
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 #: 49265 Date: 5/17/2023
Permission is hereby granted to:
Scarin e, James
26 Pearson Ave
Somerville, MA 02144
To construct accessory shed as applied for. Must maintain a minimum setback of 5 feet
from side and rear yard property lines.
At premises located at:
1180 Greenway W, Orient
SCTM # 473889
Sec/Block/Lot# 15.-1-23
Pursuant to application dated 4/14/2023 and approved by the Building Inspector.
To expire on 11/15/2024.
Fees.
ACCESSORY $151.20
CO-ACCESSORY BUILDING $50.00
Total: $201.20
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 itll)s: /wmiw.sotttlioldtoNvnny Dov,
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
p
PERMIT N0. Building Ins ector. C
Applications and forms must be filled out in their entirety. Incomplete : APR 1 4 2023
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date: y//q 2t�o�j
OWNER(S)OF PROPERTY:,;
Name: ,, -f , /t/ "tl S2.i1 SCTM # 1000-
Project Address: N 5
Phone#: 6 V1- ITS-_ IT'S� Email:lea Vy\a.r o0
Mailing Address: PeQ250� I t-LQ/ i'►if�4 . /'
CONTACT PERSON:
Name: / iAe Y-4 NZTINc5W
Mailing Address: Z 6 (- eARS00J AVC S.L./4 '
Phone#: 61-4 — Email:
-775-1 �' Viga f mar-H a&-Y% e ca l oo .
DESIGN PROFESSIONAL INFORMATION:
Name: L5hea Cc "
Mailing Address: o �J� ° l� . kxtN+u6<. + J 2
Phone#: 6 3)_ —+6 F-3D 9 Q Email, Co RckKai CZ)N
CONTRACTOR INFORMATION:
Name: 4v y 3 i , a l�
Mailing Address: 96-
Phone#: 5 — OI 1 301V Email: s � Mai I m
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
Other 5VJ*CA $ 7400-0
Will the lot be re-graded? ❑Yes VNo Will excess fill be removed from premises? ❑YesIdo
1
PROPERTY INFORMATION
Existing use of property: R�VuI �1Dm�. Intended use of property: e1Q ho V)'l�i
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes XNo IF YES, PROVIDE A COPY..
❑ Che&Box Ir R,eading�e 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 210.45 of the New York State Penal Law.
Application Submitted By(print t1a
W,, /V-LZ,lMc56/�/ ❑Authorized Agent ❑Owner
Signature of Applicant: Date:
CONNIE D. BUNCH
Notary Public,State of New York
STATE OF NEW YORK) No. 01BU6185050
Qualified in Suffolk County
SS: Commission Expires April 14, 2
COUNTY OF S r,!E-&
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
day of r'/ /
Notary Public
PROPER N OWNER AU'rFiORZ/V�F1014
(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
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