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Home My WebLink About49287-Z pµ TOWN OF SOUTHOLD a + BUILDING DEPARTMENT ra TOWN CLERK'S OFFICE s44fq ww, 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#: 49287 Date: 5/22/2023 Permission is hereby granted to: Wexler Donna M Revoc Trust _......_ ................ ....____________.......................................... .v......... 1175Hill RdW out0 d NY 11971 ............ . To: Construct additions and alterations to an existing single family dwelling as applied for. At premises located at: ..........d Southold 1175 W H.!.l..I R .___�...�................... _............... -.........� ��... SCTM # 473889 Sec/Block/Lot# 70.-4-23 Pursuant to application dated 4/4/2023 and approved by the Building Inspector. To expire on 11/20/2024. - Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $773.20 CO -RESIDENTIAL $50.00 Total: ^ $823.20 ...._ ....��. .. .......................................... ................................. Building Inspector �fff�Xkp,y� veg 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 httDs://www.southoldtow!igy.gov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. q92 Building Inspector: ^. R" PR 0 4 2023 Applications and forms must be filled out in their entirety.Incomplete �;u ww��w ,, ,�'y applications will not be accepted. Where the Applicant is not the owner,an 1)01 Owner's Authorization form(Page 2)shall be completed. Date: OWNER(S)OF PROPERTY: Name. SCTM#1000- Project Address: //7� `V�S� '�� da �OGI✓h�/�..1 /UX 11-7,7/ Phone#: Email: V le Mailing Address: CONTACT PERSON: Name: Mailing Address: Phone#:V.2/ k' Email: DESIGN PROFESSIONAL INFORMATION: con 'cAc; PROPERTY INFORMATION Existing use of property: 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 ❑No IF YES, PROVIDE A COPY. ❑ 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 is 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(prin ,name): CZAuthorized Agent ❑Owner Signature of A lican Date: - - g PP �U '° - STATE OF NEW YORK) SS: COUNTY OF being duly sworn, deposes and says that(s)he is the applicant (Name of individual signi contract)above named, (S)he is the M (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 20 ICKIT-' BERi Y Notary PAP'— Notary .blitNotary Pubiic- State of Ne�York No. 01 BE6070081 Qualified in,Suffolk County PROPERTY OWNER AUTHORIZATION mIrnisgion Expires (Where the applicant is not the owner) residing at \ do hereby authorize �� + to apply on my behalf to the Town of Southold Buildin Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 SF_0 ST�O�]KI��JMA\T]EIK Scott A. Russell SUPERVISOR N A G]E CEN T SOUTHOLD TOWN HALL-P.O.Box 1179 1�y 53095 Main Road-SOUTHOLD,NEW YORK 11971 ` � Town Af CHAPTER 236 - STO. ' WATER MANAGEMENT REFS .m, _.. .. :.:.... ( APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT ONLY FOR PROPERTIES ONEX ACRE IN AREA OR LARGER.) APPLICANT; (Property Owner, Design Professional, Agent, Contractor, Other) Date: NAME: (r Contact Information: °" �` x ........_ .... (L-Mail R I elephnne Numbed 4 � Pro ert Address / Location of Construction Site: S.C.T.M. #: 1000 District Section Block Lot _ . ,. TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT - Area of Disturbance is less than 1 Acre, No ST.D.E.S. Permit is Required.! ;i - Project does Not Discharge to Waters of the State. No S.P.D.E,S Permit is Required i - Area of Disturbance is Greater than t Acre & Storm-water Runoff Discharges Directly to Waters of the State of New York. THE APPLICANT MUST OBTAIN a S.P.D.E.S. Permit DIRECTLY From N.Y.S. D.E.C. Prior to Issuance of a Building Permit. - Area of Disturbance is Greater than l Acre & Storm-,eater Runoff Flows Through Southold Town's MS4 Systems to Waters of the State of New York, THE APPLICANT MUST OBTAIN a a S.P.D.E.S. Per throu h the Southold Town Enaineerin, De ar tment Prior to Issuance of a Buildin Permit. 17 Revievved By: ..ww. ....... Date: J W. ...._.. _� �_. ._ .._ �_. �........ _�.. . . ._ FnRNr x 0,M(-P -Tn,, n,-rni,PT gniq C