HomeMy WebLinkAbout49503-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
k " ti' 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#: 49503
Date: 7/2112023
Permission is hereby granted to:
Jacquet, Phil!pP_..e. _.......... �r
PO BOX 142
Orient, NY 11957
To: Construct a garage addition to an existing single-family dwelling as applied for.
At premises located at:
710 Grandview Dr, Orient
SCTM # 473889
Sec/Block/Lot# 14.-2-3.34
Pursuant to application dated _m6/14/2023 and approved by the Building Inspector.
To expire on _ _1/19/2025.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $320.40
CO-ADDITION TO DWELLING $50.00
Total: $370.40
A Ab. -
Building Inspector
f A(& 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 http§://www.soutlioldtownny.gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
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PERMIT NO. Building Inspector: &- JUN 144 lO 2 3
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Date:
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Name: L-;j PP-t-Z'Ann 1 ' SCTM # 1000- 11
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Project Address: '�V
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Phone#: Email: tk , 1`4)
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Mailing Address:
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CONTACT,PkSbW""" '
Name:
Mailing Address:
Phone#: Email:
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�INAN TIDES
Name:
Mailing Address:
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Phone#: Email:
CONTRACTOR INFORMATfON �'
Name:
Q, r,sllL- "P
Mailing Address: .. ....
Phone#: Email:
DESCRIPTION OF PROPOSES CONSTRUCTION
E]NewStructure Addition ElAlteration EIRepair F-IDemolition Estimated Cost of Project:
F-10ther
Will the lot be re-graded? E]Yes �No Will excess fill be removed from premises? E]Yes No
PROPERTY INF,ORMATIQN
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 Readih The owner%contractor/desigh professional is responsible for all drainage and storm Water issues as k6vided by
Chapter 236 of the Town code. APPLICATION IS HEREBY MADE to the Bull'Ing"Department for ti"Ne issuance of a Building Permit pursuant to the Building Zone
Ordinance of the Town of Southold,Suffolk,county,New York and other appLcable Laws,Ordinances or RAjjolations;for the construction of buildings,
additions,alterations or for remgval or demolitlon as herein descri[sed.�The'appficant agrees to comply with all applicable laws,ordinantes,b(iildingFode,
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'elass A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
Application Submitted By(print name). , � ( _�° �� w ❑Authorized Agent
Signature of Applicant: Date:
„,..- CONNIE D. BUNCH
• Notary Public,State of New York
STATE OF NEW YORK) No.01BU6185050
SS: Qualified in Suffolk County
COUNTY OF ) Commission Expires April 14, 2-P-C��-
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 of20 1%-r L
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
I, residing at
do herebyauthorize
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