HomeMy WebLinkAbout49511-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
`A TOWN CLERK'S OFFICE
`gym 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#: 49511 Date: 7/25/2023
Permission is hereby granted to:
McCloskey Thomas
PO BOX 223
New Suffolk NY 11956
.�......... _ �_ ......
To: Legalize an "as-built" alteration to an existing single-family dwelling as applied for.
Additional information may be required.
At premises located at:
15305 New Suffolk Ave, New Suffolk
SCTM # 473889
Sec/Block/Lot# 117.-6-15
Pursuant to application dated 5/23/2023 and approved by the Building Inspector.
To expire on w1/23/2025.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $651.20
CO-ALTERATION TO DWELLING $50.00
Total: $701.20
Building Inspector
41TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
-Nlve @* ol'll Telephone (631) 765-1802 Fax(631) 765-95021x �: fav ��w soizt[iolc�town- ,gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. Building Inspector.,
Applications and forms must be filled out in their entirety. Incomplete n
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.11 n °
Date:
OWNER(S)OF PROPERTY:
Name: t !I ( SCTM#1000-ll
_ 6
Project Address:
Phone#: 1% - x,52 - 2SO Email:
Mailing Address:
CONTACT PERSON:
Name:
Mailing Address: 26b ti- qN aq 92
Phone#: cf�5"�S Email: ��� ��.� � `1 j� co M
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address: •Z66 ��.ZY r�( 1 MV1 q92-
Phone#: V1 - 179 -73� Email: ` fir 5 a-ar v1 % Ghw-c
CONTRACTOR INFORMATION:
A
Name: A 4"omwr��n�
Mailing Address:
Phone#: W - +-��I r -(� Email:.
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition gAlteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $
Will the lot be re-graded? ❑Yes '` bio Will excess fill be removed from premises? ❑Yes []No
1
PROPERTY INFORMATION
Existinguse of property: Intended use of property:
�p
p p ���
Zone or use district in which premises is situated: Are there any covenantj and restrictions with respect to
,I Yll,ll,^ J.o f A I" this property? ❑Yes No IF YES, PROVIDE A COPY.
ll1 U1 I V 1f�1
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 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): Cod f 1y n D-e<Yuji(r WAuthorized Agent ❑Owner
Signature of Applicant: , Date:
STATE OF NEW YORK)
SS:
COUNTY OF SAk dk— )
Cr being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the
i
Contractor Agent, OffIcer, etc.
Corporate
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.
JOSEPH A. DEERKOSKI
NOTARY PlJffl...IC, Sl.-tle. of New York
Sworn before me this No, O'UDIE Y9`8125
Q.0 alitigJ wn SLAfrOlk County
day of 20 �Z
Jan. s�,
Commission .A
E�w �u�ro
tary Public
i.,.
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
residing at—E05 VJ 5 ASuffalce� Ads. Mvq
"VIC0 (( ' do hereby authorize J ( to apply on
my behalf to the Town of Southold Building Department for approval as described herein,
G
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wrier's Signature Date
Cia(
Print Owner's Name
2