HomeMy WebLinkAbout49513-Z rpt `` TOWN OF SOUTHOLD
a BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
w 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#: 49513 Date: 7/25/2023
Permission is hereby granted to:
Gilgoff, tLu�
.__
13 Douglass St
vvv__ wawa .... ....... ,
Brooklyn, NY 11231
To: Legalize an "as built" finished basement to an existing single-family dwelling as applied
for. Additional certification may be required.
At premises located at:
1155 Marlene Ln, Laurel
SCTM #473889
Sec/Block/Lot# 144.-3-3
Pursuant to application dated 6/16/2023 and approved by the Building Inspector.
To expire on 41/23/2025.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $784.00
CO-ALTERATION TO DWELLING $50.00
Total: $834.00
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
ai
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
' n Telephone (631) 765-1802 Fax (631) 765-9502 htt ./lwww.so lioldtownn . o
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only r J ;
Building Inspector; '�
PERMIT NO., J UINI 1 6 20
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date:6/12/2023
OWNER(S)OF PROPERTY:
Name:Christine Gilgoff SCTM#1000- lLf (43
I
Project Address: 1155 Marlene Lane Mattituck, NY 11952
Phone#:917-549-3153 Email:Chrisgilgoff@gmail.com
Mailing Address:13 Douglass Street 2nd floor Brooklyn, NY 11231
CONTACT PERSON:
Name:Christine Gllgoff
Mailing Address:13 Douglass street 2nd floor Brooklyn NY 11231
Phone#:917-549-3153 i:chrisgilgoff@gmail.com
DESIGN PROFESSIONAL INFORMATION:
Name:Joseph Fischetti, PE
Mailing Address:PO Box 616 Southold, NY 11971
Phone#:631-765-2954 Email:wingman@optonline.net
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
D Other legalize as built finished basement $850.00
Will the lot be re-graded? ❑Yes *No Will excess fill be removed from premises? ❑Yes ®No
1
PROPERTY INFORMATION
Existing use of property:Residential Intended use of property:same
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R40 this property? ❑Yes I*INo 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 issuance of p 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.
Christine gilgoff
Application Submitted By(pri -.P me): ❑Authorized Agent BOwner
Signature of Applicant: Date:
STATE OF NEW YORK)
SS:
CO U NTY O F i A �)
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signira contract)above named,
D)h is the w�' r
(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
�
20 23' C day of " "f
Notary Public
NATKq4AEL PANTIA
Notary Public,State,of New York
No'
01PA6276645
�' (,OPER " -H0g)Z, "I[ Qualified in Nassau County
Commission Expires February 19,20_�
(Where the applicant is not the owner)
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
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