HomeMy WebLinkAbout49577-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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 #: 49577 Date: 8/14/2023
Permission is hereby granted to:
16125 Soundview Rity LLC
107 Hendrickson Ave
Rockville Centre, NY 11570
To: Legalize as-built finished basement with egress window well at existing single family
dwelling as applied for. Additional certification may be required.
At premises located at:
16125 Soundview Ave, Southold
SCTM # 473889
Sec/Block/Lot# 50.-2-19
Pursuant to application dated 6/26/2023 and approved by the Building Inspector,
To expire on 2/12/2025.
Fees:
CO-ALTERATION TO DWELLING $50.00
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $1,680.00
Total: $1,730.00
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 ]iUt)s://www,sotitholdtowlinv.gov
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Date Received
APPLICATION FOR BUILDING PERMITa
For Office Use Only JUN 2 � 2023
PERMIT NO. Building Inspector:
ftING DEPT.
Applications and forms must be filled out in their entirety.Incomplete To dF souTHOLD
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date:6/12/23
OWNER(S)OF PROPERTY:
Name: 16125 Soundview Ave Realty LLC �SC—Tm# 1000-
Project Address: 16125 Soundview Avenue, Southold NY 11791
Phone#:917-763-8713 Email:sgrzic@whitestonecc.com
Mailing Address:50-52 49th Street, Woodside NY 11377
CONTACT PERSON:
Name:Steven Grzlc
Mailing Address:50-52 49th Street, Woodside NY 11377
Phone#:g17-763-8713 Email:sgrzic@whitestonecc.com
DESIGN PROFESSIONAL INFORMATION:
Name. � � -.X ro 1—
Mailing Address: .00 6o)o S- GreGh ro t 4-
P h o n 6
-
Phone#:. 61 Email:
V -Lf5'7 5g G n k k-ilt.lA 2 t rro dQX 12.on
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $
Will the lot be re-graded? ❑Yes RNo Will excess fill be removed from premises? ❑Yes RNo
1
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 BNo IF YES, PROVIDE A COPY.
Check Box After, eadl g: The owner/contractor/deslgn 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 int rt'arrt_ .Steven Grzic ❑Authorized Agent @Owner
Signature of Applicant: Date: (I)��3
STATE OF NEW YORK)
SS:
COUNTY OF t .
, C.,, being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the t� a 4 .
(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 ZO
Notary Public
VI6��IWA LR60 II EW YORK
AR Y PUBLIC s 'Y i. G.;, 70245
PROPERTY OWNIE11 AUTHORIZATI , Re istration 1�. tvs r✓ounty
(Where the applicant is not the owner) Quaii6ed�n out,t
Ct�ivali ssi+ara Exl ra 120 �202tI
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
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