HomeMy WebLinkAbout49612-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
a
TOWN CLERK'S OFFICE
V- r SOUTHOLD, NY
e,
Dw. ,"wo,
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#: 49612 Date: 8/23/2023
Permission is hereby granted to:
Sunstar Real LLC
4 Blueber Rid a Dr
Holtsville, NY 11742
To: install generator as applied for. Protection from vehicle impact must be provided.
At premises located at:
11160 Route 25 Mattituck
SCTM # 473889
Sec/Block/Lot# 122.-3-9
Pursuant to application dated 8/11/2023 and approved by the Building Inspector.
To expire on 2/21/2025.
Fees:
ACCESSORY $100.00
ELECTRIC $85.00
CERTIFICATE OF OCCUPANCY $50.00
Total' $235.00
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O.Box 1179 Southold NY 11971-0959
a Telephone(631)765-1802 Fax(631) 765-9502,1lti is m//Nk�hrw,u,'�ot m , ,0v/'n. y,,uq
mF �P
Date Received
APPLICA I 1Y ! IR BUILDING I IIIIIRI
EC EE WE
For Office Use Only
PERMIT NO. _ Building Inspector-.___.... _.�_er� G 20'23
Applications and forms must be filled out in their entirety.Incomplete
I o e accepted. Where the Applicant is not the owner,an
applications will not b p pp Building Department
Owners Authorization form(Page 2)shall be completed. Town of Southold
f�
Date.,
^3
ryC
OWNER(S)OF ROPERTY:.
Name: ®t4 In:I��o� ����f� SCTM#1000- a
Project Address:
Phone#: 6 -- ---� �� Email: Oti
Mailing Address.
CONTACT PERSON:
Name:
Mailing Address: $(3 ����: , ..wyj. " 1 .
— 2
Phone#t: .._. � �m ..e, Emai.ML i �� t ra "" a� "'C':: Yy)
DESIGN PROFESSIONAL INFORMATION:
Name: X r+ rt cffi :W,G
Mailing Address: O COXO q
.{-
Phone#: _W.._ Email:�ki aech B& OM (,/'lel
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
[I New Structure LIAddition Iteration ❑Repair ❑Demolition Estimated Cost of Project:
Will the lot be re-graded? ❑Yes P40 Will excess fill be removed from prem ❑Yes ONO
PROPERTY INFORMATION
Existing use of property: Intended use of property:
M�Qc�urlt.�
Zone or use district in which premises is situated: Are there any covenant and restrictions with respect to
this property? ❑Ye No IF YES,PROVIDE A COPY.
caw_
Box
eir Reading:L
Chapter 236 of the Town The owner/contractor/design professional Is responsible for all drainage and storm water issues as provided by
i
(CATION 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(pri t )• 1 uthorized Agent ❑Owne
r
CON
NIE Cr. BUNCfi
Signature of Applicant: .4 Notary Public,State of New York Date: 1281,
No.01BU6185050
Qualified in Suffolk County /�
STATE OF NEW YORK) Commission Expires April 111, 2 Ua
COUNTY OF " ) A)
LA V,�r
ez +'", � being duly sworn,deposes i�nd says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the
N
C ntractor,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.
Sworrbefore me this
Iday of 20
Notary Public
I
(III''! QI Eltl Vn' OWNER ,Ai rrivi ii IF 1 1
(Where the applicant is not the owner)
residing ata -
_ —do hereby authorize to apply on
my be )f to the T wn of Southold Building Department for approval as described herein.
g6r
Oy ti,er's Signature Date
Print Owner's Name
2