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HomeMy WebLinkAbout49617-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT k'P 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 #: 49617 Date: 8/24/2023 Permission is hereby granted to: Farmer Loretta 3635 Mystic Way.... . Grove Ci , OH 43123 . .................. m_mITITIT m_mm ,,, To: Install 12 replacement windows "in-kind" to an existing single family dwelling as applied for. At premises located at: 1145 Three Waters Ln Orient SCTM #473889 Sec/Block/Lot# 15.-6-17 Pursuant to application dated _„7/14/2023 and approved by the Building Inspector. To expire on 2/22/2025. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00 CO-RESIDENTIAL $50.00 Total: $250.00 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 littps://www,.southoldtownny.gov Date Received APPLICATION FOR BUILDING PERMIT V EEL)' 3 cs For Office Use Only �i PERMIT NO. Building Inspector;_ JUL 1 4 2023 Applications�n farm � tie filled out In th�ir�rrki�ety Ir�complet alicatlons�will r�bt ► a,cepted INhar thj '14f31�cant is n© Eft. the oWnr,an °G �; Owf>Iets�►ttthcf�iza#�cFrttorm;(Pa�e 2j shy be�o, ple OWNERS)QF PROPERTY: ti.. Name: k,,Ipk a-� Lcre rc, Farm e,- SCTM# 1000- 0) 5'-oo 06- 00, 017 0001 Project Address: // 5- -7— �� 4 1195-7 Phone#: Email: Mailing Address: S-�;C CONTACT PERSON: Name: Mailing Address: Phone#: 6�/ Ct 9 5--.5 �,Z.. ail: C DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: o �1 Mailing Address: Phone#: a-t.2 (o Qa �� Email: DESCRIPTION OF PROPOSED CONSTRUCTION p ion Estimated Cost of Project:. L' ?6tther ❑Alteratio, 1;a $❑New Stru�cttrG ❑Adtlition �ln Re airmo it Will the lot be re-graded? ❑Yes ONO Will excess fill be removed from premises? ❑Yes o a i PROPERTY INFORMATION Existing use of property: Intended use of property: Zone or use district in which premises is situated:. Are there any covenants an restrictions with respect to this property? ❑Yes F YES, PROVIDE A COPT. 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 210.45 of the New York State Penal Law. Application Submitted BY(pr( a ), � " jll�� hil � ❑Authorized Agent ❑Owner Signature of Applicant: CONNIN.%UNCH Notary Public,State of New York No.01 BU6185050 STATE OF NEW YORK) Quafified in Suffolk County SS: Commission Expires April 14, 20o I COUNTY OF ) 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 �lay of , 20 Notary Public PROPERTY OWNER AUTHORIZATION (Where the applicant is not the owner) p, 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 2 Buildigg Department Application AUTHORIZATION' (Where the Applicant is not the Owner) LORETTA L. FARMER AND RALPH G. FARMER residing at 3635 MYSTIC WAY, (Print property owner's name) Mailing Address) GROVE CITY, OH 43123 do hereby authorize PETER SCHEMBRI AND (Agent) GAIL SCHEMBRI to apply on my behalf to the Southold Building Department. A L. FARIME RALPH FARMER