HomeMy WebLinkAbout50152-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#: 50152 Date: 12/20/2023
Permission is hereby granted to:
Tahliambouris, Geo! e
63 Richards Rd
Port Washington, NY 11050
To: Construct interior demolition (surface materials) of existing single family dwelling as
applied for.
At premises located at:
20210 Soundview Ave, Southold
SCTM # 473889
Sec/Block/Lot# 51.-3-13.2
Pursuant to application dated 10/31/2023 and approved by the Building Inspector,
To expire on 6/20/2025.
Fees:
DEMOLITION $989.00
Total: $989.00
Building Inspector
rru k 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) 765-9502tts: /w .sotrtloldowr�
Date Received
APPLICATION FOR BUILDING PERMIT _
pp $q 4 e
For Office Use Only
dw
PERMIT NO,, Building Ins ecton
Applications and forms must be filled out in their entirety.Incomplete
lete
Y.
applications will not be accepted. Where the Applicant is not the owner,an
Owner's'Authorization form(Page 2)shall be completed.
Date: 5 1
OWNERS)OF PROP I't f,
y
Name: 1-0&1 �`; SCTM#1000- '1 — � —
Project Address: -LO-LI 0NY WIV-71
Phone#: "'f " Email: U
Mailing Address: (�I� �"! I" "
CONTACT PERSON:
Name
Mailing Address:
Phone#: q1 1� IJ 6 Email: Z
DESIGN PROFESSIONAL INFORMATION:
Name;
L� .
Mailing Address: 'e enk
Phone#: �) a. �� Email: C�d Z2 c Y „ -
CONTRACTOR INFORMATION:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑Repair emoiition Estimated C st of Project:
q�NewS ture� ditivn Iteratlrarc
17 �
Cdther
�� ,
Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises? ❑Yes NO
1
PROPERTY'INFORMATION
Existing use of property: i, 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 A No IF YES, PROVIDE A COPY.
❑ Check Box After Reading; The owner/contractor/design professional is responsible for altorainage and storm water Issues provided by
Chapter 236 of the Town Code.APPLICATION IS HEREBY III ADE to the Building Department for the Issuance of a Building permit pursuant to the Building Zone
Ordinanceof the Town of Southold,Suffolly County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings,'
additions,alterations or for rem'oval or demolition as herein described.-The appilcant agrees to comply with all applicable laws,ordinances,building code,
housing code and regulations and to admit authorized inspectors on Irrgmises acid False statements made herein are
in buildings)for necessary Inspections.
punishable as a Class A misdemeanor pursuant to Sectior 210.45 of�the'New York State Penal,Law. '
Application Submitted By(print name): uc I✓VV,4- 17Authori2ed Agent Jk6wner
Signature of Applicant: a CONN ."BNCq`� `
Notary Public„State of New York
STATE OF NEW YORK) No. 01 BU6185050
Qualified in Suffolk County
SS: Commission ExpiresApril 14, 2 0 IL-1
COUNTY OF
_�.._ ,,. being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
a
(S)he is the
(Contractor,Agent,Corporate Otticer, etc.)
of said owner or owners, and is duly authorized to perform or have performed 66 said wo'tk and to make and file this
application;that all statements contained.in this application are true to the best of his/Tier knowledge and belief; and
that the work will be performed in the manner set forth Nn the application file therewith.
Sworn before'me this
d
a day oft " a 20
Notary Public
PROPER"L"Y OWNER AUTHORIZATION
(Where the applicant is not the owner)
1, -- 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
Additional
Certification OCCUPANCY
OCCUPANCY OR
May Be Required.
Project Status
APPROVED AS NOT ®
USE IS) U11LMVvrIJLDATEB.P. WITHOUT CERTIFICATE
:���� � �
FE _-(D BY. OF OCCUPANCY
NOTIFY BUILDING DEPARTMENT AT
631-765-1802 8AM TO 4PM FOF THE
r�
FOLLOWING INSPECTIONS:
1. FOUNDATION-TWO REQU RED '"" TT
rr ser � fsr rr {u raer r wr rr
FOR POURED CONCRETE
2. ROUGH-FRAMING&PWN BING
3. INSULATION 4
4. FINAL-CONSTRUCTION M JST
BE COMPLETE FOR C.O. r t4 k j
ALL CONSTRUCTION SHALL MEET THE 4m", _ {
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OF THE CODE OF NEW -
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REQUIREMENTS - -
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COMPLY DES OF
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AS ED AND CON !TIONS OF = x
SOUiliO�LD Ton
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