HomeMy WebLinkAbout50246-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
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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#: 50246 ,,.
Date: 1/23/2024 ..........................
Permission is hereby granted to:
Burke, Michael
111 Boxwood Dr
Kin s. — _ .......w. —
�
Park,, NY 11754
To: Construct a one-story bathroom addition to an existing single-family dwelling as
applied for.
At premises located at:
2295 Stillwater hoque
�...9 r Ave, utc...
SCTM # 473889
Sec/Block/Lot# 103.-8-5.1
Pursuant to application dated 12/20/2023
and approved by the Building Inspector.
To expire on mmm 7/24/202.5........
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $278.50
CO-ADDITION TO DWELLING $100.00
.....................
Total: $378.50
Building Inspector
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I
TO"R"N Off"S0(JT TOLD— IWILD1 NG Dri PAITTME,NT �
Town Hall Annex-54375 Maar Road P. O. Box 1179 Southold, 11° 11971� ��
Telephone(631) -ll tl Fax, (631) 765-950 fiat ,�l �M—A—MtL42)1 ar rip �Y,.
Date Receivw
APPLICATION DING PER 1"
For office Use Only
PERMIT NO. w � Building lnspector:---�i-&,-]&,,..,w_- 14,
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: I ot
OWNER(S)OF PROPERTY:
Name: t Ca�h�l�\ 15 „U SCTM#1000- L c(
S� ►� vvo - AAL�� U.li f�7 11
Project Address: Z°[ v� C 1 3
Phone#: "� 0 3 Email: l * u T l 2� anti 11 r� pr'n
Mailing Address: a Awo 6( 1 r1 S rA r
CONTACT PERSON: ��
Name: �t ca ,tolQi� 0Im
Mailing Address: ` ) d o vvag
Phone#: E'° — v3 3 S Email: okw
DESIGN PROFESSIONAL INFORMATION:
Name: 11 AZ--
Mailing
/Mailing Address: 6 L '
Phone#: Email:Mk-r r(- + • (, Q -0 1 Ok r' /L
CONTRACTOR INFORMATION.
Name: l G�t,,ri ��_r(1,:�
Mailing Address: ( 0-,W w oj, em N
I
Phone#: 3 l j d 3 Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure 54Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $
i
Will the lot be re-graded? ❑Yes ?
g �No Will excess fill be removed from premises. ❑Yes RfNo ,
f
i
1
PROPERTY INFORMATION
Existing use of property ,Lg ��c-k�� i l Intended use of property: r G�,
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑YesI2N0 IF YES,PROVIDE A COPY,
'ieck Box Aft Re din The oamer/contractor/design professional is responsible for all drainage and storm water issues as provided by
Chapter 236 of the Town Code.ApPUCATION IS HEREBY MADE to the Building Department for the Issuance ofd Building Permit pursuant the Building Zona
ordinance of the Town of Southold,Suffolk,County,New York and other applicable laws,ordinances or Regulations,for the construction of buildings,
agrees to comply with all applicable laws,ordinances,building code,
additions,eFteretloro or for removal or demolition ro herein described.The applicant gra P
housing code and regulations and to admit authorised inspectors on premises end In bufldingls)for necessary Inspectbro.False statements made hare)^ars
punishable es a gess A misdemeanor pursuant to Section 210.45 of the New York State Penal Low.
, Agent
Downer
Application Submitted By(print name): �/r�l I c.Ir,U�I Q IA r�i ❑Authoraed g .mow
Signature of Applicant: M YJ Date:
gI'`�
i {p mils•- n . �Incrhi
ur New York
STATE OF NEW YORK) N�� .
.01 618F0F0
; ���t. ANlres ril 14, 2
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
aday of
otary Pugli
OXSuff
H LINDSAY
.ill.
stat
I NOWYO
�w Pub.
Notary f New York o'N ' � " R O N 'No OINA"a'"i Q2
N0 illi iuw^�oifnli coup
Qualiounty (Where the applicant is not the owner) i:iripm3ssia&ra Ewlr63 iG1)mrnlssi 'I4,
I, residing at
do hereby authorize to apply on
II
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signature � Date
Print Owners Name
2