HomeMy WebLinkAbout50328-Z °M- TOWN OF SOUTHOLD
� � BUILDING DEPARTMENT
" 4 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 #: 50328 Date: 2/12/2024
Permission is hereby granted to:
Ma enta Ca M mnt LLC
520 E 86th St
New York, NY 10028
To: construct horse shed (#1) as applied for per Planning approval. Future relocation will
require approvals.
At premises located at:
13945 Oregon Rd, Cutcho ue
SCTM #473889
Sec/Block/Lot# 83.-2-9.3
Pursuant to application dated 1/9/2024 and approved by the Building Inspector.
To expire on 8/13/2025.
Fees:
CERTIFICATE OF OCCUPANCY $100.00
NEW COMMERCIAL, ALTERATION OR ADDITIONS $400.00
Total: $500.00
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 https://www.sotitlioldtoivnny.gov.
Date Received
APPLICATION FOR BUILDING
For Office Use Only
PERMIT NO. Building Inspector: �n �� 124
.:k
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: 12- 12- Z3
OWNEIt(S)OF PROPERTY: )) �
Name: - r� LLL. , SCTM#1000- '33 -a -:J, .3
Project Address: 13gt�5- DleE601v '/R,:L • CufG�O /.te
Phone#: Email:
Mailing Address: 5-,2-0 F e6 s -A7 8 /ve-ti) NY
CONTACT PERSON:
Name: KAIL�Ie2✓L e ('Q 5e
Mailing Address: 520 1E816 sr. N ��do2
Phone#: ��7 30 _ o � Email: �eend �e -CDIK
DESIGN PROFESSIONAL INFORMATION:
Name: -,. S+ -i0
Mailing Address: 17�L �C CGa nc+� /e . SK.� 020 ' New Y2 K lV
Phone#: q'0 8 - s-6 (0 L/l/ Email: >l e1`��7 0
I - I� .
CONTRACTOR INFORMATION:
Name: 1 . I
Mailing Address: �r S 01c- . Li
sem(-4�,. �s� ..� ���. ,
Phone#: S/(p P7 -0?-5 7 S Email: O n "� 0
DESCRIPTION OF PROPOSED CONSTRUCTION
O ew Structure ❑Addition ❑Alteration []Repair ❑Demolition Estimated Cost of Project:
❑Other r S6 (0 , ?< ZU '
Will the lot be re-graded? ❑Yes Mv7No Will excess fill be removed from premises? ❑Yes 19 o
1
Y
PROPERTY INFORMATION
Existing use of property: Intended use of property: / o �
f fo/SE / ✓ r r �.t�fGcra u i
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes Cr7NO IF YES, PROVIDE A COPY.
Box After eaf i rig: 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 cue 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 210A5 of the New York State Penal Law.
Application Submitted By(print name): QAuthorized Agent ❑Owner
Signature of Applicant: Date:
STATE OF NEW YORK)
SS:
COUNTY OF )
S<457 M L4� being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signi g,c n t)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
day of 2Q
Notary Public
iiii . i v� ALF
(Where the applicant is not the owner)
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
2