HomeMy WebLinkAbout50335-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
w 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#: 50335 Date: 2/13/2024
Permission is hereby granted to:
Celli, Pas uale
1210 Country Club Dr
Cutcho ue, NY 11935
To: Construct addition and alterations to existing single family dwelling as applied for.
Has BOH green stamp for a completed, updated sanitary system.
At premises located at:
1210 Country Club Dr, Cutcho ue
SCTM # 473889
Sec/Block/Lot# 109.-3-2.14
Pursuant to application dated 8/3/2023 and approved by the Building Inspector.
To expire on 8/14/2025.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $885.00
CO-ADDITION TO DWELLING $100.00
Total: $985.00
Building Inspector
i
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
t�,� Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-09S9
Telephone(631) 765-1802 Fax (631) 765-9502 htt� s,1 ? r�.st� l i of 'to �n ^. 0V
Date Received
APPLICATION FOR BUILDING PERMIT
,Qtl6 y�m q
For Office Use Only � N
PERMIT NO. Building Inspecter: � AUG 3 2023
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,anTTT aW
Owner's Authorization form(Page 2)shall be completed.
Date: .2 0,-V
OWNER(S)OF PROPERTY:
Name: -� (IAL SCTM#1000-
Project Address: IQ �i11�I l�l C 4b Q LLA-1 C..�'loato 0 Y' L
Phone#: CT12
y Email: ( C ! ! w C 0 fr)
Mailing Address: SA e IN,( pec
CONTACT PERSON:
Name:
Mailing Address:
Phone#: Email:.
DESIGN PROFESSIONAL INFORMATION:
Name: • R U c,k0>'A -
Mailing Address "
Phone#: J'Email: �� � �
fD jk (0))t'+CcY
CONTRACTOR INFORMATION:
Name: Rob G ,britL m
Mailing Address:
Phone#: 51(c =3 ' a 1 Email:CA Eb, (Uiatc)Am 'W--
Ld@cJl „ kie
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DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure.J21Addition ❑Alteration ❑Repair nDemoiition Estimated Cost of Project:
❑Other ,C� `JQ)
Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises?)�Yes El No
1
PROPERTY INFORMATION
Existing use of property: f.olrefUce? Intended use of property:
Zone or use district in which premises is situated: Are there any cov ants and restrictions with respect to
this property? ,_Ye No IF YES,PROVIDE A COPY.
LZ!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.APPUCATION 15 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(plr't t narn Z Authorized Agent ❑Owner
Signature of Applicant: Date:
CONNIE D.BUNCH
STATE OF NEW YORK) Notary Public,State of New York
SS: No.01 BU6185050
COUNTY OF Svc _ ) ✓� G���
Commission Exp
Qualified
ires Apruffolk a 14,249
being duly sworn, deposes and says that(s)he is the applicant
(Name of individ,191 signing contract)above named,.
(S)he is the
(C: ntractor,Agent, rporate 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
in✓� L
ay of 20
Notary Public
PROPERTY OWNER A TI-rIORI T6®1'�
(Where the applicant is not the owner)
residing at
1(_ iAC"_ do hereby authorize s Lt°/ /� Z- to apply I on
my half to the Town of Southold Building Department for approval as described herein.
'C
Owner's Signature Date
C�-LL
Print Owner's Name
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