HomeMy WebLinkAbout50870-Z Eernt � TOWN OF SOUTHOLD
BUILDING DEPARTMENT
�� py 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 #: 50870 Date: 6/26/2024
Permission is hereby granted to:
Roeser ,, Douglas
50025 Main Rd
Southold NY 11971
To: construct interior alterations to existing single-family dwelling as applied for.
At premises located at:
50025 Route 25, Southold
SCTM # 473889
Sec/Block/Lot# 70.-5-1
Pursuant to application dated 5/7/2024 and approved by the Building Inspector.
To expire on 12/26/2025.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $250.00
CO-ALTERATION TO DWELLING $100.00
Total: $350.00
Building Inspector
TOWN OF SOUTHOILD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
� Telephone(631) 765-1802 Fax (631) 765-9502 h p. Hwww o thnldtow-ni v. ov
Date Received "
BUILDINGAPPLICATION FOR y
or Office Use Only . . r
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PERMIT NO. 5606Building Inspector: Y
Applications and forms must be filled out in their entirety. Incomplete ; `''°
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applications P lira ions will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date: 6111 �A
OWNER(S)OF PROPERTY:
Name: e SCTM#1000-
Project Address: :°" N�►`oti o gay , , " �( .
Phone#: Email;
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Mailing Address: 4 .;I, VA O,,, o s, (—A
CONTACT PERSON:
Name: ,.. " r
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Mailing Address. a °
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Phone#: � � � � p ��- Email: 4, 4AV •� � esri
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DESIGN PROFESSIONAL INFORMATION:
Name: ------ .
Mailing Address:',--
Phone#: '�"'"� Email: ■�
CONTRACTOR INFORMATION:
Name: . C
Mailing Address:
Phone#: 6..St � 47 Email: "user- � a �-) rl'F 1 . e 004
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition (916teration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $ ,
Will the lot be re-graded? ❑Yes o Will excess fill be removed from premises? ❑Yes ❑No
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PR INFORMATION
Existing use of property: Intended use of property:
Zone or use district in which premises is situated: Are there any covena s and restrictions with respect to
this property ❑Yes o IF YES, PROVIDE A COPY.
GKIleck Box After Reading: The owner/contractor/deslgn 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 B (print name): `,, ` []Authorized Agent Owner
Signature of Applicant:
STATE OF NEW YORK) Notary Public,State of New York
SS: No.01 BU6185060
COUNTY OF Qualified In Suffolk County j
Commission Expires April 14,2 OD 2
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the �•�-� iI'll -
(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 therew'.
Sworn before me this
day of 20
�66
1, Notary Public
PROPERTY OWNER AUjIl-ORIZATION
(Where the applicant is not the owner)
residing at
do hereby authorize to apply on
m behalf to the Town of Southold Buildin Department for approval as described herein.
Y g p Pp .
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Owner's Signature Date
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Print Owner's Name
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Scope Of Work:
Roeser Residence
50025 Main Road
Southold, NY 11971
Den&TV Room:
-Remove ceiling tiles,trim, exterior wall(interior side)sheetrock, interior wall panels and sheetrock
in TV Room.
-New electrical wiring to new recessed lighting. New electrical wiring brought to outlet and switch
locations(where necessary)to be code compliant.
-Electrical Inspection.
-Air sealing,fire caulking, and batt insulation installed (peF eneFgy tab where alteration has
occurred.
-Insulation Inspection.
-Drywall Installation.
-New trim and paint.
Total Square Footage is approximately 450 Square Feet.
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