HomeMy WebLinkAbout51115-Z TOWN OF SOUTHOLD
'r BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
0 fide 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#: 51115 Date: 8/22/2024
Permission is hereby granted to:
Rowsom, Andrea
PO BOX 119
Orient, NY 11957
To: legalize "as built" generator as applied for.
At premises located at:
825 Munn Ln, Orient
SCTM # 473889
Sec/Block/Lot# 17.-2-7.1
Pursuant to application dated 7/10/2024 and approved by the Building Inspector,
To expire on 2/21/2026.
Fees:
AS BUILT-ACCESSORY $250.00
ELECTRIC $200.00
CERTIFICATE OF OCCUPANCY $100.00
Total: $550.00
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 bit 2%vni1 c, v
Date Received
APPLICATION FOR BUILDING PERMIT D E C E 0 V E
For Office Use Only 1 �•
�q ,,pp
PERMIT NO. I BuildingInspecttor.
-! J
Building Department
Applications and forms must be filled out in their entirety.Incomplete Town of Southold
applications will not be accepted. Where the Applicant Is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date:07/09/2024
OWNER(S)OF PROPERTY:
Name:ROWSOM AF IRRV TRT SCTM#1000-17.-2-7.1
Project Address:825 Munn Lane , Orient, NY 11957
Phone#:631-965-3993 Email:prowsom@gmail.com
Mailing Address:PO Box 119, Orient, NY 11957
CONTACT PERSON:
Name:peter Rowsom
Mailing Address:203 4th St, Greenport, NY 11944
Phone#:631-965-3993 Email:prowsom@gmail.com
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
I
Phone#: F"EM71
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
[i]Other Generator $
Will the lot be re-graded? ❑Yes El No Will excess fill be removed from premises? ❑Yes ONO
1
PROPERTY INFORMATION
Existing use of property:Residential Intended use of property:Residential
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes - 'No IF YES, PROVIDE A COPY.
Cpleadk,Box ���. tt��1"' Reading: The owner/contractor/design professional is responsible for all drainage and stone water issues as provided by
Chapter 236 of the Town Cade.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,buildit code,
housing code and regulations and to admit authorized Inspectors on premises and in building(s)for necessary Inspections.False statements made hereft are
punishable as a pass A misdemeanor pursuant to Section 210AS of the New York State Penal Law.
Application Submitted By(print name):Peter Row$om ❑Authorized Agent @Owner
Signature of Applicant: Date: 07/09/2024
STATE OF NEW YORK)
SS:
COUNTY OF 3( 6., I IL )
-I-CI' XCL being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the G�X�`��'
(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 J LAJ 20
tart'Public
\11j aRIT7aANY A CONR D
Notary Publice Stole cif New York
PROP RTY OWN ��� qAUTIJQRIZA ION Re CC 74at54
kua if-led in Suffolk County �
(Where the applicant is not the owner) Ccrnmission Expires July 18,20L-
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
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