HomeMy WebLinkAbout51206-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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#: 51206 Date: 09/20/2024
Permission is hereby granted to:
Village Green Shops LLC
PO BOX 614
Fishers Island, NY 06390
To:
Reconstruct an exterior staircase to an existing rear accessory business apartment as
applied for.
Premises Located at:
643 Equestrian Ave, Fishers Island, NY 06390
SCTM#9.-4-8.5
Pursuant to application dated 08/07/2024 and approved by the Building Inspector.
To expire on 03/22/2026.
Contractors:
Required Inspections:
Fees:
Commercial-Addition&Alteration $300.00
CO Commercial $100.00
Total $400.00
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Ci.
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone(631) 765-1802 Fax(631) 765-9502 � 1 ,. o . a1cla ' ►1r ,m10
Date Received
For Office Use Onlyo
PERMIT NO.,5 1 2062 Building Inspector:
i
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,ann
Owner's Authorization form(Page 2)shall be completed. Yovir oA,
Date: ,p 23 2 0 24
OWNER(S)OF PROPERTY:
Name: SCTM#1000-
� � M - ° - g•s
Project Address: GA-3 1 l �►a av o�3 O
Phone#: U60 - q3_2R 6 0, Email:
Mailing Address: 4 oX 1 ��S F ,C S��.N �► 3 0
CONTACT PERSON:
Name:
Mailing Address: p a goy
Phone#: 'UO - 303_ 2A o Email: SPa�a 9P,
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
DOther o It S atw �a
? excess fill a removed from remises? dyes ❑No
Will the lot be re-graded. ❑Yes C�No WIII e c b p
1
PROPERTY INFORMATION
Existing use of property: Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes ANo IF YES,PROVIDE A COPY.
❑ 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 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 210.4S of the New York State Penal Law.
Application Submitted By(print na SP\ �0'l +i� ❑Authorized Agent 2(owner
Signature of Applicant: Date: D S/25/2,oz'r
STATE OF NEW YORK)
S :
COUNTY OF S`u o
JGf.�`'i�r `A 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
r �j
day of / ( X .20-� �rrrewwwrrrrrrrrr
JASON
vt °F � r Public �; ...». �»
Qualified in Suffolk County N» » t y r
Notary Public-State of New York rr „
No.01DR6350454
My commission Expires November 07,2024 C) / 40 �
(Where the applicant is not the owner) •�,
��r rrw'w caw w w wy"�w"v�
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
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