HomeMy WebLinkAbout51227-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#: 51227 Date: 09/30/2024
Permission is hereby granted to:
John P Carter
235 Douglas Rd
Orient, NY 11957
To:
legalize"as built"additions and alterations to existing single-family dwelling as applied for
with flood permit. Additional certification may be required.
Premises Located at:
235 Douglass St, Orient, NY 11957
SCTM# 26.-3-4
Pursuant to application dated 05/07/2024 and approved by the Building Inspector.
To expire on 10/01/2026.
Contractors:
Required Inspections:
Fees:
As Built Addition/Alteration $920.00
CO-RESIDENTIAL $100.00
Flood Permit $150.00
Total S1,170.00
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 littt)�s://www.soutliold�.owii!nyaov
Date Received
APPLICATION R BUILDING PERMIT
For Office Use Only
PERMIT NO, �6JI91Building inspector:
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MAC' - 7 20
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. u „
r ,.
Date:4.29.24
OWNER(S)OF PROPERTY:
Name:John Carter SCTM#1000-26-3-4
Project Address: 235 Douglas Rd. Orient
Phone#:917-209-6756 =Maarternewyork@gmail.com
Mailing Address:235 Douglas Rd. Orient
CONTACT PERSON:
Name:Joan Chambers
Mailing Address:PO Box 49 Southold NY 11971
Phone#:631-294-4241 Email:joanchambers10@gmail.com
DESIGN PROFESSIONAL INFORMATION:
Name:Lou Schwartz
Mailing Address: 7 Ridgewood St, Bay Shore, NY 11706
Phone#031) 410-6838 Email:tiderunnereng@gmail.com
CONTRACTOR INFORMATION:
Name:as-built alteration
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
[]New Structure ❑Addition *Alteration ❑Repair ❑Demolition Estimated Cost of Project;
❑Other
Will the lot be re-graded? ❑Yes RiNo Will excess fill be removed from premises? ❑Yes BNo
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
R-40 this property? ❑Yes R'No IF YES, PROVIDE A COPY.
chapter�. 23fi of the Town Colo. AP .�� ��p, �
C �.k Bo �nn After
Re,�.,,.Reading:
ontr� euNdst Permit pursues ceded by
er e I n The owrar/conErocto►/des professional Is responsible for etl drainage and storm water Issues as
PUCATiON IS HEREBY MADE to the Build) De artment for the Issuance of t 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 remaval or demolition as herein described.The applicant agrees to comply with an applicable laws,ordinances,building code,
housing r�and regulations and to admit authorized Inspectors on premises and In building(s)for necessary Inspections.False statements made herein are
P p S of the New York State Penal law.
punishable ffi a Class A misdemeanor pursuant to Section 210A .W....
Application Submitted By (print name):.
Joan Chambers @Authorized Agent ❑Owner
Signature of Applicant: # � � Date:
CONNIE D.BUNCH
STATE OF NEW YORK) Notary Public,State of New York
SS:
No.01 BU6185050
Qualified in Suffolk County
COUNTY OF ) Commission Expires April 14,
Joan Chambers being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
Agent
(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
--�Aay of C 20 :�:i .
Notary Public
(Where the applicant is not the owner)
1
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residing at
do hereby authorize_ ____to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
01
02.9 #10 2
Date
Owners ignature
COT
Print Owner's Name
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JOAN CHAMBERS
(631)294-4214