HomeMy WebLinkAbout51280-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 PANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 51280 Date: 10/15/2024
Permission is hereby granted to:
Hasday 2023 Family Trt
PO BOX 163
Laurel, NY 11948
To:
Legalize "as built"alterations to include HVAC system and window/door replacements to an existing
single-family dwelling as applied for per manufacturers specifications.Floodplain Development Permit
required.
Premises Located at:
200 Macdonalds Crossing, Laurel, NY 11948
SCTIVI# 145.-4-16
Pursuant to application dated 06/05/2024 and approved by the Building Inspector.
To expire on 10/15/2026.
Contractors:
Required Inspections:
Fees:
As Built Alteration $500.00
CO Single Family Dwelling-Addition /Alteration $100.00
Flood Permit $150.00
ELECTRIC -Residential $200.00
Total $950.00
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Building Inspector
� r 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 lit )S:flWWW southold tow ot '.go
Date Received,,
APPLICATION FOR BUILDING PERMIT
For Office Use Only "ZI V
L—
PERMIT NO. '51 C6® Building Inspector: �
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.
Date:May , 2024
OWNER(S)OF PROPERTY:
Name:Hasday 2023 Family Trust SCTM#1000-145-04-016
Project Address: 200 MacDonald Crossing, Laurel, New York
Phone#:917-573-5318 Email:cho8172000@gmail.com
Mailing Address:
CONTACT PERSON::
Name: Craig Hasday or Ina Hasday
Mailing Address: 200 East 61 st Street, 11 FG New York, New York 10065-8585
Phone#:917-573-5318 Email:
DESIGN PROFESSIONAL INFORMATION:
Name: N/A
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name: N/A
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
Demolition Estimated Cost of Project„
Other ksure�treff�
Srat' V( �r .°(JQ(). $
6 ' �oor l
Will the lot be re-graded? ❑Yes iRNo Will excess fill be removed from premises? ❑Yes RNO
1
PROPERTY INFORMATION
Existing use of property: residence Intended use of property:residence
Zone or use district in which premises its situated: Are there any covenants and restrictions with respect to
this property? ❑Yes ®No IF YES, PROVIDE A COPY.
❑ 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. 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 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(print name): At& tAe0i -y 4cj, ❑Authorized Agent El Owner
Signature of Applicant: Date: May 17, 2024
STATE OF NEW YORK)
SS:
COUNTY OF SUFFOLK )
CRAIG HASDAY, as Trustee being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the Trustee of the Hasday 2023 Famil __T
(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
17 tbay of May 20
Notary Public
PATRICIA A.CLARK
( I Notary No.01 GL 711005 ate of w York
(Where the applicant is not the owner) Oualifiedin Suffolk County
Commission Expires September-10, Ao�
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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