HomeMy WebLinkAbout51426-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#: 51426 Date: 12/03/2024
Permission is hereby granted to:
Greenway LI LLC
11 Livingston St
Bayshore, NY 11706
To:
legalize "as built" outdoor shower as applied for.
Premises Located at:
540 The Greenway, East Marion, NY 11939
SCTM# 30.-2-43
Pursuant to application dated 10/10/2024 and approved by the Building Inspector.
To expire on 12/03/2026.
Contractors:
Required Inspections:
Fees:
As Built Accessory Structure $250.00
CO Accessory $100.00
Total S350.00
Building Inspector
rc 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 http ://www.south ldtoLNnt� . *o
Date g .
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. Building Inspector;
Applications and forms must be filled out in their entirety. Incomplete m '
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date: /0- 7 -
OWNER(S)OF PROPERTY:
Name: te SCTM# 1000- u3o .Uv -0,2_ 00 -0 Y3,00(}
Project Address: 2��lG�. -"`{
Phone#: 39 Email: vs L_ ✓l�l
Mailing Address:
CONTACT PERSON:
Name: �� v
Mailing Address: 1-4J
Phone#: S-y 394 Email
DESIGN PROFESSIONAL INFORMATION:
Name;
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address: 3o7 ISLIP, /-7S/
Phone#: 3 Email:,eVs
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Reair ❑Demolition Estimated Cost of Project:
ther t5 -. $
Will the lot be re-graded? ❑Yes JNo Will excess fill be removed from premises? ❑Yes ONO
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 ONO 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 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 By(print name): �� 0�' �v ❑Authorized Agent I .Owner
Signature of Applicant: ,. ' Date: A9 - J a v
STATE OF NEW YORK)
SS:
COUNTY OF Sv 6D[-1C )
/fllc-Aw- l-p—L„&pa)- being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the I :22
(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.
" ll SA
Sworn before me this Notary pubw lic • State of Now York
N0. 01 OLllO19699
Qualiliad in It,04.1k trust
day of 120 M! comfro. Err ira lalt. llx
Notary Public
PROPERTY ER AUTHORIZATION
(Where the applicant is not the owner)
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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