HomeMy WebLinkAbout51435-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#: 51435 Date: 12/04/2024
Permission is hereby granted to:
William A Gatz
1492 Skunk Ln
Cutchogue, NY 11935
To:
legalize "as built"finished basement to existing single-family dwelling as applied for. Additional
certification may be required.
Premises Located at:
1492 Skunk Ln, Cutchogue, NY 11935
SCTM#97.-3-11.8
Pursuant to application dated 08/12/2024 and approved by the Building Inspector.
To expire on 12/04/2026.
Contractors:
Required Inspections:
Fees.
As Built Addition/Alteration $1,320.00
CO-RESIDENTIAL $100.00
Na Total $1,420.00
uilding Inspector
aF�lct�`w TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
*� iYTelephone(631) 765-1802 Fax(631) 765-9502 htWs://www.southoldtownny.gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. �5 Building lnspector.
c) --
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an DEPT.
Ownets Authorization form(Page 2)shall be completed. 'r'Q m ay O '
Date:
OINNER(S)OF PROPERTY:
Name: SCTM#1000- 1
Project Address:
Phone#: Email:
s
, ? , r
Mailing Address: okaw—
CONTACT PERSON:
Name: -
ig Address:Malin 0`
;
Phone#: Email: tw
DESIGN PROFESSIONAL INFORMATION:
Name: ""
Mailing Address:
Phone#: Email: "48�Allll
CONTRACTOR INFORMATION:
Name:
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? ❑YesNNo Will excess fill be removed from premises? ❑Yes"QNo
PROPERTY INFORMATION
Existing use of property: d Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑YeA"No IF YES,PROVIDE A COPY.
Check Box After Reading.: The owner/oontractoar/design professional is responsible for all dirainagie and storm water issues as provided by
Chapter 236 of the Town code. AP"P'UCATION IS HEREOY fw1ADE to the Building Depa.h. nt for the Issuance of*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 210AS of the New York State Penal law.
Application Submitted By(print name): &frn ❑Authorized Agent Xowner
Signature of Applicant: Date:
STATE OF NEW YORK)
SS:
COUNTY OF )
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 t)teir with.
Tda'y0
ere me this
of " 20L
Notary Public
SETH G BANK
PROPERTY OWNER AUTHORIZ ►TIC Notary Public-State 7 New York
N0.01 BA6427783
(Where the applicant is not the owner) Qua
i� ExpiresSuffolk county
My Commission Expires Jan 3,2026
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
PLEASE NOTE
Sanitary system is not to be
placed Under driveway area.
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PREPARED FOR
NICO REALTY Corp.
FILE No_ 9799 FILED JANUARY 25, 1996
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UA CUTCHOGUE
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f 1n `0 SUFFOLK COUNTY, NEW YORK
P *g a �� S.C. TAX No. 1000-97-03-11.8
SCALE 1"=80' 1! ]
JULY 27, 1999 1
SUPFOLK COUNTY DEPART I=OF FMALTH SERVICES
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