HomeMy WebLinkAbout51490-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#: 51490 Date: 12/18/2024
Permission is hereby granted to:
Richard Forrestal
1450 Cedar Dr
Southold, NY 11971
To:
Construct interior alterations to finish the basement of an existing single-family dwelling as applied
for.
Premises Located at:
415 Lakeside Dr, Southold, NY 11971
SCTM#90.-3-13
Pursuant to application dated 10/25/2024 and approved by the Building Inspector.
To expire on 12/18/2026.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $640.00
CO Single Family Dwelling-Addition /Alteration $100.00
Total $740.00
IJv&��
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 bttDs://www.southo,ldtownjiv,gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only "
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PERMIT NO. 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.
/ .2/- 2
Date: D—
OWNER(S)OF PROPERTY:
Name: / veL,-olf/chard f-oRReSTa 1 SCTM#1000- 96.-3— /3
Project Address: 415- Lcj l'eslc% Z)o ve 6-e0-/-ho/(D1 r A/y ll q 7/
Phone#: ( l^ ZS5 "' S-Q.3Z Email:,h/-atroro,gr)� / 7� g�G/L- Co/y
Mailing Address: �/S 1, ,ci fe5l e. b4lve. SoO-holc / A/y //97/
CONTACT PERSON:
Name: 'CZ/G/O /-O)A—P Z p /
Mailing Address: ,�lys'�0 At &,in /C oad , C✓fcho ve, AIL 1113,5
Phone#: (a3/- $"99-3/3 Z Email: e/O�eZCo�'J7/7'ctC� n'IGiL. C
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address: A0, /,SOX 2 297 q /,[e60 ve, N //13 1
Phone#: (p3�, �Z 3 , .f 8 79 Email: /�,y ,q�-ch�' CG7'@ mor�L. cow
CONTRACTOR INFORMATION:
Name: . /��O �OAC Z
Mailing Address: 31y570 lijajyl Rcctd, doAho vex A/X l/935
Phone#: 631- 5-q9- 3/3 Z Email: e� eZCSohh,^G1GT)1) yneFi. Cc/"
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $ /7, ,SOO
Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises? ❑Yes No
1
PROPERTY INFORMATION
Existing use of property: AeJr/rle1111&(1C Intended use of property: Resjclenha L
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
�a L this property? ayes ❑No IF YES, PROVIDE A COPY.
heck Box After Read i I'Ig: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by
Chapter 236 of the Town Code. APPUCATION 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 210AS of the New York State Penal Law.
Application Submitted By(print name): ,E/1/G /0 kold Z Authorized Agent ❑Owner
Signature of Applicant: `r9l U ® - Date: 1clZ i/211
STATE OF NEW YORK)
:
COUNTY OF 50?(-0(�)
,EA/6-/D 4 OAG Z being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)
above named,
(S)he is the C_on7 eo C�'O/�
(Contractor,Agent,Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perform or have performedM- i
ke and file this
application;that all statements contained in this application are true to the bend belief; and
that the work will be performed in the manner set forth in the application file
Sworn before me this ,
day of 20
RA V. s AiEGH
NOTARY PUBLIC,STATE OF NEW YORK
Registration No. 02SA6407223
F' ��� ""(""' II , LJ-Fll µ �I j Il l Qualified in Suffolk County
,rv.rvrvrvrv �, ,...�..�� (�
(Where the applicant is not the owner) Commission Expires 05118/'20�
o
,
, / G�.�"Cc. 01,reSTu �- residing at �/S �a�(es/o% Drr�e So�Th
I
II'I�-hold A/)/ /147/ do hereby authorize )E-L/6-/0 �OPeZ- to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
/
Owner's Signature
NOTARY PUBLIC,STATE OF NEW YORK
Registration No. 02SA6407223
Print Owner's Name Qualified in Suffolk County. .
2
Commission Expires 05/18120 Z