HomeMy WebLinkAbout51495-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#: 51495 Date: 12/19/2024
Permission is hereby granted to:
Saiegh SV Trust
PO BOX 392
East Marion, NY 11939
To:
Construct a deck addition to an existing single-family dwelling as applied for.
Premises Located at:
545 Bayview Dr, East Marion, NY 11939
SCTM# 37.-1-22.1
Pursuant to application dated 10/25/2024 and approved by the Building Inspector.
To expire on 12/19/2026.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Addition&Alteration $513.00
CO Single Family Dwelling-Addition /Alteration $100.00
Total $613.00
Building Inspector
gl'04k 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 l tt. :, w o110101 j,to��nn r. rotir
Date Received
APPLICATION FOR BUILDING PERMIT
i
For Office Use Only
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 F Ai
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY: 'I
Name:S�Np�,V "
Project Address: 54tE" rl"u tLoi 3oZS �)0 WiW P��QA In
Phone#: (�C�(o — C�S-� I O 54 Email 519 5 L�ri�
Mailing Address: Q . �ioy-
CONTACT PERSON:
Name: L l f�'� P1✓
Mailing Address: J HcYl`1J 3
Phone#: r'pm _ 3 [� C o CPA t A-i`C
Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address: ' Z Z18 .p i l"s 9 I
Phone#: w [ Email: IZ ATO6� (L'
n
m.. ...__.� _
CONTRACTOR INFORMATION:
Name: c
MailingAddress:
Phone#: —S — l 7j Email: l
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure?KAiddition ❑Alteration ❑Repair ❑Demolition Estimated Cost ofProject:
❑Other $ l G es) b D "
Will the lot be re-graded? ❑Yes KNo Will excess fill be removed from premises? ❑Yes ❑No
1
PROPERTY INFORMATION
Existing use of property: ( Intended use of property:
Zone or use district inwhic"I premises is situated: Are there any cove ants and restrictions with respect to
this property? ETY s ONO IF YES, PROVIDE A COPY.
t _ -
heck 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): p �� uthorized Agent ❑Owner
bu
Signature of Applicant: .6 // Date:
STATE OF NEW YORK)
SS:
COUNTY OF
-Eb'6.(} CZ being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
Ci
(S)he is the �-cM Q k 1=
(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
Z( day of 0 ZO
Notary Public
S
AND , SAI"'
PUBLIC,STATE OF NEW YORK
PROP E QINiTH() rtlorl No.02 SA6407223
(Where the applicant is not the in Suffolk Countyission Expires 05/18120
1, n residing at
do hereby authorize to apply on
my behal ow f uthold Building Department for approval as described herein.
D �Lr- z It
wn Si ture� Date
Print Owner's Name
2
8 �
d
DEC 1 } 202
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SURVEY OF PROPERTY
AT
EAST MARION
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
1000-37- 01-22.1
Scale: 1"=30'
JUNE 4, 2012
AFEA = 17,5i 4 sq.fl.
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