HomeMy WebLinkAbout51496-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#: 51496 Date: 12/19/2024
Permission is hereby granted to:
Christopher T Crozier
1050 Arshamomaque Ave
Southold, NY 11971
To:
Construct interior alterations to an existing single-family dwelling to include doors and windows as
applied for.
Premises Located at:
1050 Arshamomaque Ave, Southold, NY 11971
SCTM# 66.-2-27
Pursuant to application dated 10/23/2024 and approved by the Building Inspector.
To expire on 12/19/2026.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $327.50
CO Single Family Dwelling-Addition /Alteration $100.00
Total $427.50
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 htt,s:!'l www.sotitlio�l to wnn , goy'
Date Received
APPLICATION FOR BUILDING PERMIT
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For Office Use Only
PERMIT NO. Building Inspector:,-� .�
Applications and forms must be filled out in their entirety.Incomplete 1 E�
applications will not be accepted. Where the Applicant is not the owner,an 4-0 SOM01
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Owner's Authorization form(Page 2)shall be completed.
Date: October 8, 2024
OWNER(S)OF PROPERTY:
Name: Christopher T Crozier SCTM # 1000- 66- 2- 27
Project Address: 1050 Arshamomaque Ave, Southold NY 11971
Phone#: Email:
Mailing Address: 1050 Arshamomaque Ave, Southold NY 11971
CONTACT PERSON:
Name: Ural Talgat
Mailing Address: 436 7th Street, Greenport, NY 11944
Phone#: 631 477 8963 Email: ural59@hotmail.com
DESIGN PROFESSIONAL INFORMATION:
Name: Ural Talgat
Mailing Address: 436 7th Street, Greenport, NY 11944
Phone#: 631 477 8963 Email: ural59@hotmail.com
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition RAlteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $ 25,000
Will the lot be re-graded? ❑Yes RNo Will excess fill be removed from premises? RYes ❑No
1
PROPERTY INFORMATION
Existing use of property: Single Family Residence Intended use of property: Single Family Residence
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R-40 I
this property? ❑Yes ®No IF YES, PROVIDE A COPY.
8 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 210.4S of the New York State Penal Law.
Application Submitted By(print name): Ural Talgat I7Authorized Agent ❑Owner
Signature of Applicant: Date:
STATE OF NEW YORK)
SS:
COUNTY OF 5'u Fr`O I Y— )
Ural Talgat being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)heisthe Architect
(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
7 Z day of /OCAi2,6 20�
Notary Public
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Oft7pubit%slats of Mm°IINaI!It
No.01MC6342308
PROPERChxdftW F EI „�,�,,,i ) TI a ml ossi wln Suffolk
i*w MjW 281t111Zq,
(Where the applicant is not the owner)
Christopher T Crozier residing at 1050 Arshamomaque Ave, Southold NY 11971
I, .
do hereby authorize Ural Talgat to apply on
my behalf t4thwn of Southold Building Department for approval as described herein.
Own Signature Date
M '
Print Owner's Name
2