HomeMy WebLinkAbout51516-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
r 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#: 51516 Date: 01/03/2025
Permission is hereby granted to:
Cornell Family Prtnrshp
c/o David E Cornell
Princeton, NJ 08540
To:
Constructa foundation under existing dwelling to raise it in compliance with FEMA requirements and
rebuild the existing deck as applied for. Floodplain development permit required.
Premises Located at:
950 East Rd, Cutchogue, NY 11935
SCTM# 110.-7-24
Pursuant to application dated 10/29/2024 and approved by the Building Inspector.
To expire on 01/03/2027.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Addition &Alteration $340.00
Foundation $250.00
CO Single Family Dwelling-Addition /Alteration $100.00
Flood Permit $150.00
Total $840.00
Building Inspector
J 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 littps://www.southoldtownny.gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only °� ` ` 9 N21
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
Owners Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: ! YIL I SCTM#1000-
Physical Address:
Phone#: &05 !J'Email:delk��z3-3&�
Mailing Address:-f�q � LA. kv ►«
CONTACT PERSON:
Name: bfurmo Expediting Services
2938 Hcinpstead Turnpike
Mailing Address: u 1
Phone#: 3 _ 5(OOa Email:apa ex dtM'
DESIGN PROFESSIONAL INFORMATION:
Name: ' -
Mailing Addres : I M 1. t
Phone#: J� �( —Uq n Email !�„
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition teration ❑Repair ❑Demolition Esti rriated Cost of Project:
❑Other s
If
Will the lot be re-graded? Xyes QNo Will excess fill be removed from premises? ❑Yes KNo
1
PROPERTY INFORMATION
Existing use of property: �y Intended use of property:
I at
Zone or use district in which•premises is situated: Are there any covenants and restrictions with respect to
-u this property? ❑Yes ❑No 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,ordlnances,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): Lr�.SP�S�� Wluthorized Agent ❑Owner
Signature of Applicant: Date: I Z-3I2,q
STATE OF NEW YORK)
SS:
COUNTY OF )
i
l 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 ther"ith.
Sworn before me this
day of OVJL[L 20-RL4
Notary Public
Rosemarie Edith Kilicarslan
PROPERTY OWNER AUTHORIZATION Notary Public-State of New York
No.D1 K16360137
(Where the applicant is not the owner) Qualified in Suffolk Counter
My Commission Expires 6112125
v residing at 41 f Ins
do hereby authorize , ""h R to apply on
y beh if to the Tow iilding Department for approval as described herein.
1011-0ZI
O ner`s Signature Date
Print Owner's Name
2
•-•^ �•�•� a r—AHEO AND DN HIS BEHALF TO THE TITLE COMPANY.GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON.AND TO THE ASSIGNEES OF THE LENOING INSTITUTIDN CERTIFICATIONS ARE NOT TRANg={ABLE TO ADDITIONAL TIO
INSTITUNS OR SUBSEQUENT OWNERS-.. (5)THE LncanoN of wtLu(wT,»r nc lanrta pp x u;
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