HomeMy WebLinkAbout51560-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
01-1 AP
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#: 51560 Date: 01/15/2025
Permission is hereby granted to:
Charles Turner
1405 Crittens Ln
Southold, NY 11971
To:
Construct an accessory pergola as applied for,
Premises Located at:
415 Park Way,Southold, NY 11971
SCTM#70.41-1
Pursuant to application dated 11/06/2024 and approved by the Building Inspector.
To expire on 01/15/2027.
Contractors:
Required Inspections:
Fees:.
Accessory-New Structure $248.50
CO Accessory Structure $100.00
Total m-50
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Building Inspector
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� � o �D�Adam Road lP-®-Box I t79 n 1
TOWN O� O —.�BUILDING DES
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Tdcpbow(631)765-1 Fax((631)765-9
W 1itt s://www.sou,t:holdto ii av
DaW Recemedl
APPLICATION FOR BUILDING
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Owner's Authorization form JPaige Ta shall be corr,pleted. *FQWr Of If*,outhold
Date:
-7
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Project Address:
CONTACT PERSON:
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Phone#: jI GLP 03-71 Email:
DEAF V1111OFE ilIONIN K WOMMUKIft
Mailing Address: P-0 , Box- 5—/ , �Ci
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Name:
DESCRIPTION OF PROPOSED CONSTRUCTION
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Will the lot be re-graded? ®Yes MNo Will excess fill be removed from premises? ®Yes ®No
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PROPERTY INFORMATION
Eyds ffug ww off ��- untended use of w�
7aw or use disbdkt i`em .ii*PTOMMS im;sa" Am dwe amy cow0fl lifts aml neEtbrii¢mons wdb ME tlD
this property? ®Yes gNo IF YES,PROVIDE A COPY.
C r Reading: Ulhe waNlis SfaraW adlraa�a a
Chapt
er Z36 of the Town Code. APPLICATION I5 HEREBY MADE to the Building Department for the Issuance of a Building Permit pursuant to the Building Zone
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housing code and regulations and to admit authorized inspectors on premises and In building(s)for necessary inspections.False statements made herein are
IpaidWWWIeasarm lllerc.
Application Submitted By(print name): VV t, r' ZG I n t f ®ALrtholized Agent Owner
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STATE OF NEVON/TOW
SS:
COUNTY OF S U-�-I�p 1 _ _ j
a( I r baugdakysmmIng,depans and sapttlhmt((s))i e i stlhe appliimrtt
(Name of individual signing contract)above named,
(S)he Ts tube 0 1, xl e
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off said ownesrr or oulo mers3,and is dUfy ailttlhio nmEd tho par(f®ma or h me parkiemnd Sm saiid alaw k amLdl to mmaltie Mid Tide ttlhis
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.
Swam bebm me this
�—
day of �ovcm6cr „20 ?—4 A I" d:
pw wlic
TRiACEY L DER
NOTARY PUBLIC,STATE OF NEW YQ.1j'K
NO,01OW63069M
PROPERTY OWNER AUTHORIZATION OUA�LIFIE`D IN SUFFOLK COUNTY
('Where the applicant is not the owner) c��nlIN'FIFIENE ,209
I, residing at
aka byehW a>twltih mme waovom
my behalf to the Town of Southold Building Department for approval as described herein.
owale s s'
ftiimlt Ouari naves Namne
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5U1Z� OF LOT 35
MAP OF 5OUTHNOOD N
FILED W'VEMBER 24, IcI53 FILE NUMBER 2141 ' e
SITUATE: PINE NECK *117
TOM SOUTHOI-D
SUFFOLK COUNTY, NY Xs
SURVEYED 06-001-03
5UFFOLK COUNTY TAX #
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GRAPHIC SCALE JOHN Q. EHLERS LAND SURVEYOR UJ
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6 EAST MAIN STREET N.Y.S.LIC.N0.50202
RIVERHEAD,N.Y. 11901
369-8288 Fax 369-8287 REF.—\\Hp serveAd\PR0S\03-196.pro
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