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Home My WebLink About51572-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#: 51572 Date: 01/21/2025 Permission is hereby granted to: Fedora Rucconich 10 Cedar Ln Sands Point, NY 11050 To: Construct interior alterations to an existing single-family dwelling as applied for to include window replacements. Premises Located at: 1130 Clearview Ave, Southold, NY 11971 SCTIVI#70.-9-57 Pursuant to application dated 11/15/2024 and approved by the Building Inspector. To expire on 01/21/2027. Contractors: Required Inspections: Fees: Single Family Dwelling- Alteration $741.00 CO-RESIDENTIAL $100.00 Total $841.00 Building Inspector TOWN OF SOIITHOLD-BUILDING DEPARTMENT i Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 titt .//ww .soutbojdtgLA�� Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. "` BuildingInspector NOVV 1 5 2 024 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 Owner's Authorization form(Page 2)shall be completed. Date: OWNER(S)OF PROPERTY: Name: - J�� SCTM# 1000- (7 Project Address: l 13o C heir0 r, t SOLA 1 1 I 1 Phone#: �� ' - Email: �ckcc "" c? GHho Cdvh Mailing Address; Me CfeerviewAvR &414A� y CONTACT PERSON: Name: , G 7o Mailing Address: *1 Phone#: / r';-f ( S 7 a� Email: �l DESIGN PROFESSIONAL INFORMATION: Name: ,, c, L/+e Mailing Address: f Phone#: a S l0 I 1 - f Email: 5'.e e--QAJ S e- i"1411 -t I CONTRA TOR INFORMATION: Name: `-✓G r Gict r,- ° Z-1,0 Mailing Address: /�d11 Phone# (' �I). a) 9- J �.(p mall: C il��+'fr�� i'1 " rYtGa w CGS DESCRIPIC+N O PROPOSED CONSTRUCTION ❑New Structure ❑Addition C4Alteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $ Will the lot be re-graded? ❑Yes Zho Will excess fill be removed from premises? ❑Yes 6o 1 PROPERTY INFORMATION ExistiE erty: Intended use of property: Zone n which premises is situated: Are there any covenants and restrictions with respect to 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 ofthe 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): IJAuthorized Agent ❑ 7i g Owner Signature of Applicant: Date: i) STATE OF NEW YORK) SS: COUNTY OF SL_-P& I �� ) ( individual signing con r � .being duly sworn, deposes and says that (s)he is the applicant Nam g g tract) above named, (S)he is the . y (Contractor,Agent,. orporate Officer, etc.) of said owner or owners, and is duly authorized to pe orm 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 Iro day of , 20c,, CK pry Public PROPERTY OAUTHORIZATION .r.>t.nRv€��s�! ,� ; _AT 2.car cal=AnrY 0ui.:� yyy N, 0 i DV C-11.;0`0 (Where the applicant Is not the owner I, 0�2.A c d p-) ( � residing at C'�.-e,4 LlJ �oLi �.clo hereby authorize ' U to apply on my al o the Town of Southold Buil g Department for approval as described herei ner's Signature Date -90 C)CG 0� Print Owner's Name 2 PROPERTY INFORMATION Existing use of property: Intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? Dyes ONO 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 JS 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 tint Warne l�U�'✓�� C9(�rr, ZZO L�'JAuthorized Agent ❑Owner Signature of Applicant: Date: y— STATE OF NEW YORK) SS: COUNTY OF 6L1-Rfi2 I K ) C—:73W q Y �rr �Z2-0 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, orporate Officer, etc.) of said owner or owners, and is duly authorized to performs 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 s day of �QV , 20� 0�. pry Public TRAC:r.-'v, L. DWYEIR NOTARY PUBLIC,ST'aTE OF NEW YORK „1Ilf P NERD ,,,m,,,'I I_ "ION NO.01DIV C33,3900 (Where the applicant is not the owner) QUALIFIED[N SUl F O:K U1'snV i residing at a do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein., Owner's Signature Date Print Owner's Name 2