HomeMy WebLinkAbout51629-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#: 51629 Date: 02/12/2025
Permission is hereby granted to:
Michael J Spicer
2150 Anchor Ln
Southold, NY 11971
To:
legalize "as built"additions and alterations to existing single-family dwelling as applied for. Additional
certification may be required.
Premises Located at:
2150 Anchor Ln, Southold, NY 11971
SCTM#79.4-34
Pursuant to application dated 12/16/2024 and approved by the Building Inspector.
To expire on 02/12/2027.
Contractors:
Required Inspections:
Fees:
As Built Addition/Alteration $689.00
CO-RESIDENTIAL $100.00
Total $789.00
k�',
Building Inspector
TOWN OF SOUTHOLD-BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
� ` m Telephone(631) 765-1802 Fax(631)765-9502 Pitt ://%vww.southwoldlow nn .,°"o�w
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APPLICATION FOR BUILDING PERMIT
For Office Use Only DEC
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: /L -lb- z Y
OWNERS)OF PROPERTY:
Name: E�m
1000-
Project Address: �5p A�►/�Ib/L Lam' fper /oC�o N y // 971
Phone#: 5/1- q4 4 - O`f 33 Email: le-47-y, .5P1 C4UO-_ e ,rW A-t L. Co
Mailing Address: 5 A-pm4er
CONTACT PERSON:
Na me: �7 C49.f PA*e /- is yS f zne— B pw-.: r*ve— 14-A'--eJ4 P f'
Mailing Address: 6,8 W,hA,4-tV S?-, 6 ySYJ`
Phone#.: !j/G - 9ZZ ✓�q 7L 5� -/3 Email: /N� ogS ,�B.y D�+.►,�r,�.►� , �o.M
DESIGN PROFESSIONAL INFORMATION:
Name: gEi✓N/S /u E L-E/ �Z, A- .
Mailing Address: 6 g &j. Ms1-s-/ Sfi DYS �- Q'�y may- 177
Phone#: (l — 9L2— 5-117A )c -/o Email:A¢a-Gk trErr--e 0jeey-FiL-B•&el DvLvA-f--Z r
CONTRACTOR INFORMATION:
Name: /ip- fNd-r/'-tX -//I/
Mailing Address:
Phone#: EM:
ail:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑N'ew Structure N Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
Other
Will the lot be re-graded? ❑Yes�?No Will excess fill be removed from premises? ❑Yes WNc,
PROPERTY INFORMATION
Existing use of property_ /-Ie--lsrx; jeC-Crf11Eove, - Intended use of property_ '44-ME
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
12 leS/ L- this property? ❑Yesj;'M"3No IF YES, PROVIDE A COPY.
i
❑ Check Box After Reading: The owner/contractor/deslgn professional Is responsible for all drainage and stonn 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 constnution 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 Gass A misdemeanor pursuant to Section 210.45 of the New York state Penal Law.
Application Submitted By(print name): ljCo{f-/ta-44^1 MAuthorized Agent ❑Owner
Signature of Applican`�� Date:
STATE OF NEW YORK)
SS:
COUNTY OF .jiff
being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
k8lhe is the /¢ uT �4 C:i U4fN
(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 t rewitt.
Sworn before me this
�?day Df����c� � 202 York
Cit.
, County
CoMitileaion EXplMs February 13,20*
_PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)��
I / N GEC / 5 P Gcl residing at 2/ s��u�l ol� LW'
S'yv1 o Lo do hereby authorize S �'¢�� to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
ZJ3-A eA-4J z/�ao zY
Owner's Signatur Date
lee, V1 -<0
Print Owners Name