HomeMy WebLinkAbout51716-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#: 51716 Date: 03/06/2025
Permission is hereby granted to:
Alfano Family Trust
PO BOX 266
Laurel, NY 11948
To:
construct accessory structure as applied for per SCHD approval.
Premises Located at:
800 Corey Creek Ln, Southold, NY 11971
SCTM#78.4-12
Pursuant to application dated 01/28/2025 and approved by the Building Inspector.
To expire on 03/06/2027.
Contractors:
Required Inspections:
Fees:
Accessory-New Structure $477.00
CO Accessory $100.00
Total 577.00
8uilci� ng Inspector
4 r 6f "°
0, TOWN OF SOUTHOLD—BUILDING DEPARTMENT
�y
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-95021i1-tps: /�'5 Lt tl?o1�Lttc1� on -
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT N0._ 4 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
Owner's Authorization form(Page 2)shall be completed.
Dater
OWNER(S)OF PROPERTY:
Name„ V9/4,/L) SCTM#1000- I
Project Address: - Cc ee C )( 6 P�'e -SCvo a i� A,'k1
Phone#: P Email:
a ..
Mailing Address; , p�, � � � L,� I y
CONTACT PERSON:
Name:
Mailing Address:------------
d
Phone#: �®l !j `'� - �' �' Email:
DESIGN PibIFESSJONAL INFORMATION:
Name: '57P
Mailing Address:
Phone#: Email: ` eve
CONTRACTOR INFORMATION:
S � �� � 1
Name: � ,"
Mailing Address:
Phone#: ��� �� ® ���"- Email: ., C
h '
DESCRIPTION OF PROPOSED CONSTRUCTION
c
e ❑
wStructure ❑Addition Alteration ❑Repair ❑Demolition Estimated Cost of Project:
���
❑Other
Will the lot be re-graded? ❑Yes o Will excess fill be removed from premises? ❑Yes o
1
PROPERTY INFORMATION
Existing use of property: �� C � j I Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
�. i this property? ❑Yes>kMo 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.APPUCATION 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 onprerntses and In bultdinds)for necessary Inspections.False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 210AS of the New York State Penal taw.
` e° thorized Agent ❑Owner
Application Submitted By name): I
Signature of Applicant° Date: /2
STATE OF NEW YORK)
COUNTY OF S Vt" ....
3,`—� ` 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 therewith.
Sworn before me this
2fday of 2e�
��
Not ry u Ic
A.STAPON
"nJ Piibiic«
iA K?M'��'i6
PROPERTY OWNER AUTHORIZATION O OI i 70
(Where the applicant is not the owner) iali
I, residing at
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
B t Ap
211cati2a
L"THORIZA '"ION
(Where the Applicant is not the Owner)
I, -t residing at CO'r27 C 4 L,A AP
c - (Print property owner's name) (Mailing Address)
do hereby authorize (, bi9 v
(Agent)
�L p Q I t/ '11 to apply on my behalf to the
Southold Building Department.
(Owner's Signature) (Date)
R
�. .r
(Print Owner's Name)