HomeMy WebLinkAbout51762-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#: 51762 Date: 03/19/2025
Permission is hereby granted to:
Dominic Fonti
70-36 Kessel St
Forest Hills, NY 1137S
To:
construct a roof over an "as built" patio addition to the single-family dwelling as applied for.
Additional certification may be required.
Premises Located at:
522 S Harbor Rd, Southold, NY 11971
SCTM#75.-4-27
Pursuant to application dated 12/05/2024 and approved by the Building Inspector.
To expire on 03/19/2027.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Addition&Alteration $613.00
As Built Addition/Alteration $726.00
CO-RESIDENTIAL $100.00
Total S1,439.00
Building Inspector
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TOWN OF SOUTHOLD—BUILDING DEPARTMENT
w� Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone(631) 765-1802 Fax(631) 765-9502 htt s//www southoldtownn . Gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
C ,
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:Domini nti SCTM#1000-75-4-27
Project Address, South Harbor Road, Southold, NY 11971
Phone#:g17-699-4591 Email:dfonti2735@gmail.com
Mailing Address:70-36 Kessel Street, Forest Hills, NY 11375
CONTACT PERSON:
Name:Dorninic Fonti
Mailing Address: 70-36 Kessel Street, Forest Hills, NY 11375
Phone#:917-699-4591 Email:dfonti2735@gmail.com
DESIGN PROFESSIONAL INFORMATION:
Name:Stacy Duka
Mailing Address:55 Gerard Street, #158 Huntington, NY 11743
Phone#:212-505-2020 Email:stacy@phabitatdb.com
CONTRACTOR INFORMATION:
Name:
Mailing Address:.
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
BNew Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $75,000.00
Will the lot be re-graded? ❑Yes BNo Will excess fill be removed from premises? ❑Yes RNo
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PROPERTY INFORMATION
Existing use of property:Residential Intended use of property:Residential
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R-80 Primary / R-40 Secondary 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,ordinances,building code,
housing code and regulations and to admit authorized Inspectors on premises and In butlding(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 r t name):St ac D u ka I7Authfrri2 Agent ❑Owner
Signature of Applicant: Date: ( 7 y
STATE OF NEW YORK)
SS:
COUNTY OF
Stacy Duka being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the Authorized Agent
(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
A�J day of Qicewaocw 20 Zy ew IA
Notary Public
_rwy Odai s Moreira-Quifii,anill
Notary pu lic.State of New York
N�.01 M0002 Y 547
PROPERTY OWNER AUTHORIZATION Aug.fied in 00021county
(Where the applicant is not the owner) ,,y ,,ommission Suffolk
County
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Dominic Fonti residing at 70-36 Kessel Street, Forest Hills
NY 11375 do hereby authorize Stacy Du ka to apply on
my behalf to the Town of Sout old Buii Ing Department for approval as described herein.
, Z
Owner's Signatare Date
Print Owner's Name
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