HomeMy WebLinkAbout51785-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#: 51785 Date: 03/26/2025
Permission is hereby granted to:
NF Community Club LLC
PO BOX 1672
Mattituck, NY 11952
To:
construct accessory structure (accessory carport with pavilion) as applied for.
Premises Located at:
2050 Depot Ln, Cutchogue, NY 11935
SCTM# 102.-2-5
Pursuant to application dated 03/07/2025 and approved by the Building Inspector..
To expire on 03/26/2027.
Contractors:
Required Inspections:
Fees:
Accessory-New Structure $1,109.00
CO Accessory $100.00
Total $1,209.00
i
Iff
ui ding Inspector
'r13� r " TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 Iitt ://",V w.soLitholdt win . !L) .
Date Received
MPPLICMiION FOR BUILDING PERMIT
For Office Use Only V>�a `�
D
PERMIT N0. Building ectar:� g Ins p
J JUL 1 1 2024
Applications and forms must be filled out In their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an I1 G DEPT-
Owners Authorization form(Page 2)shall be completed. B SOUT111,01
•
Date: 7 C�
OWNER(S)OF P OPE _
Name: OU C' 7gMVnI I CI_cI SCTM#1000- "
s
Project Address: 24575 662 L A-,/617 C. � (j C1 —.
Phone#: 2 Z Email: a � I°
Mailing Address:
CONTACT PERSON:
IL'-1
/ I
Name: 10 F-1 '
Mailing Address:
Email
Phone#: I Z CP' j E' i „ °t' ki (P
DESIGN PROFESSIONAL INFORMATION:
NameC �� I
Mailing Address:
P °
' r
Phone#: Email: h ,
I � � I � J
CONTRACTOR INFORMATION:
Name: SIfA
CG' /
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
New Structure a kddition .,Iteration []Repair ❑Demolition Estimated Cost of Project:
❑Other r -Fi/"d%s $
Will the lot be re-graded? ❑Yes _No Will excess fill be removed from premises? WYes El No
1
PROPERTY INFORMATION
Existing use of property:KIJ 16 S o cc,L-UI413 ,,f' ! Intended use of property: 51 1�&L,,E pA M , Lei-
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? Eyes 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 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 demoRtion 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 210AS of the New York State Penal Law.
Application Submitted By(print name): , V j q ❑Authorized Agent Xowner
Signature of Applicant: Date: Z ��f
STATE OF NEW YORK)
SS:
COUNTY OFb1W(6 K r�tJ
('V .being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the ad N bv�71—
(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.
Swornefefore me this
day of Jbi
Notary Public
CAVID J.JA NU M
Notary Public, State of New York
No, 0 J,A6,0525BS
PROPERTY OWNER Ali T HOREA T i iON qualified in Suffolk County,
Where the applicant
ant is not the owner) Co mmi
si nExpirea
21
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
Building Department Application
AUTHORIZATION
(Where the Applicant is not the Owner)
2 3 A,
1, �.........__. .m... residing at .......__ _ ... .....
(Print property owner's name) _..... (Mailing Address)
do hereby authorize
..... .......�... . �.._.m(Agent)
J Aj� .
_...... to apply on my behalf to the
Southold Building Department.
C.,-(Owner's Signature) (Date)
f
TL ri, _
(Print Own6's Nanie)
—#J R,
Albert J. Krupski, Jr. �� SUFFg/r 5 TO]KNI WAT 1E][,
SUPERVISOR ( r �']
l��l[A\I�A\G]El��l[]EI� F
SOUTHOLD TOWN HALL-P.O.Box 1179 p
53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of Southold
CHAPTER 236 - STORMWATER MANAGEMENT REFERRAL FORM
( APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT
ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER. )
APPLICANT: (Property Owner, Design Professional, Agent, Contractor, Other)
NAME: [?,ev L o Date: p� -
A 1110
Contact Infoi ion:
��v D �C c c=5 Cl,) Z C Z= �,' v s Z
(E-Vlad&Telephone Nu 1 0
Property Address / Location of Construction Site:
Z o 5,0 D/ S.C.T.M. #: 1000
District
Section Block Lot
TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT
❑ - Area of Disturbance is less than 1 Acre. No S.P.D.E.S. Permit is Required 1
- Project does Not Discharge to Waters of the State. No S.P.D.E.S. Permit is Required!
❑ - Area of Disturbance is Greater than 1 Acre & Storm-water Runoff Discharges Directly
to Waters of the State of New York. THE APPLICANT MUST OBTAIN a S.P.D_E.S. Permit
DIRECTLY From N.Y.S. D.E.C. Prior to Issuance of a Building Permit.
❑ - Area of Disturbance is Greater than l Acre & Storm-water Runoff Flows Through Southold
Town's MS4 Systems to Waters of the State of New York. THE APPLICANT MUST OBTAIN
a S.P.D.E.S. Permit through the Southold Town Engineering Department
Prior to Issuance of a Building Permit.
Reviewed By: / � � �sG� Date: S
FORM # SMCP-TOS December 2024