HomeMy WebLinkAbout51787-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#: 51787 Date: 03/26/2025
Permission is hereby granted to:
Joachim Yahalom
965 Edwards Ln
Orient, NY 11957
To..
construct additions and alterations to existing single-family dwelling as applied for.
Premises Located at:
965 Edwards Ln, Orient, NY 11957
SCTM# 18.-3-20
Pursuant to application dated 02/20/2025 and approved by the Building Inspector.
To expire on 03/26/2027.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling Addition&Alteration $488.00
CO-RESIDENTIAL $100.00
Total S588.00
Building Inspector
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 lIttDS://www.soutl�,ioldt�ownny.go .
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. Building Inspector: ti
F E B 2 0 2025
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.
Date:
OWNER(S)OF PROPERTY:
Name: SCTM#1000- t a a L 3 - Zp
���cKr,ti, `10��,��dM
Project Address: cos- "u-m DS S ptLI cy" T
Phone#: Email:
Mailing Address: S q,1� A-560
CONTACT PERSON:
Name: T C o t, 5 Tn-JC,77t5 l�
Mailing Address: '7 kJ by- 6-7 k TVCrK
Phone#: l C.)' Email: o I t -(F S 0) re 'j e i7c)N
DESIGN PROFESSIONAL INFORMATION:
Name. � i
�A-t� 1fv s
Mailing Address:
Phone#: 3 Email: "�+'a ,..6s�il<""0G m ,
CONTRACTOR INFORMATION:
Name: 6 A—.> cc>t,- -i AC—`
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
El New Structure VAddition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $ jOt3,oc>v
Will the lot be re-graded? ❑Yes Wo Will excess fill be removed from premises? ❑Yes KNo
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PROPERTY INFORMATION
Existing use of property: ��S ��1 , Intended use of property: �� ���-`tiTl i-L
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
(&d this ro ert p p y? ❑Yes KNo 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 buildingls)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(prl 556uthorized Agent El Owner
Signature of Applicant- Date: Z•IQ-2-0z-5
STATE OF NEW YORK)
SS:
COUNTY OF&APC-0\\( )
�G rC--y 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
day of feixauq . 20 ry, I
ENO
I,.GATZ-SCl `r N1 r
RY PUBLIC.ST\F Cr
egistration No,01 Q,�6E740ZS
PROPERTY OWNER��'� I HO IZA NQualified ir,>uttolt•.
mission Exp.res P UQ
(Where the applicant is not the owner)
I, Joachim Yahalom residing at 965 Edwards Lane, Orient, NY 11957
do hereby authorize Fred Seifert to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Fefruary 9 , 2025
Owner's Signature Date
Joachim Yahalom
Print Owner's Name
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