HomeMy WebLinkAbout51818-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#: 51818 Date: 04/08/2025
Permission is hereby granted to:
Haines GM Revoc Trt
715 Front St
Greenport, NY 11944
To:
legalize "as built"alterations to existing single-family dwelling as applied for. Additional certification
may be required.
Premises Located at:
75650 Route 25, Greenport, NY 11944
SCTM#48.4-9
Pursuant to application dated 02/28/2025 and approved by the Building Inspector.
To expire on 04/08/2027.
Contractors:
Required Inspections:
Fees:
As Built Alteration $588.00
CO-RESIDENTIAL $100.00
Total $688.00
d
M ding Inspector
�rtr 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 hU //www ,soutlioldt 'v-na , o—V
� a p ) ) �
Date Received
APPLICATION FOR BUILDING PERMIT
2CLE9WL
For Office Use Only ° I
i
� �PERMITNO, g InsPector: 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: 01 a
OWNER(S)OF PROPERTY:
Name: G" f eic SCTM# 1000- _
Project Address: 7/5 �Q/Ur S j C-4 e eAJPOK�% , A)'Y
Phone#: 5�(Q J3�v-7� Email: / CV c?PT/m l/h ,, /J e "
Mailing Address: &/m e CAS A-r3 DU
CONTACT PERSON: -
Name: S^1-17 C2 kS A13
Mailing Address:
Phone#: Email;
DESIGN PROFESSIONAL INFORMATION:
Name: vl (26 fA) l } C.luA-
Mailing Address:
Phone#: ,� Email: V,4( q 1/A- A 0/2 (P
/.�� - tea /
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure :Addition Iteration ❑Repair ❑Demolition Estim ited Cost of Project:
❑Other
$
Will the lot be re-graded? ❑Yes o Will excess fill be removed from premises? ❑Yes No
1
PROPERTY INFORMATION
Existing use of property: Intended use of pro perty:�144 t
of
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes*o IF YES, PROVIDE A COPY.
Yha
heck Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by
terl236 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 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): (��'c�t-�7j,c�2 it
e—, ❑Authorized Agent Owner
Signature of Applicant: " Date: 1 / v
STATE OF NEW YORK)
SS:
COUNTY OF
being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the 1
(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 ^,20
to P
" Oni KRAMER
NCbT RYP
PUBLICSUFFC7LK COUNTY NEW
YORK
LIC.#01 KR6221360
PROPERTY ER AUTHQRIZATl COMM. EXP.05103IZe.
(Where the applicant is not the owner
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