HomeMy WebLinkAbout51843-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPTON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 51843 Date: 04/18/2025
Permission is hereby granted to:
Scott F Kruk
49852 CR 48
Southold, NY 11971
To:
Legalize an "as built"shed addition to an existing accessory barn as applied for.
Premises Located at:
49700 CR 48, Southold, NY 11971
SCTM# 55.-3-4.4
Pursuant to application dated 03/12/2025 and approved by the Building Inspector.
To expire on 04/18/2027.
Contractors:
Required Inspections:
Fees:
As Built Addition/Alteration $510.00
CO Accessory Structure $100.00
Total $610.00
Building Inspector �� �
roe 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 huttlj, �Ce �uv p l ldt«wr
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. S t, � Building lnspector:,__J.. .... MAR 1 2 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 "' ` M
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: ��L� --� F �/ SCTM#1000- SS _7J _ L-.-q
Project Address: t `100
Phone#: G'3 j — Li ( Lj- q 1 eC!j Email:
Mailing Address:
CONTACT PERSON:
------------
Name:
Mailing Address: �CA-YV-\
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PR POSED CONSTRUCTION
❑New Structure G-Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other
Will the lot be re-graded? El es r No Will excess fill be removed from premises? ❑Yes ::.No
1
PROPERTY INFORMATION 11
Existing use of property: s�P5� Intended use of property: RP S CF✓1 C
Zone or use district in which premises is situated: Are there any covenant and restrictions with respect to
this property? ❑Yes covenant
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 15 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 210.45 of the New York State Penal Law.
Application Submitted By(print name): F ❑Authorized Agent Eylowner
Signature of Applicant: . Date:
STATE OF NEW YORK)
SS:
COUNTY OF
+ a � + I\L wwwww being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the Oorw
(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 h,
L7dayof i" afA 2095 rl.
Lary Public
T r ZY L. DWYEr
NOT,kny PU UC,STATE OF NEW YOR
PROPERTY OWNER AUTHORIZATION NO,01OW M900
(Where the applicant is not the owner) `91t1 ll'IE" 1"4 SijtF0LK COUNTY
CO '�` 'Ott EXPi it S JUNE fit►,ZQI!
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
� � TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
' ti° Telephone (631) 765-1802 Fax(631) 765-9502 lit :,/'lwrv.;outiltoldtowna . >oy
BUILDING PERMIT APPLICATION INSTRUCTIONS&CHECKLIST
• Applications and forms must be filled out in their entirety. Incomplete applications will not be
accepted.
• The work covered by this application, including land clearing/site work, may not be commenced before
issuance of a building permit.
• No building shall be occupied or used in whole or in part for any purpose whatsoever until the Building
Inspector issues a Certificate of Occupancy.
• Every building permit shall expire if the work authorized has not commenced within twelve (12)
months after the date of issuance or has not been completed within eighteen (18) months from such
date. If no zoning amendments or other regulations affecting the property have been enacted in the
interim,the Building Inspector may authorize, in writing,the extension of the permit for an additional
6 months. Thereafter, a new permit shall be required.
ALL APPLICATIONS MUST BE SUBMITTED WITH THE FOLLOWING MATERIALS:
1� Building Permit Application: Complete, signed and notarized.
❑A survey/site plan, drawn to scale at original size, showing the location of lot and of buildings on
premises, relationship to adjoining premises or public streets or areas and waterways.
El Four(4)sets of plans bearing the signature and original seal of a NYS licensed professional engineer
or architect illustrating compliance with the Building Codes of New York State.
❑Contractor's proof of insurance and Suffolk County license:
• Certificate of Workers' Compensation Insurance (C105.2 or U26.3)AND a Certificate of
Disability Benefits Compensation Insurance (DB120.1)
• Certificate of Liability Insurance
"Note: Final Fees will be calculated by the Building Department using the fee schedule. Fees will be
collected after the permit is written"
ADDITIONAL DOCUMENTATION MAY BE REQUIRED AS IDENTIFIED BELOW:
❑Suffolk County Department of Health Services Approval (original copy)
❑Approval of the Zoning Board of Appeals, Planning Board, and/or Historic Preservation Commission
(if applicable)
ElElectrical Permit Application (FILED SEPERATELY): Electrician must have an active license with Suffolk
County
❑Flood Plain Development Permit Application (if applicable)
❑Southold Town Trustees Permits may be required: If any work will be done within 100' of a tidal or
fresh water wetland.
❑NYS D.E.C. Permits may be required: If any work will be done within 300' of a tidal wetland or 100' of
a fresh water wetland
❑1 copy of ComCheck/ ResCheck(if applicable)
❑1 copy of Manual J, Manual D and Manual S (if applicable)
❑Utilization of truss re-en ineered wood/timber construction form (if applicable)
❑Single and separate title search (if applicable)
El Curb cut permit (NYS or Suffolk County form 239F) (if applicable)
❑Original signed Owners Authorization: if applicant is other than owner.
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APPROVED AS NOTED
DATE: B-P.
4-6 I
NOTIFY BUILDING DEPARTMENT AT
631-765-1802 8AM TO 4PM FOR THE
FOLLOWING INSPECTIONS:
FOUNDATION-TWO REQUIRED
_ FOR POURED CONCRETE I
ROUGH-FRAMING&PLUMBING
INSULATION
FINAL-CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
YORK STATE. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS
Additional
R
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i
D
5 Certification
Required.May Be
COMPLY WITH ALL CODES OF
NEW YORK STATE &TOWN CODES
AS REQUIRED I
SOMOLDTONZRA
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