HomeMy WebLinkAbout51883-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#: 51883 Date: 04/29/2025
Permission is hereby granted to:
Brandon J Stout
12960 Main Rd
Orient, NY 11939
To:
construct deck addition to existing single-family dwelling as applied for.
Premises Located at:
235 Cemetery Rd, East Marion, NY 11939
SCTM# 31.-10-6
Pursuant to application dated 03/24/2025 and approved by the Building Inspector.
To expire on 04/29/2027.
Contractors:
Required Inspections:
FOOTING/REBAR, FRAMING/STRAPPING , DRAINAGE, FINAL,
Fees:
Single Family Dwelling- Addition &Alteration $370.00
CO-RESIDENTIAL $100.00
Total $470.00
Building Inspector
x' e "
rF�cx TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
tl Telephone (631) 765-1802 Fax (631) 765-9502 littps://www.soutlioldto,wiin�. .
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only �G' �L nn 2
L[PERMIT NO. 5)KV— Building InspectorsMAR 2 4 2 ," U
Applications and forms must be filled out in their entirety.Incomplete ����ic:
I
pplications will not be accepted. Where the Applicants not the owner,an
Owner's'Authorization form(Page 2)shall;be completed. Building Department
Town of Southold
Date: -
OWNER(S)OF PROPERTY:
Name: _ SCTM#1000-
Project Address:
C
Phone#: Email:
Mailing Address: 3 — -7 5 T
CONTACT PERSON:
Name:
Mailing Address:
Phone#: Email:
DESIGN,iPROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Names ;
Mailing Address:
Phone#: l a m (y Email: S
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure COddition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other
Will the lot be re-graded? ❑Yes IgNo Will excess fill be removed from premises? Wes o
1
PROPERTY INFORMATION
Existing use of property: Intended use of property:4'0f
aLa .�
Zone or use district in which premise is situated: Are there any covenants ano restrictio s with respect to
this property? Eyes 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.APPUCATION 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 210.45 of the New York State Penal Law.
Application Submitted By(print name): �N�j vl'�Z L ❑Authorized Agent ❑Owner
Signature of Applicant: Date:
" e
•-• CONNIE D.BUNCH
Notary Public,State of New York
STATE OF NEW YORK
" � No.01 BU6185050
SS: Qualified In Suffolk County
COUNTY OF
Commission Expires April 14, .,1'
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
y of i�(ti1 W1 , 20 Q / u 1
Notary Public
PROPERTY OWNED AUTHORIZATION
(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