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HomeMy WebLinkAbout52043-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#: 52043 Date: 06/26/2025 Permission is hereby granted to: Karen Blasko 59 Calebs Way Greenport, NY 11944 To: construct alterations (oil to gas conversion)to an existing single-family dwelling as applied for. Premises Located at: 135 Calebs Way Unit R59, Greenport, NY 11944 SCTM#40.1-1-59 Pursuant to application dated 05/23/2025 and approved by the Building Inspector.. To expire on 06/26/2027. Contractors: Required Inspections: Fees: Single Family Dwelling- Alteration $250.00 ELECTRIC -Residential $100.00 CO-RESIDENTIAL $100.00 , To a l $450.00 _ Building Inspector V, 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 littps://'www.southoldtownny.gov ll Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO, Building Inspector: �'ulk�•� Applications and forms must be filled out in their entirety.Incomplete otlde� �,o��t"' t applications will not be accepted. Where the Applicant is not the owner,an sra o1 so ' Owner's Authorization form'(Page 2)'shall be completed. Date: OWNER(S)OF PROPERTY: Name: E�M::#:1000- r)alen.................��'c � qd e , Project Address: ° q A DCI Phone#: _ _3 l Email: vi Mailing Address: 39 C CONTACT PERSON: Name: Mailing Address: J Cc) Li 11 Phone#: i - - Email: DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: 1 Mailing Addres es Ic L-Y�- .W y'11\ Phone#: �� -'( a�., a=-( CD © Email: DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: Other : Will the lot be re-graded? ❑Yes ❑No Will excess fill be removed from premises? ❑Yes ❑No 1 PROPERTY INFORMATION Existing use of property: Intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes ❑No IF YES, PROVIDE A COPY. ❑ hec ' o (After Rpaoog Ue owner/contra orCdesi n professional is responsible for all drainage and^sstor!m grater issues as provided by Chapter 2U MtheloWn Cg`6. �A� `ION 15 ERESY ADD the Building part ent for the Issuance of a Building Permit pursuant to the Building zone, ord nance of the low of 5outho ,5� 64,inty, leuw(York and other ari p le r Ordinances or Regulations,for the eo trua ors of b ildingx additions,alterations or for removal or demolition as herein described The applicant agrees to comply with all applicable laws ordinances,building code, housingcode afid regulations and to admit authorized ins ectors on p remises gndin building(s) g p p p for necessary inspections.False statements made herein are >. punishable as a Class A misdemeanor pursuant to Section210AS of the New York State Penal taw. Application Submitted By (print name): �cer-1 � ..0 ❑Authorized Agent lqwner Signature of Appllc t t. � 1�� Date: \�-Oa I STATE OF NEW YORK) SS: COUNTYOF�,tE' ) KCI.I'CO alas �� being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)he is the 01-0\-�Cf (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� Cx otary Public T--A-;C`'L. GVlYI=R NOTARY PUPLIC,STATE OF NEW YORK PROPERTY OWNER AUTHORIZATION NO.01UW63016909 r�,Jtl 151ED IN SIJ=FC)LKC01jN''Y (Where the applicant is not the owner) Cc�MM19B;ON Et P19E JUNE.30, 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