HomeMy WebLinkAbout52109-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#: 52109 Date: 07/16/2025
Permission is hereby granted to:
Vincent J Culmone
18450 CR 48
Cutchogue, NY 11935
To:
Construct additions and alterations to an existing single-family dwelling as applied for.
Premises Located at:
18450 CR 48, Cutchogue, NY 11935
SCTM#96.4-4.2
Pursuant to application dated 06/03/2025 and approved by the Building Inspector..
To expire on 07/16/2027.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Addition &Alteration $797.50
CO Single Family Dwelling-Addition /Alteration $100.00
Total S897.50
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�tt)s://vnv sootlioldtownii gLy
Date Received
APPLI11CATION FOR BUILDINGIII 0 � d I q `
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To
For Office Use Only
PERMIT NO. Building Inspector:
Applications and forms must be filled out in their entirety.Incomplete d $00
applications will not be accepted. Where the Applicant is not the owner,an
Owners Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: ��Gt�'! Cµ �) w�oti SCTM#1000- i �—� _ q,
Project Address: Is, ti SO o'— (r C'VC'k. + N H S�
Phone#: 3I - G�-sr �I� Email: vW`rt\o1%e,
Mailing Address: 5O
CONTACT PERSON:
Name: ir\C-tn�' LAItnOn-c--
Mailing Address: I 1?uSO Cot--J '1*'Zj LV
Phone#: 01 — F�'�� � s� Email: \f(L,.1fnowL
DESIGN PROFESSIONAL INFORMATION:
Name:
Mg ailin Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:.
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
El New Structure ®Addition IJAlteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $ aco,000
Will the lot be re-graded? ❑Yes [ANo Will excess fill be removed from premises? ❑Yes XNo
1
PROPERTY INFORMATION
Existing use of property: �es i eev L Intended use of property: ;,r, t s
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes LkNo IF YES, PROVIDE A COPY.
❑ Check Box After Readir1g: 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 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 Icy hint am ): Ur/�C-eA (C4I rn o� ❑Authorized Agent IROWner
Signature of Applicant: " Date:
STATE OF NEW YORK)
S
COU! OF� (
n e t A� (LAO' 0v -,_— 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
S�1 day of (juh . 20 ?K_
Notary Public
JOHN A.MAKI
Notary Public-State of New York
No.01MA6164838
PROPERTY E R AU 11JORIZA rolq (qualified in Suffolk County
(Where the applicant Is not the owner) w1y Commission Exp.04/30/2027
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
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