HomeMy WebLinkAbout52191-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#: 52191 Date: 08/19/2025
Permission is hereby granted to:
Reem A Batarseh
19 Dutch St Apt 43B
New York, NY 10038
To:
Construct alterations to an existing single-family dwelling as applied for to include converting the
garage to living space and finishing the basement.
Premises Located at:
5950 N Bayview Rd, Southold, NY 11971
SCTM# 79.-2-9
Pursuant to application dated 07/16/2025 and approved by the Building Inspector.
To expire on 08/19/2027.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $868.50
CO Single Family Dwelling-Addition /Alteration $100.00
Total $968.50
�� Building Inspector
V :c� 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 I tfi s:/ v .sogtholdto r�► . ;
Date Received
APPLICATION FOR BUILDING
(t
For Office Use Only
PERMIT NO. 5a 19 1 Building Inspector:
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. ` .I." rOwn of Southold
Date: ►u ZS
OWNER(S)OF P PERT"Y:
Name:. LOO LSC:TM
#1000- 71 _ Z - +�
Project Address: le7ou �
Phone#: u _ 450 — of6l3 Email: L 1. 9"A @ 1 C OVP. ejM
Mailing Address: Q Avb t-J,V.
CONTACT PERSON:
Name: MCN �1A'�D A. A ,
Mailing A dress: �. 0. tlQX 2�iv &050 t t,-)• It 3
Phone#: (�?�(� " ,' . Email: e4ki*C-T L .
DESIGN PROFESSIONAL INFORMATION:
Name: H47tV t A.
Mailing Ad ',ress: ,0. SOX Vh � N� I R3 '
Phone#: y�3 5-0-7 Af C01T I (1,LWU. aat
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
DOwStructure ❑Addition EfAlteration ❑Repair CDemolition Estimated Cost of Project:
ZOther AW414V 40w 4101V
Will the lot be re-graded? ❑Yes Q4101, Will excess fill be removed from premises? ❑Yes 21ro
1
PROPERTY INFORMATION
Existing use of 449 *ILY Intended use of property:4lk4v,fl�!vy
Zone or use district in which premises is situated: Are there any covenants an�estrictions with respect to
VIA this property? ❑Yes Leo IF YES, PROVIDE A COPY.
"IhI Box After IReadirig: 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 210.4S of the New York State Penal Law.
Application Submitted By(print name): Lr uthorized Agent ❑Owner
Signature of Applicant: w _ Date: 71 , 2
STATE OF NEW YORK)
SS:
COUNTY OF �����""" )
I eO* being duly sworn,deposes and says that(s)he is the applicant
(Name otndividu I 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
day of ,� .,,.,.�20
_ " NarutrS, Notary P41k.Stftof Now Yori,
z
►uric � No,01
Qualified in s",cofty
AR AUTHORI,. . .�,. . .. .WRTY iI /
(Where the applicant is not the owner)
residing at �1t7 iN • V
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