HomeMy WebLinkAbout52217-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#: 52217 Date: 08/27/2025
Permission is hereby granted to:
David J Moore
3100 N Ocean Dr
Singer Island, FL 33404
To:
Unit 80 A-Construct an alteration to convert an existing covered porch to an enclosed screened
porch as applied for
Premises Located at:
4 Harvest Pointe Ln Unit 80, Cutchogue, NY 11935
SCTM# 102.1-1-48
Pursuant to application dated 07/22/2025 and approved by the Building Inspector.
To expire on 08/27/2027.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $325.00
CO Single Family Dwelling-Addition /Alteration $100.00
Total $425.00
B6ildwing 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 httos-,//www,so tholdtownny.ilov,
Date Received
APPLICATION FOR BUILDING PERMIT
1 a
�Q:q (" �JI LJ GJ
For Office Use Only
PERMIT NO. CA a Building Inspectar; U L 2 2 ^
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an
Owners Authorization form(Page 2)shall be completed. own of
Date:
OWNER(S)OF PROPERTY:
Name: SUM#1000- 2 Y
Project Address: e SY1 - 80
Phone#: 7a 3- Email
Mailing Address:
CONTACT PERSON:
Name: I "
C
Mailing Address:
Phone#: � ('7, Email:
DESIGN PROFESSIONAL INFORMATION:
Name: k"
Mailing Address: AY,
Phone#: I_ " l� mail:
CONTRACTOR INFORMATION:
Name:
Mailing Address: a
Phone#: Em il:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure IIAddition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other
Will the lot be re-graded? ❑Yes tAo Will excess fill be removed from premises? E Yes A3f4o
1
PROPERTY INFORMATION
Existing use of property: 00S Intended use of property:
— /�
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ,l�Yes ❑No IF YES,PROVIDE A COPY.
Ea'a-leck Box After Reading: The owner/contractor/design owner/contractor/design professkmal Is responsible for all drainage and storm water issues as provided by
Chapter 236 of the Toxin 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 regulatkms 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): wg y �C (� ��Z EIAuthorized Agent ❑Owner
Signature of Applicant: Date: D 712//2,�
04C-7 f
CONNIE D.BUNCH
STATE OF NEW YORK) ,,i '; Notary Public,State of New York
if' No,01BU6185U50
SS: VQualified in Suffolk County
COUNTY OF 57Vry:oc ) J� Commission Expires April 14
�G de o d lwn ses and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the f
(Contra or, en ,Corporate Office ,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
l
\\CC
day.of ., �" °"� 20 c�J
Notary Public
(Where the applicant is not the owner)
residing at d t.
i
do hereby authorize J � J w Z to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
calZe
'1-04Vrnees Signature Date
n
Print Owner's Name