HomeMy WebLinkAbout52230-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#: 52230 Date: 09/03/2025
Permission is hereby granted to:
Anders Jensen
80 Roxbury Rd
Franklin Square, NY 11010
To:
construct an accessory garage as applied for.
Premises Located at:
605 Youngs Ave, Southold, NY 11971
SCTM# 61.-4-27
Pursuant to application dated 07/28/2025 and approved by the Building Inspector.
To expire on 09/03/2027.
Contractors:
Required Inspections:
Fees:
Accessory-New Structure $625.00
CO Accessory $100.00
Total $725.00
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 htt s:# .southoldtownn ov
Date Received
APPLICATION FOR BUILDING PERMIT
mr Office Use Only
PERMIT NO. �� 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.
Date:
OWNER(S)OF PROPERTY:
Name; V _ SCTM#1000-
Project Address: AV(. � �1'�l�l�
Phone#: ail:Ciflde,R,S�C f .Cun4,
Em
MailingAddress:-, J(:), c ru yam- )U M) Ll
CONTACT PERSON:
Name: !4a _
i
Mailing Address: "P.0. ��� &11 Qnkt'4 ,)(Lr- I1(;LlLl
Phone#: 62,51 80-7 1'7 Email:cv1Ct1�S
DESIGN PROFESSIONAL INFORMATION:
Name: »nbu->1� 1=1�L'i+-II"'1
Mailing Address:
Phone#: 51 y r� ,61 Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:.
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
XNew Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other . 100,0 o- "a
Will the lot be re-graded? ❑Yes ONo Will excess fill be removed from premises? ❑Yes WNo
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 AVo IF YES, PROVIDE A COPY.
❑Check Box After Reading: The owner/contractor/deslgn professional is responsible for all drainage and storm water issues as provided by
Chapter 236of 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,
houshM code and regulations and,too 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.
r:)Application Submitted By(p i t name): 4NQASb ❑Authorized Agent lZowner
Signature of Applicant: Date: -7/ 2 �0k
✓ "`"ONNIE 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 14,2 ;k
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
of�' �4 �.�. 20 41�-
Notary Public
PROPERTY OWNER 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