HomeMy WebLinkAbout52618-Z ho���rta����aro TOWN OF SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD, NY
4�uwYr."�
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#: 52618 Date: 01/21/2026
Permission is hereby granted to:
Joseph Formato
540 Grange Rd
Southold, NY 11971
To:
construct an accessory garage as applied for.
Premises Located at:
540 Grange Rd, Southold, NY 11971
SCTM# 75.-4-15
Pursuant to application dated 11/21/2025 and approved by the Building Inspector,
To expire on 01/21/2028.
Contractors:
Required Inspections:
Fees:
Accessory-New Structure $367.00
CO Accessory $100.00
Total S467.00
Building Inspector
Q7 TOWN OF SOUTHOLD BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold NY 11971-0959
Telephone (f31 765-1802 Fax (f31) 765-9502
)
Date Received
APPLICATION FOR BUILDING PERMIT
�,N 143
For Office Use Onlynr
PERMIT NO. Building Inspectorl;
Applications and forms must be filled out in their entirety. Incomplete fi t
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:
�I
Name: 03 V\W -1�70 yyVC)L-�—o SCTM# 1000- 0'+S 00 0 1f,-0 0
WCL& 30V+k0l Project Address: DqC> G / &I MVI 1 t9
UY
Phone 41 Z-7 1,e-[ Email: ir
Y�A
zat ii iring Address-. &atrf, St)O*oV& , N41 iA,,ct+J
CONTACT PERSON:
Name:
Mailing Address: Zf),- ocxV, Pf\rC t&NN"
Phone#: cl 10S —cf I S zJ Email: �c Ats�3-n ,, &)cVeJ0-0 i- Oeu�
..........
L.DESIGN PR+DFESSIC�NAL INFORMATION:
Name:ame r,A_
ailingAddress: (1+ CC" [ N nOb1
Phone!# 631 -45� so-ow 31 S�D Email: -TckV)11'q- &V0RVne",y)6r
CONTRACTOR INFORMATION:
...........
Name.
LM
, ,
FM�----- Oam # 09 3 NV I'l A 9 61"*
l rl ngAddress:
Phone#: Emal : 01nieoe eU W V\A
DESCRIPTION OF PROPOSED CONSTRUCTION
.. .............. —-—,New Structure FlAddition FlAlteration Cl Repair ElDemolition Estimated Cost of Project:,
$
F�Other
A
Will the lot be re-graded? FlYes XNo Will excess fill be removed from premises? DQYes DNo
----------
................
PROPERTY INFORMATION
...........
Existing use of property:SINGLE FAMILY RESIDENTIAL DWELLING Intended use of property:SINGLE FAMILY RESIDENTIAL DWELLING
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R..40 this property? DYes No IF YES, PROVIDE A COPY.
0 Check'Box AfterReading;-, The, is,,m,pomiNe,for a#draimpsod bsw,$,as provided by,
I
Chapter 236 of the"t,own,Code, APPMMION4's 14CRESY"MADE,-tollhe'OUN""Oft'Depadmeat for the,lssuanwe of a 00ding Permit,pursuant to,the 00111414g,Zone
oklihatwe,of'ft'Town 0f5outh,*W,,,Suffo*,Xoun%,No w York oodotherapp4oble Ums,Ordinanwsor Reoft0oftiftitt1w,oonsom,Woo' of buildl
additions,itfterations,or fcwm nov*l�or,dem wft, ,, a4appomble,hws�orftmo mm,,,bu es,
housift oode mW regulstlom and, WOOM"00 Pf"*"a"d lo'bWkW,*i)1c'woeommy,knPecW"i.,Fw(se sbowmfflb' 'M,ade twein ate,
P unw,Unwell as,a Class,A,mWeAvanor pursuant to Uwdm 210AS,of Ow,New Yot*,Staie,P010 tSw,.
Application Submitted By(print name}: e Authorized Agent ElOwner
Date: h
Signature of Applicant:JC4
MICHAEL MCCORMACK
STATE OF NEW YORK) NOTARY PUBLIC-STATE OF NEW YORK
SS: No.01 MC620671 0
Qualified in orange County
COUNTY OF
My Commission Expires 05-26-2025
Fa
rnand a cadsniflas being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is theAgent
(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
I q, day of 20
Notary Public
PROPERTY OWNER AUTHORIZA TION
(Where the applicant is not the owner)
, Joseph Formato residing at 54CJ Grange Road Southold 119?1
do hereby authorize Femanda Cad en,iflas,(Agent) to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
.2.
be wriers Signature Date
Print Owner's Name
2
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