HomeMy WebLinkAbout52782-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD. NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH, ONE SETOF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 52782 Date: 03/25/2026
Permission is hereby granted to:
Robert J Bertorello
1800 Country Club Dr
Cutchogue, NY 11935
To:
Legalize an "as built"shed accessory to an existing single-family dwelling as applied for per ZBA
approval. Requires a floodplain development permit.
Premises Located at:
1800 Country Club Dr, Cutchogue, NY 11935
SCTM# 109.-3-2.18
Pursuant to application dated 02/18/2025 and a pproved by the Building Inspector.
To expire on 03/24/2028.
Contractors:
Required Inspections:
Fees:
As Built Accessory Structure $449.00
CO Accessory Structure $100.00
Flood Permit $150.00
Total 699.00
uiidin Inspector
X N
TOWN
OF OUTHOLD--BUILDING DEPARTMENT
11 Amex 54375 Main Road P. C . Boy 1179 Southold, NY` 11971-0959
oa To�v�.H
765 'V
-1802 Fax (631) 765-9502 h:tt .- �� . oo'Ut, � �� ���01,
p Telephone (631)
------------
Date Received
APPLICATION FOR BUILDING PERMIT
'A
For Office Use on
PO
PERMIT NO. Building Inspectors' '
� Applications and fo
rms
ms mus
t be fille
d out in their entirety. Incomplete
"'
not be accepted. Where the Applicant is not the owner,an ri.of n,'
applications will p �3�
Owners Authorization form(Page 2)shall be comple ro n
Dates �► `
OWNER(S) OF PROPERTY.
SCTM #1000- 1&1T,0
,_ �J
Nam
e: fj e,(Z 1 . "��; r,
,,� � h,C � L�"`3 �
Project Addessy A
rr Email CU
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Phone#: -- -
MailingAddress: -5Ae.-
CONTACT PERSON:
N a m e: ,
Mailing Address: OZ) L 4-
Phone#: .. ..,, '—"" ' Email
40
DESIGN PROFESSIONAL INFORMATION:
Name '"' V o L tA_c<
' • Address: , V 1 •'� �- ` I G`
Mailing �`z... ��'�� �.--,�--��, � �
•, 'd
i I
Phone#. .� "� ,� �` �
CONTRACTOR INFORMATION:
Name:
Mailing Address: Y-e_t)o co
Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
In n RA� i ° e olition Estimated,:Cast of Project:
Jew Sti 1 irt,ire � .fAdditio►n ElAIt rayi
Cl other
-, b
Will the lot be re-graded? `des 0Na Will excess fill be removed from premises? ❑Yes ).QNo '
i
PROPERTY INFORMATION
Existing use of property:
Intended use of property.
Are there an covenants and restrictions with respect to
Zone or use district in which premises is situated. y
this property.
? ❑Yes 7No IF YES, PROVIDE A COPY.
Check Box After Reading: The owner/contractor/designp
rofessional is responsible for all drainage and storm water Issues as provided by
Chapter 236 of the Town Cede. APPLICATION
j5 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,
rr
applicant a ,ordinances,building code,
additions,alterations or for removal or demolition as herein described.The a pp reel to comply with all applicable laws
g
g
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. .................
��J��'
&(+d-elio Owner
Application Submitted By sprint name).
Cl Authorized Agent
�i re of A licant:
Date.
ST �OF NEW YORK)
SS
COUNTY OF
0 being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) ,above named,
(S)he is the
Corporate Officer, etc.
Agent,
)
(Contractor, en r
authorized to perform or have performed the said work and to make and file this
of said owner or owners, and IS duly p and
application;that
all statements contained in this application are true to the best of his/her knowledge and belief
that the work will be performed In
the manner set forth in the application file therewith.
Sworn before me this
day of , 2O
2,4
Public
MATTHEWSANOHEZ
NOTARY PUBLIC STATIE oF NEW yORK
O LK COUNTY
lC,#01SA
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
p
...c.,,, residing at
to apply on
do hereby authorize
my behalf to the f South
old BuildingDepartment for approval as described herein.,
A,Lie
Date
Owner's Signature
Print Owner's Name
2
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