HomeMy WebLinkAbout52838-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD, NY
�Vo
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ONTHE PREMISES
WITH ONE SET OF APPROVED PLANS ANDSPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 52838 Date: 04/07/2026
Permission is hereby granted to:
Kelly 2023 Rev Living Trt
230 First St
Cutchogue, NY 11935
To:
install a wood stove in an existing single-family dwelling as applied for.
Premises Located at:
230 First St, Cutchogue, NY 11935
SCTM# 101-7-6.1
Pursuant to application dated 03/16/202+6 and approved by the Building Inspector.
To expire on 04/06/2028.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $250.00
CO-RESIDENTIAL $100.00
Total 350.00
i
Building Inspector
TOWN OF SOUTHOLD--BUILDING DEPARTMENT
`own Hall Annex 54375 Main Road P. 0. Box 1179 Southold,NY 11971--0959
,NON.' Telephone(631) 75 1 02 Fax(631) 765 9502 Ott � w ww,� oi,tlold,tow,
ti V
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
Lop I
r t
L `
PERMIT NO, 5e2 Building Inspector.,.__.-
.
MAR 1 6 o
Applications and forms must be filed 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
Date:
OWNER(S)of PROPERTY:
NamzSCTM#1000- 103
WRIPPOW
Project Address: 0 15f 1 ,�-P VC
Phone#: Email:
Girt - ' y'� r` Z_ �
MallingAddress: . ►
CONTACT PERSON:
Name:1 ,�r�►e
Mailing Address:
Phone#: Email:
i
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone# Email,
CONTRACTOR INFORMATION:
Name: DUy-L( Je -t ,► + .
a' w Address:ng
C ('ZJ'
Phone#Y 0 00{Q G �rr Email:
Yln �� -�WiM�"� �Yd/ i
_ 3
DESCRIPTION OF PROPOSED CONSTRUCTION
EI New Structure F�Addition F-]Alteration C-I Repair ❑Demolition Estimated Cost of Project:
$
< 00
0ther
X�:e
Will the lot be re-graded? nYes RNo Will excess fill be removed from premises? ❑Yes El No
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? MYes MNo IF YES, PROVIDE A COPY.
Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water Issues as provided by
Chapter 236 of 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,
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.
16�wRow M R�1 I I I
Application ❑Submitted By(print name): kv-d-K �-e ElAuthorized Agent 006�ner
Signature of Applicant: Date:
STATE OF NEW YORK)
Qz-
COUNTY OF
5�)&^r\ 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
.0000
day of 0r 20
Notary Public
'ANIL 'Aljj AL
CATHERINE MARGARET WARD
D
Notary Public-State of New York
No.01WA0038041
IH Z IRROPERTY OWNER , 11 ALYrl 10 ,1'
Qualified in Suffolk County
My Commission Expires Jun 3,20 29
(Where the applicant is not the owner)
1i
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