HomeMy WebLinkAbout52868-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Jill
.�of 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#: 52868 Date: 04/15/2026
Permission is hereby granted to:
Alice Kramer
PO BOX 277
Southold, NY 11971
To:
legalize an "as built"generator as applied for.
Premises Located at:
230 Booth Rd, Southold, NY 11971
SCTM# 54.-7-6
Pursuant to application dated 04/01/2026 and approved by the Building Inspector.
To expire on 04/14/2028.
Contractors:
Required Inspections:
Fees:
As Built Generator $250.00
CO-RESIDENTIAL $100.00
Total $350,00
Building Inspector
4
r TOWN OF SOUT':HOLD_BUILDING DEPARTMENT
Town Hall Annex 54375 Main.Road P. 0. Box 1179 Southold,NY 11971-0959
Telephone (631) 76 5-1$ 2 Fax (d31) 765-950 � �w�.�Sou � � , r
Date Received
APPLICATION FOR BUILDING PERMIT
E W LL=
For Office Use only n
PERMIT NO s�
W
Building Inspector:,-, f
4-----
A P R 1 2026
.........................
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. °
I
Date:
OWNER(S)OF PROPERTY:
Name:Alice Kramer scTM#1000-
Project Address: 230 Booth Road Southold NY 11971
Phone#:631-765_5699 Email:remarke@optonline.net
Mailing Address:Box 277 Southold NY 11971
CONTACT PERSON:
Name:Alice Kramer
Mailing Address:Box 277 Southold NY 11971
Phone#:6 1_765-5699 Email
DESIGN PROFESSIONAL INFORMATION.
Na me:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name,
Mailing Address:
Phone i Email,
DESCRIPTION OF PROPOSED CONSTRUCTION
i
i n ❑Re air ❑Demolition Estimated Cost of Project:
C�Ne Stru lure ❑Addltlon ❑Alterat o
p
ter
Will the lot be re-,graded? ❑Yes ❑No Will excess fill be removed from premises? ❑Yes ❑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? FYes FNo IF YES, PROVIDE A COPY.
W-0: 01:1 ............ ...........
0 Check Box Aftei",' SIP 1ea d 191 111go" 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 210AS of the New York State Penal Law.
Alice KramerApplication Submitted By(print narnFlAuthorized Agent ROwner
"10 ,
Signature of Applicant: Date:
CONNIE 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.LIA-14
I 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
&1A 14�day of q-&
Notary Public
PROPERTY OWNER AUTHOFUZATION
(Where the applicant is not the owner)
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