HomeMy WebLinkAbout52874-Z . TOWN of SOUTHOLD
BUILDING DEPARTMENT
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#: 52874 Gate: 04/17/2026
Permission is hereby granted to:
Terrence J Fleming
355 osprey Nest Rd
Greenport, NY 11944
To:
Legalize "as built"alterations to an existing single-family dwelling to include an outdoor shower as
applied for.Additional certifications may be required.
Premises Located at:
1845 Shipyard Ln, East Marion, NY 11939
SCTM#38.-1-20
Pursuant to application dated 11/21/202S and approved by the Building Inspector.
To expire on 04/16/2028.
Contractors:
Required Inspections:
Fees:
As Built Alteration $1,090.00
CO Single Family Dwelling-Addition /Alteration $100.00
Total S11190.00
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Building Inspector
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� TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold, NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 s: � � .,soutt t SO4
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
NO.
Inspector-
PERMIT
Applications and forms mint be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization farm(Page 2)shall be completed.
Date:
OWNS S OF ,, OPEN
SCTM # �.n00-
Name:
3`9
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Gam'
Project Address:
----------------
Phone#: Email: ................
Mailing Address:
CONTACT PERSON:
Name: (I�N] LIC-I
Mailing Address-
Phone It- 'mail.-
or
DESIGN PROFESSIONAL INFORMATION.*
N:
Name: _J\J
Mailing Address:
w
Phone#� � � � � Email, �,� '- ��
CONTRACTOR INFORMATION:
Name:
'.'0' Zo.
Mailing Address'
t,,�fo'
Phone#- ,� Email: �0 Af
7_J '_ V- /);-.-7 1.
DESCRIPTION+ i CONSTRUCTION
❑ 0*
New Structure ❑Addition DAlteration epair ❑Demolition Estimate Cost of Project:
❑Other
Will the lot be re-graded? ❑Y"+e o Will excess fill be removed from premises? ❑Yes No
1�tl 10 A I"%
PROPERTY INFORMATION
.....................
Existing use of property: r intended use of property:Z-e6l
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Zone or use district in which premises is situated: Are there any covenants,an restrictions with respect to
this property? F-lYes, b IF YES, PROVIDE A COPY.
CJ Check Box Ader,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.
Application Submitted By(print name):6, /4�Fu L MAuthorized Agent wrier
10
Signature of Applicant: Date:
....................
STATE OF NEW YORK)
SS:
CO U N TY 0 F
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
day of 20
`.....
&r" . ...........
(yotary Public
TRACEY L. DWYE'Fi,
NOTARY P'U13LJ'Cw STATE OF N E"W YORK
PROPERTY OWNER AUTHORIZATION NO.oit)w63()6,9001
GVLWIED IN SUFFOLK COUNTy
(Where the applicant is not the owner) comkqj ,
SSIM EXPIRES)UNE,W,zca, 46
0
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 6ate
kjN, (�a-�\JjqA
Print Owner's Name
2
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