HomeMy WebLinkAbout53030-Z �o�,�AF�aUryo`a TOWN OF SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD, NY
Will.
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#: 53030 Date: 05/28/2026
Permission is hereby granted to:
John M Lademan
PO BOX 123
Cutchogue, NY 11935
To:
construct repairs and alterations to apre-existing single-family dwelling as applied for.
Premises Located at:
633 Pine Neck Rd, Southold, NY 11971
SCTM#70:5-25
Pursuant to application dated 05/21/2026 and approved by the Building Inspector,
To expire on 05/27/2028.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $250.00
CO-RESIDENTIAL $100.00
Total 350.00
Ong Inspector
i
lie .. ......
TOWN of SOUTHOLD--BUILDING DEPARTMENT
Town:Hall Annex 54375 Main Road P. 0. Boy. 1179 Southold, NY 11971-0959
7"ele home f 31 7 5-1 02 "ax (631 7 5-950 tt�)s:, ,ww .so,° tl,oldto ��,. n
Date Received
APPLICATION FOR BUILDING
PERMIT
f ,
For office f
` u it e+Ji I ql9 Iliillo yl' ` °"
r a 6 II III I I
r' tl"..�o
u
u
3615
PERMIT NO Building inspector
� 2
Applications and forms must be filled out in their entirety. incomplete
applications will not be accepted. Where the Applicant is not the C► ner,an
n
wnees, uthodUation form(Page 2):shell be completed.
Date.
OWNER(S) OF PROPERTY:
Dame: SCTM # l000- ,..�.
Project Address:
Phone#: Email
MA
Mailing Address. `
CONTACT PERSON:
Name
Mailing Address fffiOc' '
�.
"
u
01n
Email-,#: .- ,
Phone w
"
0
DESIGN PROFESSIONAL INFORMATION
Name:
Mailing Address:
Phone#: Email-
"ONT ACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION of PROPOSED CONSTRUCTION
UCTION
D New Struc
ture ❑Addition C-]Alteration ❑Repair e°molition Estimatle'd,Cost of Project:
❑other I illa
Will the lot be re-graded? EIYes KNo Will excess fill be removed from premises? ❑Yes �Mlo
........ .........
...........
...........
..............�hi ..............................-
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
t
this property? F]Yes FINo IF YES, PROVIDE A COPY.
El Check Box After Reading' The owner/contra car/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.
Ai mB , name): W ( ydC EAuthorized Agent -Owner
itt A
Date: SIZ:2 ZG
Signature of Applica
CONNIE D. BUNCH
STATE OF NEW YORK) Notary Public,State of New York
SS: No.01 BU6185050
COUNTY OF Qualified in Suffolk County
ommission Expires April 14, 2
C
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
W I
C� "day A)el4e,� 20-c)L— .. .....
of
Notary Public
PROPERTY OWNER AUTHORIZATION
(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
NNNWIWN��,
..............