HomeMy WebLinkAbout53049-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
.� SOUTHOLD, NY
Ca,
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#: 53049 Date: 06/04/2026
Permission is hereby granted to:
F I White House LLC
PO BOX 17950
Richmond,VA 23226
To:
demolish and reconstruct an accessory garage as applied for.
Premises Located at:
4923 North Hill Rd, Fishers Island, NY 06390
SCTM#6:2-8
Pursuant to application dated 03/06/2026 and approved by the Building Inspector,
To expire on 06/03/2028.
Contractors:
Required Inspections:
Fees:
Accessory-New Structure $367.00
CO Accessory Structure $100.00
Total $467.00
Building Inspector
TOWN OF SOUTHOLD -BUILDING DEPARTMENT
f Tows. Hall Annex 4 7 Main Road P. 0. Boy 1.1.79 Southold,NY 1 1971-0959
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Date Received
APPLICATION FOR BUILDING PERMIT
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PERMIT NO., Building Inspector-,__ ' 4.
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plicati..ons and forms must be filled out in their entirety. Incomplete
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: applications will not be accepted. Where the Applicantis not the owner,a
Owner's Authorization form(Page 2)shall be completed.
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Date: ' .. ►
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f OWNER(S)OF PROPERTY.
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DESIGN PROFESSIONAL,INFORMATION.
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Mailing Address:
Phone,:
Email
CONTRACTOR INFORMATION#
Name.
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Mailing dress
M51.
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:DESCRIPTION,017�PROPOSE10 CONSTRUCTION
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1..0.... New Structure ❑Addition F�Alteration FI repair ❑Demolition Estirniated Cost of Pro"ast
%0ther
----
will the lot be re-graded? es ❑No Will excess fill be removed from premises? ❑Yes Flo
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PROPERTY INFORMATION
Existing use of property: -� �. Intended use of property.
Zane or use district in which premises is situated, Are there any covenants and restrictions with respect to
this property? F: Yes o IF YES, PROVIDE A COPY.
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Check k er owner/contractor/design professional, r p, ns b1 fc r rll drains e,and storm Ater issues as prPaid_ by
Chapter 236+f the Town Code. APPLICATION A?ION IS HEREBY MADE to the Building Department nt for the issuance oaf,a Building Permit pursuant t*the Building Zone
f n of Southold,Suffolk,County,Ne"wYork,and other applicable Laws Ordin�'nces rrr ' 6Iati+a� br t +��r�s ruOtl+�n o #uild�r s�
Ordinance' � �w �� b�� � � " '`� Pp �
, ; d , o 'bI -�+raisr �r removal
]yr demolition Myindr Ih I r 6 p r, �rddltiQn cte. "'
I o usin ode and re. uiatiorrs a nd to,admit authorized Inspectors on premises and in building(s)for necessary,ins'ectl r ►.,Fai stet rnbiit s"m4de hirpin are;
punishable�a Class A►misdemeanor pursuant to Section 210AS of the New York State Penal Law.
Application Submitted By(print name KlAuthorized Agent ❑Own+er
Signature of Applicant: [date: Do.
' ,C)2
STATE of NEW YORK)
SS:
CO U NTY 0 F }
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being duly sworn deposes and says that (s)he is the applicant
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(Name of Individual signing contract)above named,
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(50he is the
Contractor, Agent, Corporate Officer, etc.
r -f said duly authorized to perform or have performed the said work and to make and file this
� owner or owners, ,and is d u
� �d d � p
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
3,—I-day of
M 202
Notary Public
S MUEL LEON
Notary Public
PRO
PERTY Y R AUTHORIZATIONstate of Florida
Where the a licant is not the owner Comm#HH729323
p p ) fxplres 19/8/2029
Not
AP911 residing at
, ......... �, i NOT
do hereby authorize to apply on
my behalf to the Town of Southold' Building Department-for approval as described herein.
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C�vner's Signatu e a Date
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