HomeMy WebLinkAbout46719-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
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 #: 46719 Date: 8/23/2021
Permission is hereby granted to:
Schein, Alvin
21~45 Little econic Ba Ln
Southold, NY 11971
To: construct interior alterations to existing single-family dwelling as applied for.
At premises located at:
2145 Little Peconic �ay Ln. ~Southold ~_..._._.__....................... w..._w_ ........... as
SCTM # 473889... ... . .......................... ........... _...... --_w_,,,..... �...__ _.__ .....
Sec/Block/Lot# 90.-1-15
and approved by the Building Inspector.
Pursuant to application --- ........................._
To expire on __...2/22/2023.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $396.00
CO-ALTERATION TO DWELLING $50.00
Total: $446.00
Bild Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502
Date Received
APPLICATIONI LPERMIT
C, ..
" For Office Use Only
e
eIf-
PERMIT NO. _ � _ Building Ins ectoi
Applications and forms must be filled out in their entirety.Incomplete Pf 1tL11° DEPT.
applications will not be accepted. Where the Applicant is not the owner,an E P�. .. L
Owner's Authorization form(Page 2)shall be completed. tl
I L
.......m__. ....... . ......�._��..ww_�_. .��....�...............�..._......._.. ___�.....,...�....... �
Date:August 1st 2021
OWNER(S)OF PROPERTY:...................- .... .�__�_.._.....mmm_.. _.._..._.�.__. _....---------
_.�. � _.........__.w....�
Name:Alvin & Lisa K Schein - [SCTM"# 1000-90-1-15 __ ..
Project Address:2145 Little Peconic Bay Lane Southold NY 11971
Phone#:516-606-0399 Email:alschein@gmail.com
Mailing Address:2145 Little Peconic Bay Lane Southold NY 11971
...._..........._...........�............................... __����.M.M.M...................w_w_.._�.....�..�..._...._wwwww.........._�w � .......ww �.�.�... -..........
CONTACT PERSON:
.........._ _ _ww ... _._________..... ..._.._.._...._—
Name:Alvin Schein
Mailing Address:2145 Little Peconic Bay Lane Southold NY 11971
Phone#:516-606-0399 Email:alschein@gmail.com
_M -_ -a......_...__._...............
DESIGN PROFESSIONAL INFORMATION:
Name Stromski Architecture, p.c. -
Mailing Address:400 Ostrander Avenue Riverhead NY 11901
Phone#:631-779-2832 JEmail:robert@stromskiarchitecture.com
CONTRACTOR INFORMATION: - m� _.,,,,,,_,.,._... .....�..-_.._._.............o_.........m..............-.__........ ..._._.
Name:Stromski Architecture, P.C.
Mailing Address:400 Ostrander Avenue Riverhead NY 11901
Phone#:631-779-2832 FEmail-robert@stromskiarchitecture.com
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition FAAlteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $10,000
Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises? Dyes - No
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Existing use of property:��r)��e FC�rrt�� Intended use of property:Sl �� Faml�"
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R-40 this property? ❑Yes No IF YES, PROVIDE A COPY.
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_ name,.RoberStromskiAppIicationSubmitted By(prin
Authorized Agent ❑Owner
Signature of Applicant:
Date:
STATE OF NEW YORK)
S :
COU NTY O F
., being duly sworn, deposes and says that(s)he is the applicant
(Name of individ al igning contract}above named,
_
Mhe is the .,.i'
17—
(C ntractor, Agent,C rporate Officer,w
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 they h.
Sworn before me this
day of ,9 �' . . .. 20 a
Not a�r PubI
NE E GTrj()M0rjq
NOTARY PUBLIC
PROPERTY OWNER AUTHORIZATIONQUAUF1MV40852
(Where the applicant is not the owner) LTi MITA S DE-CEMBER 31,
residing at
�do hereby authorize�0 �d to apply
.._- •-. on
my behalf t e ; w f Southold Building Department for approval as described herein.
Owner's Signature Date
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Print Owner's Name
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