HomeMy WebLinkAbout47087-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#: 47087 Date: 11/8/2021
Permission is hereby granted to:
Rohrbach, George
PO BOX 1155
Mattituck, NY 11952
To: install window replacements to existing single-family dwelling as applied for.
At premises located at:
1620 Grand Ave., Mattituck
SCTM #473889
Sec/Block/Lot# 107.-3-9.2
Pursuant to application dated 10/25/2021 and approved by the Building Inspector.
To expire on 5/10/2023.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00
CO-ALTERATION TO DWELLING $50.00
Total: $250.00
i
)ddir'g actor
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 :, n- ¥ww so l: I :, y ,.
Date Received
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For Office Use Only j
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PERMIT NO. Building Inspector: -
IBU LI IN' U- >I
Applications and forms must be filled out in their entirety.Incomplete T0'10,0�0 r S0U:rH0 D
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date: 9/17/21
OWNER(S)OF PROPERTY:
Name:Adriana and George Rohrbach SCTM#1000- 10 — '3— C] D,Project Address:1620 Grand Ave f
Phone#:(631) 949-1089 Email:ag ,525@yahoo.com
e Mailing Address: 1620 Grand AVe
CONTACT PERSON:
i
Name:
Lisa Einsidler
I Mailing Address:ggg South Oyster Bay Rd, Bethpage, NY 11714
Phone#:888.736-6335 Email:llsa.einSidler@powerhrg.com
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
' CONTRACTOR INFORMATION:
Name:Power Home Remodeling
Mailing Address:ggg South Oyster Bay Rd, Bethpage, NY 11714
Phone#:888-736-6335 Email:lisa.einsidler@powerhrg.com
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition *Alteration ❑Repair ❑Demolition Estimated Cost of Project:
EJ Other Remove and replace 5 windows.U factor 0.27,SHGC 0.25.No structural changes. ? $10,896.00
Will the lot be re-graded? ❑Yes *No Will excess fill be removed from premises? ❑Yes ONO
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PROPERTY INFORMATION
Existing use of property: Residential i Intended use of property:Residential
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes No IF YES, PROVIDE A COPY.
Check Box After Read Ing: 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.
Application Submitted By(print name): Lisa Einsidler ligAuthorized Agent Downer
Signature of Applicant: Date: 9/17/21
STATE OF NEW YORK)
SS:
COUNTY OF
Lisa Einsidler being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the AGENT
(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
17th day of September 2021
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
Adriana and George Rohrbach residing at 1620 Grand Ave
Power Home Remodeling do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
See signed contract (attached) 9/17/21
Owner's SignatureDate
SLALAdriana and George Rohrbach cI * -m4y,
My Col22b
Print Owner's Name C-ammission Nun"r 12t-2
2
National Headquarters AJri9na ,d ; ,r-e hr-a,--[-
2501 Seaport Drive,Chester,PA 19013 _e
888 736-6335
WWW.POWERHRG.COM
PRODUCT SPECIFICATIONS '
Buyer(s)'Information and Description of the Property: Project Number:35-37094 September 10,2021
Adriana Rohrbach Date of Agreement
George Rohrbach (631)298-4782(Roma) age525@yahoo.com
1620 grand ave (631)949-1089(Adriana's Cell) E-Mall Address 1
MATTITUCK,NY,11952
County:Suffolk
Township:
Buyer(s)listed above hereby jointly and severally agrees to purchase the goods and/or services listed on the accompanying specification
sheets,in accordance with the prices and terms described in the Custom Remodeling and Improvement and the Product Specifications
(collectively,this"Agreement").
Pre Installation Inspection Date:Your pre installation inspection is tentatively scheduled for Wed 9/22 between 9:00a and 10:00a.
Windows-Inspira Inclusions: Includes composite reinforced meeting rails, night time safety lock on double hung windows and two part
window sliders only.Welded corners,foam injected frames,concealed tilt latch on all double hung windows.total protection spacer,
Heatshield, Duraglass, exterior custom capping, installation,clean up and haul away of all job related debris.
Windows-Elegance-Architectural Inclusions:Fully welded frames with Duraglass, installation,clean up and haul away of all job related
debris.
Doors-Dynasty Series Inclusions:Includes all new hardware,ball bearing hinges,foam core, reinforced wooden lock block, installation,
clean up and haul away all job related debris.
It is agreed and understood by and between the parties that the Product Specifications, along with the Custom Remodeling and
Improvement Agreement,constitutes the entire understanding between the parties, and replace any and all prior negotiations,
representations, or agreements, either written or oral. The Product Specifications may not be changed, modified,or varied in any way unless
such changes are in writing and signed by both Buyer(s)and Contractor. Buyer(s)hereby acknowledge that Buyer(s)has read the Product
Specifications.
I have read and received each page of this 3 page agreement.
Power Home Remodeling Group Buyer(s) Buyer(s)
/09/10/21 �109/10/21 -- 109/10/21
Signature of Remodeling Consultant Signature Signature
Justin Costantini Adriana Rohrbach George Rohrbach
YOU,THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY
AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF
THIS RIGHT.
September 10 2021 14.03 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
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