HomeMy WebLinkAbout47541-Z rk Int
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 #: 47541Date: 3/14/2022
Permission is hereby granted to:
Bialeski, Timothy_,,,,,,, .................................. _.
PO BOX 1153
.Mattituck, NY 119..52
To: Construct dormer additions and interior alterations to existing single family dwelling as
applied for.
At premises located at:
2.5.,....Law,r ,1................................... ...._.
5100 Route ___.�....._wwwww____........................
SCTM # 473$$9
Sec/Block/Lot# 125.-3-14
Pursuant to application dated __12/9/2021 and approved by the Building Inspector.
To expire on 9/13/2023. ww
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $428.80
CO-ADDITION TO DWELLING $50.00
....._._. .............
Total: $478.80
Building Inspector
�wr TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Towyn Hall Annex 54375 Main Road P. O. Box 1179 Southold NY 11971-0959
� �� Telephone 631 765-1802 Fax 631 765-9502 1)It� . ,Fµ k�, w ):I„tl:��1�-,, �.nii � Lll���
Date Received
APPLICATIONR BUILDING PERMIT
For Office Use Only
PERMIT NO. � Building inspector-
0 ..,
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date:12/8/21
OWNER(S)OF PROPERTY:
Name:Tim Bialeski SCTM #1000- ;W-03-14
Project Address:5100 Main Rd Laurel NY 12.5 -3-14-
Phone#:631-484-7283 Email:tim@eastendsecurity.com
Mailing Address:5100 Main Rd Laurel NY
CONTACT PERSON:
Name:AMP Architecture, Jess Magee
Mailing Address: 1075 Franklinville Rd Laurel NY 11948
Phone#:516-214-0160 Email:jmagee@amparchitect.com
DESIGN PROFESSIONAL INFORMATION:
Name:AMP Architecture, Anthony Portillo
Mailing Address: 1075 Franklinville Rd Laurel NY 11948
Phone#:516-214-0160 Email:aportillo@amparchitect.com
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition *Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $--
Will
._...Will the lot be re-graded? ❑Yes RNo Will excess fill be removed from premises? ❑Yes No
1
..........w..... PROPERTY INFORMATION
ExuWng mrar.n of properl v Sri& Family Residence Mntended use m.mf prop rtym Single Family Residence
Zone or use rice Mn which premises Is 0uale d Are tV°r ue any covenants and r° stdc8o n's wr kllln mmmnfmrnrmt to
C thk pi'lrty 17M'Yes No W YES,PM'I WJl�? A COPY,
4"",ftet',floxhfrrri, @munnn Mr �'optifftnar f1f,rtirmuiOrA's ps provi'dird by
ampmar:amr of tholown Ccwk, AFTUCATION WS WACAY WOE rim the W&KI 410pirtsmank,0 r th m3'v m murar 0404 s m urlmorrrft pip,marmmm rru th#Vamn dh1',�r ZMAN,
oranflrw mmrn i of rnmmm Y o mm 04' menthol .Smftotk.CAmnl,rmOW'V cork,And,athof rrm^owdommi or jk*pWrmmmummr,x frrr the mmnmnrmmrm%m n min VaaaWWt4,
�n� mmummaa � rr� �a scot r m� a�r i�Va' m dim m°r��aw�w'��m �° rr� �I�r mui�,p �y� I� Y� ��Mr� wi r�m�+rrarrr�;�Maim#fluaww,�rrm +rre I
�r mwmamr m m (00 411404M*rma'mmra NPAJ rmm mIMItmmr i 01,04 ffr wrta"On Pr OWOAra#041 to fait rr 1,v vvrry u'+rrdamINa+oref'am aro
amwm sht+ r44%rr t"h4am 1,r , OURM r %m mwm a r rhe Now n" r1, rrrrarn u
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,� IPS ifte cur � m��fnrar� r1, �r°m� ren nr
App'l'ication Submitted By Q' rMmn�� �rn e) � �� �
MirnaarfplMm .. Date: � rm'
5,1 ATE OF NEW YOR�10
ss"
cw'wihim oar' SiAkmMr
AMP ..p.II „SII o�y_�.. .�
hitec tl 6e gypnjllr tfly's%pwoPU ,deposes anid says tM"°Icw ("s)M iii Mmµthe a#Iipi M ant
Il �
(" an kxi mal rGgInlrr nu artm)
above rn conned,
ent
rMnr�
(Corktracm% Agent, q)orate Officeii etc)
of rMmiW owner or ruar'u'ners,and Mrs m'ni,nly authoidzed to perfmmrrm r have p rforu°rneol rM°'mr^sfld work and to make umrnd f0e ffiM.,
a his/her k nc w v4P !mJg� am)beHel'f;and
�nVMr��mMrrnr„ ��mril��:AMM r'����ma�unn�rnm�r rrum`m�uallmn �rl Mrm�M'mM w MMnrn'�M �.m arm. �u mmm"mm urr�M°m Jnr a� �lnm�
that Umrm work will be performed Mian the manner pet forth 41 the appMom a6o n(He��nrrrrr° u�Mn
BARBARA H.TANDY
nu ren mmrfrnu°n'u r M°mM a No Public f f N York
. 04TA6088001
Qualffied In Suffolk Courdy
n of '� COMM391
mmnrnrwm, . .N, ,
.�. ��.W�.� ru'. PurV'rMM
M"nR 0 P F FIT`°" OrN ,AUwr f,,i Q R I Z A T nN
(Where Mrnm �:IppHcant Mrs not thie owner)
ner)
Tim Bial en,rs k i
resWk', t�w ... ,.do .
'4' 1 E �
mmwn �arMr�mrrMr��r� to
nnM �on
nary Mmr^Ili'.Mff to SII°ma Town of SouthoW Bu ldl ng Deparrurnnm'.mmnt for mr ll)rru'vA as aescrMMmcd Mnmr'Ci n
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Signature at
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