HomeMy WebLinkAbout48364-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 #: 48364 Date: 10/3/2022
Permission is hereby granted to:
Kaufman, Scott
62 Cooper Sq Unit 3B
New York, NY 10003
To: Construct accessory storage barn at existing single family dwelling as applied for.
At premises located at:
2050 Di Hans Rd., Cutcho ue
SCTM # 473889
Sec/Block/Lot# 83.-2-7.3
Pursuant to application dated 4/7/2022 and approved by the Building Inspector.
To expire on 10/3/2023.
Fees:
ACCESSORY $1,309.20
CO-ACCESSORY BUILDING $50.00
Total: $1,359.20
Building 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 https://www.southoldtownny.gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only (r1 p!
e
PERMIT NO. Building Inspector:
Applications and forms must be filled out in their entirety. Incomplete .,,,,BUILDING DEPT
applications will not be accepted. Where the Applicant is not the owner,an d" 'I OuSi" UTHOLF)
Owner's Authorization form(Page 2)shall be completed.
D4 q ', I
OWNER(S)OF PROPERTY:
Name: Scott Kaufman SCTM# 1000- 83-02-7.3
Physical Address: 2050 Dignans Rd, Cutchogue, NY
Phone#: 917-405-8500 Email: Scottkaufman@mac.com
Mailing Address: 2050 Dignans Road, Cutchogue, NY 11935
CONTACT PERSON:
Name: John Olinkiewicz- Southold Construction Design
Mailing Address: 15A Sherman Ave Hampton Bays, NY 11946
Phone#: 631-445-8263 Email: Southoldconstructiondesign@gmail.com
DESIGN PROFESSIONAL INFORMATION:
Name: John Olinkiewicz- Southold Construction Design
Mailing Address: 15A Sherman Ave Hampton Bays, NY 11946
Phone#: 631-445-8263 Email:Southoldconstructiondesign@gmail.com
CONTRACTOR INFORMATION:
Name: BY OWNER
Mailing Address;
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
IKGw Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
®Other Barn 350=0
Will the lot be re-graded? Dyes [NNo Will excess fill be removed from premises? Eyes 1XNo
1
PROPERTY INFORMATION
Existing use of property: Residential Farm Intended use of property: Same
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? Eyes KNo IF YES, PROVIDE A COPY.
M Check Box A'f'ter Reading: 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 210.45 of the New York State Penal Law.
John Olinkiewicz
Application Submitted By(print name): Southold Construction Design MAuthorlized Agent ❑Owner
Signature of Applicant: Date: t " .
STATE OF NEW YORK)
SS:
COUNTY OF a "-o OL )
John Olinkiewicz 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
day of l L 20
Iioi� Public
BONNIE DICARLO
NOTARY PUBLIC,STATE OF NEW YORK
Registration No 01D16326366
Qualified in Suffolk County
PROPERTY OWNER AUTHORIZATION
Commission Expires June 15,20111
(Where the applicant is not the owner)
I, Scott Kaufman residing at 2050 Dignans Rd, Cutchogue NY
do hereby authorizdohn Olinkiewicz & Southold Construction Design apply on
my b 'f to the Town of Southold Building Department for approval as described herein.
C:::::� December 31, 2021
Owner's Signature Date
Print Owner's Name
2