HomeMy WebLinkAbout48616-Z �rat . TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
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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 #: 48616 Date: 12/19/2022
Permission is hereby granted to:
Watts, Laurel
445 7th St
Brooklyn, NY 11215
To: Construct interior alterations to existing single family dwelling as applied for.
At premises located at:
295 Harbor River Rd, Orient
SCTM # 473889
Sec/Block/Lot# 24.-2-8
Pursuant to application dated ,10/19/2022 and approved by the Building Inspector..
To expire on 6/19/2024.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $227.20
CO-ALTERATION TO DWELLING $50.00
Flood Permit $100.00
Total: $377.20
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 I'tt S://WW . OL[ lioldloi nii
Date Received
APPLICATION L IT
For Office Use Only [D D
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Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an B1,TDMTG DE
Owner's Authorization form(Page 2)shall be completed. TOWN OF S UTHOL
OWNER(S)OF PROPERTY:
Name:LAURE L WATTS TSulvl#1000-24.-2-8
Project Address:295 HARBOR RIVER ROAD ORIENT NY
Phone#:7182166609 1 Email:wattslaurel@gmail.com
Mailing Address:295 HARBOR RIVER ROAD ORIENT NY 11957
CONTACT PERSON:
Name:KATHERINE SAMUELS
Mailing Address:25235 MAIN ROAD CUTCHOGUE NY 11935
Phone#:631-235-1177 Email:kat ,@samuelsandsteelmanxom
DESIGN PROFESSIONAL INFORMATION:
Name:KATHFRINF SAM(1FI S
Mailing Address:25235 MAIN ROAD CUTCHOGUE NY 11935
Phone#:631-235-1177 Email:kate@samuelsandsteelman.com
CONTRACTOR INFORMATION:
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Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
[--]New Structure ❑Addition ®Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other 35,000
Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ❑Yes i@No
1
PROPERTY INFORMATION w ,
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Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R-40 _ _ --
this property? OYes i@No IF YES,PROVIDE A COPY
N Check Box After Reading: TM owmr/eontradw/dedo prahssland Is responsible for all dmkmp and storm wow IOU"of prodded hl
OmWtar MG of the Toam Code.APPLICATION 5 HERESY MADE to the Building Department for the hauarm of a Su k ft Permit pursuant to the Budding Zone
additions,afteratforts or far removal or demostton as hare%dwaftmod.The appamt agrees to comply with as applicable laws,ordinances,busfns coda,
houslr4 code and replaSons and to admit autimebed lmpecbm on premim and in brdldlns(s)for necessary bspedbro.False statements made Mn%are
punishable as a ties A misdemeanor pursuant to section 210AS of the Now York Ste"ftnall ta'w..
KATHERINE SAMUELS
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Signature of Appllcanil: ?41 Date: / /.1 L �
STATE OF NEW YORK)
SS:
being duly sword,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the p
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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
Z-7 day of 2D
@.PIS t W0WSKI
Notary Public,State of New York
No. 301 PA5044871
PROPERTY ) 4iPNER AUTHORN "ZATN hied in New Fork County
i inion Expires June 5,2023
(Where the applicant is not 4�Wfttr'N'
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L. W residing at 21QMV-WA) AN I 1 16
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Owner's Signature Date
Print Owner's Name
2
October 17, 2022
Southold Building Department0 2
54375 NY-25,
Southold,NY 11971 B13UDING DEPT.
TOWN OF SOUTHOLD
Dear Sirs and Madams,
This letter is to inform the Southold Building Department that Date Samuels of Samuels and
Steelman will be acting as my designated representative for a planned renovation at 295 Harbor
River Road Orient Village,NY 11957.
If you need to contact me,please call me at 718-206-6609.
Sinc
Laurel Watts
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