HomeMy WebLinkAbout48660-Z .V.16 TOWN OF SOUTHOLD
" BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
ria 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 #: 48660 Date: 12/28/2022
Permission is hereby granted to:
Mitchell, Stephen
1061 Briar Ln
Pottstown, PA 19464
To: install generator as applied for.
At premises located at:
7132 Indian Neck Ln. Peconic
SCTM # 473889
Sec/Block/Lot# 86.-7-8
Pursuant to application dated 9/21/2022_ and approved by the Building Inspector.
To expire on 6/28/2024.
Fees:
ACCESSORY $100.00
ELECTRIC $85.00
CERTIFICATE OF OCCUPANCY $50.00
Total: $235.00
uil ing Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
� V-` Telephone (631) 765-1802 Fax (631) 765-9502 https://www. out,holdtowiin . ov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. Building Inspector: WD
DEC13 2922
Applications and forms must be filled out in their entirety. Incomplete 81.11WING
applications will not be accepted. Where the Applicant is not the owner,an E 01_n_
Owner's Authorization form(Page 2)shall be completed.
Date:9/27/2022
OWNER(S)OF PROPERTY.
Name:Stephen Mitchell SCTM# 1000-86-7-8
Project Address:7132 Indian Neck Lane - Peconic, NY 11958
Phone#: Email:
Mailing Address: 1061 Briar Lane - Pottstown, PA 19464
CONTACT PERSON:
Name: Ray Nemschick - RA
Mailing Address:66 East Main Street - Patchogue, NY 11772
Phone#:631-563-2130 Email:r.nemschick@nsarchitects.com
DESIGN PROFESSIONAL INFORMATION:
Name: Ray Nemschick - RA
Mailing Address:66 East Main Street - Patchogue, NY 11772
Phone#:631'-563-2130 Email:r.nemschick@nsarchitects.com
CONTRAC 0R INFI RMATIO
um�.Name:.Mark Boeckm.an-- Boeckman Building Construction Corp.
Mailing Address:P. O. BOX 1453 - Mattituck, NY 11952
Phone#:631-298-5319 Email:mark@boeckmanconstruction.com
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
OOther New Generator $20,000
Will the lot be re-graded? ❑Yes RNO Will excess fill be removed from premises? ❑Yes IR No
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PROPERTY INFORMATION
Existing use of property:Single Family Residence Intended use of property:Single Family Residence
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R-80 this property? ❑Yes LRio IF YES, PROVIDE A COPY.
Check Box After 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.
Application Submitted By(print gprne): Ray Nemschlck - RA RAuthorized Agent ❑Owner
Signature of Applicant: " Date:
STATE OF NEW YORK)
SS:
COUNTY OF
being duly sworn, deposes and says that(s)he is the applicant
Nam of individual signing contract) above named,
(S)he is the
(Contractor,Agent,C rporate 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 Z
---- &Notary Public
LILLIANNA R KIEL
�7� "WER .. GINNER � ..��"'� � o��li Gi Notary Public-State of New York
NO.01K16424267
_. Qualified in Suffolk County
(Where the applicant is not the owner) My Commission Expires Oct 25, 2025
Stephen Mitchell residing at 1061 Briar Lane - Pottstown, PA
do hereby authorize Ray Nemschlck - RA to apply on
my behalf to the'1-071 Southol ;Building Department for approval as described herein.
Owner's/Signature L Date
Print Owner's Name
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