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Home My WebLink About48749-Z :MTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE `a 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 #: 48749 Date: 1/18/2023 Permission is hereby granted to: Shapiro, Brian 18 Pin Oak Ln Chappaqua, NY 10514 To: construct additions and alterations (to include as-built exercise room) to existing single-family dwelling as applied for. At premises located at: 100 Park Wa , Southold SCTM # 473889 Sec/Block/Lot# 70.-10-38 Pursuant to application dated 11/7/2022 and approved by the Building Inspector. To expire on 7/19/2024. Fees: AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $184.80 SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $302.80 CO-ADDITION TO DWELLING $50.00 E l: $537.60 Building Inspector � $ � TOWN OF SOUTHOLD—BUILDING DEPARTMENT o Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 � Telephone (631) 765-1802 Fax(631) 765-9502 htt s:Hrwr.southoldtowg "y Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO., Building InsPectar, 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. i ` Date:11/7/2022 OWNER(S)OF PROPERTY: Name:Brian & Sara Shapiro scTM# Zo )010-10.38 Project Address: 100 parkway, Southold Phone#:914-319-5508 Email:so'aps129@yahoo.com Mailing Address: 100 parkway, Southold, NY 11971 CONTACT PERSON: Name:Michael Hand Mailing Address:PO 1256, Mattituck, NY 11952 Phone#:631-965-1947 Email:michael@mchdesignservices.com DESIGN PROFESSIONAL INFORMATION: Name:James Deerkoski, PE Mailing Address:260 Deer Drive, Mattituck, NY 11952 Phone#:631-774-7355 Email:jamesdeerkoski@yahoo.com CONTRACTOR INFORMATION: Name: Mailing Address: Phone#: Email: DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure l@Addition iiAlteration ❑Repair ❑Demolition Estimated Cost of Project: ❑other $75,000 Will the lot be re-graded? ❑Yes ii No Will excess fill be removed from premises? ❑Yes RNo 1 PROPERTY INFORMATION Existing use of property:Single family dwelling Intended use of property:Single family dwelling Zone or use district in which premises is situated:., Are there any covenants and restrictions with respect to r40 this property? ❑Yes RNO IF YES, PROVIDE A COPY. ❑ Check Box A'fter Read!ng: 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 WAS of the New York State Penal Law. Application Submitted By,,,A,n.n .fteSZchuZm ,,, rl@r @Authorized Agent ❑Owner OP Signature of Applicant: Date: 11/7/2022 STATE OF NEW YORK) SS: COUNTY OIF-jt/r—r-O 1-9—) dbeing duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the -AJ7— (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 qday of "v,,: , 20_ZZa__ Notary P' lic I 141'. L ZATARGA W ry NOTARY (V,M,f�d'�,STATE OF NEW YORK �f°f�F' � ��H0RIZ � ' 1 FIkzg3� io i on No.01SC6315527 ROP F�fi �m in Suffolk.0 County � (Where the applicant is not the owner) Commission Ex ares aanua 3,2023 I, residing at do hereby authorizeto apply on , my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 Bgilding Department Application AUTHORIZATION (Where the Applicant is not the Owner) r 1 U hP ► v residing at ► (Print property owner's name) (Mailing Address) 1-71 do hereby authorize (Agent) to apply on my behalf to the Southold Building Department. L C-Y4 (Owner's Signature) (Date) (Print Own ac's Name)