HomeMy WebLinkAbout48750-Z x TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
N 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#: 48750 Date: 1/18/2023
Permission is hereby granted to:
Fischetti, John
1675 Pine Neck Rd
Southold, NY 11971
To: Legalize as built family room over garage at existing single family dwelling as applied
for.
Additional certifiction may be required.
At premises located at:
2615 Wells Rd, Peconic
SCTM # 473889
Sec/Block/Lot# 86.-2-1.2
Pursuant to application dated 12/14/2022 and approved by the Building Inspector..
To expire on 7/19/2024.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $920.00
CO-ALTERATION TO DWELLING $50.00
Total: $970.00
Building Inspector
Offal 41
.a TOWN OF SOUTHOLD—BUILDING DEPARTMENT
.; Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
M "= Telephone (631) 765-1802 Fax (631) 765-9502 lttS://WWW.SOLItliol,dtowtitiy'.gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only L�
PERMIT NO. f 7S 0 Building Inspector. DEC 0 6 2022
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 TOWN OF SOUTHOLD
Owner's Authorization form(Page 2)shall be completed.
Date:1 1/10/2022
OWNER(S)OF PROPERTY:
Name: John Fischetti SCTM# 1000-86.-2-1.2
Project Address:2615 Wells Road Peconic, NY 11958
Phone#:917-723-7420 Email:jfischetti@mac.com
Mailing Address:2615 Wells Road Peconic, NY 11958
CONTACT PERSON:
Name: John Fischetti
Mailing Address:2615 Wells Road Peconic, NY 11958
Phone#:917-723-7420 Email:jfischetti@mac.com
DESIGN PROFESSIONAL INFORMATION:
Name.
Mailing Address;
Phone#: Email:
CONTRACTOR INFORMATION:
Name: John Bertani
Mailing Address:
Phone#: Email
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition *Alteration ❑Repair ❑Demolition Estimated Cost of Project:
110therFinishing of existing space to be Family Room X301000
Will the lot be re-graded? ❑Yes W No Will excess fill be removed from premises? ❑Yes *No
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PROPERTY INFORMATION
,.
.
Existing use of property:: 3eSldentlal Intended useof property:Residential
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes *No IF YES, PROVIDE A COPY.
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 Fischetti
Application Submitted By(print name): ❑Authorized Agent ROwner
Signature of Applicant: Date: 11/10/2022
CONNIE D.BUNCH
Notary Public,State of New York
STATE OF NEW YORK) No. 01BU6185050
SS: Qualified in Suffolk County
COUNTY OF Suffolk ) Commission Expires April 14,20.)-1-1
John Fischetti
being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
Owner
(S)he is the
(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 °'°( 20
Notary Public
(Where the applicant is not the owner)
I, residing at
_........_._..... _..�� ._ ...do
hereby authorizeto apply on
my behalf to the Town of Southold Building Department for approval as described herein.
I
Owner's Signature Date
Print Owner's Name
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