HomeMy WebLinkAbout48760-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 #: 48760 Date: 1/19/2023
Permission is hereby granted to:
Krestin DS Living Trt
790 Indian Neck Ln
Peconic, NY 11958
To: Construct addition to existing accessory structure as applied for.
At premises located at:
790 Indian Neck Ln, Peconic
SCTM # 473889
Sec/Block/Lot# 86.-4-1.10
Pursuant to application dated 12/9/2022 and approved by the Building Inspector„
To expire on 7/20/2024.
Fees:
ALTERATION OF ACCESSORY BUILDINGS $426.40
CO-ACCESSORY BUILDING $50.00
Total: $476.40
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 jht) WHw w.southol tgy�r'v'
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only I VI'"til LR
PERMIT NO. Building Inspector:
DEC 0 9 2922
Applications and forms must be filled out in their entirety.Incomplete BUILUING
applications will not be accepted. Where the Applicant is not the owner,an TOWNOFSOUTHOLD
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: David Krestin ,, If'1'► it res l�h SCTM#1000-086.00-04.00-001 .010
Project Address: 790 Indian Neck Lane, Peconic, N.Y. 11958
Phone#: 917.617.9580 Email: dkrestin@gmail.com
Mailing Address: 790 Indian Neck Lane, Peconic, N.Y. 11958
CONTACT PERSON:
Name: Nigel Robert Williamson
Mailing Address: P.O. Box 1758, Southold, N.Y. 11971
Phone#: 631 .834.9740 Email: nigel_architect@hotmail.com
DESIGN PROFESSIONAL INFORMATION:
Name: Nigel Robert Williamson R.A.
Mailing Address: P.O. Box 1758, Southold, N.Y. 11971
Phone#: 631 .834.9740 LEmail: nigel_architect@hotmail.com
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure R'Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
Other $
e Yi a-o
Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises? ❑Y
A.
P,F-HO 1E ExIsT111134 ovenCg6 . ADD A S6co Jo STV 3{`-8 L x. 26'-0'*
ox
22 0- MAXI MOM HIaC,KT SToRAtiE mor-9— $23.875 FT-)
1
I
PROPERTY INFORMATION
Existing use of property:siaicri.e P"'48 -buELL-ljC Intended use of property: $iclll+-E Pjpv j bion,- d Iijjj
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
Q. $Q this ro ? ❑Yes�1G IF YES, PROVIDE A COPY.
p Pert Y
hf"f;;(t 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,
Iadditions,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 210A5 of the New York State Penal Law.
Application Submitted By(print name): Zew OPYA—Uthorized Agent ❑Owner
Signature of Applicant: ., Date: q'iEcisMEtQ/ 2o2.-,-
STATE
o2,1STATE OF NEW YORK)
SS:
COUNTY OF ) 1l
fji >v, Iia tj- i u►aws being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the &CAr
(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
Xday of T3EMmB9V— 2022- ILI
Notary ..
J.J
' i
NOTARY pU?!iC,STATE,J';=f" W YORK'.
Regist,--cWon;`le.03.jpvS052585
PROPERTY
1 w EI °Po � Ql,aliiied in Sus,oik County
Commission Exp4as February 13,E
(Where the applicant is not the owner)"
�p,u
,�� I Ja i A►� N�r;k,
K6 AA ° 4esi+ding at '
PLOaiC, IJ. 1195 do hereby authorizeto apply on,
my, alf to the'T wn of Southold Buil "tig Depa ment for approval as described herein.
1 11 lv-
Owner's Signature Date
VNI
Print Owner's Name
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