HomeMy WebLinkAbout48819-Z . aTOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
A `4 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 #: 48819 Date: 1/31/2023
Permission is hereby granted to:.
Treiber, Irene
5 Tanglewood Ln
Sea Cliff, NY 11579
To: Convert accessory garage to pool house at existing single family dwelling as applied
for, with SCHD and HPC approvals.
At premises located at:
405 Racketts Ct, Orient
SCTM # 473889
Sec/Block/Lot# 17.-6-8
Pursuant to application dated 12/27/2022 and approved by the Building Inspector.
To expire on 8/1/2024.
Fees:
ACCESSORY $212.00
CO-ACCESSORY BUILDING $50.00
Total: $262.00
Building Inspector
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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 litti.)s://w�vww.soLitll()Idtowiiiiv.gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
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PERMIT NO. Building inspector:
910"
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Applications and forms must be filled out in their entirety.Incomplete BUtLDING DEP
applications will not be accepted. Where the Applicant is not the owner,an y,,iafhT nr q(NI
Owner's Authorization form(Page 2)shall be completed.
Date:12/22/2022
OWNER(S)OF PROPERTY:
Name:Peter & Irene Treiber scTM#s000-17-06-08
Project Address:405 Racketts Court Orient NY 11957
Phone#:516-403-3434 Email:pstreiber@gmail.com
Mailing Address:P,0 BOX 152 Mattituck NY 11952
CONTACT PERSON:
Name:Michelle Sarabia, AMP Architecture
Mailing Address:P.0 BOX 152 Mattituck NY 11952
Phone#:631-603-9092 Email:msarabia@amparchitect.com
DESIGN PROFESSIONAL INFORMATION:
Name:Anthony Portillo, AMP Architecture
Mailing Address:P.0 BOX 152 Mattituck NY 11952
Phone#:631-603-9092 Email:aportillo@amparchitect.com
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:,
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure RAddition ❑Alteration ❑Repair *Demolition Estimated Cost of Project:
❑Other $
Will the lot be re-graded? ❑Yes *No Will excess fill be removed from premises? ❑Yes ANo
1
PROPER'L'Y 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-40 NC this property? ❑Yes iRNo IF YES, PROVIDE A COPY.
Il l Check Box After Rea;ding: The / imo(or wrfl wat", by
Chop*r 236 0(tiro Town Caft. Af„lrUCAnor 3 HEREVY MADEto the WdOX 1 W tho, ”ate s ulming ft jM W to 0 tt zorw
OnOnance of OreTow of SmUtaid,SuffoH4 f,"wnW,No w,r York w W o" w bkw t wwwra or fR s,for Ow amsuutWo of buUmp,
*d0d",a w for ftmoW or do o as h"W ,IN to, wr Ikh A d ,ord m +tea,
hoarder a§w%awed RwwqA*dom oml to win*arws0x*be4 lrmpoMrw on a wW In w)for www.Palo*shrtaraw"b rawrwurkr f urrrfn error
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Application Submitted By(print name):AMP Architecture, Michelle Sarabia IlAuthorized Agent
❑Owner Signature of Applicant:Date: ��`13 °L
STATE OF NEW YORK) w.
SS:
COUNTY OF SuffolkC
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AMP Architecture, J866-Malee_being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the agent
(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 there ith..
Sworn before me this ,
c -3 day of 202i:1— , )
t)� ,Pub Orlowski
;f NOTARY"°, Notary Public,State of New Yorl;
w*f Pueua !a® No.Ol OR6280392
PROPERTY OWNER AUTHORIZATI �," wlifiedinSrrifolljl�'owilay
w '` Coa* lost E. it 03113P2�P
"'PxPtl Ntlw N11'nti
(Where the applicant is not the owner)
I, &YA /t residing at S 7*,4/
G L " _ �'l2d hereby authorize
AMP Architecture o apply on
my behalf to#mTown of Southold Building Department for approval as described herein.
6�Owner' Da e
Print Owner's Name
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