HomeMy WebLinkAbout48821-Z TOWN OF SOUTHOLD
"pr BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
" yby SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLAN'S AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit #: 48821 Date: 1/31/2023
Permission is hereby granted to:.
Lesko Mark
29 U er Shee Pasture Rd
East Setauket, NY 11733
To: Construct addition and alteration to existing single family dwelling as applied for.
At premises located at:
920 Pine Neck Rd, Southold
SCTM # 473889
Sec/Block/Lot# 70.-8-19
Pursuant to application dated 1/4/2023 and approved by the Building Inspector,.
To expire on 8/1/2024.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $452.00
CO-ADDITION TO DWELLING $50.00
Total: $502.00
Building Inspector
4U"
al � TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
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Telephone (631) 765-1802 Fax (631) 765-9502 htt s://www.souw
tholdtonnv.sJov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. O / Building Inspector:
Applications and forms must be filled out in their entirety. Incomplete JAN 0 4 2023 LD
applications will not be accepted. Where the Applicant is not the owner,an BUILOINU UtPT.
Owner's Authorization form(Page 2)shall be completed. TOWNOFSOUTHO D
Date:12/23/22
OWNER(S)OF PROPERTY:
Name:Mark and Karen Lesko SCTM # 1000-70- 8 - 19
Project Address:920 Pine Neck Road, Southold NY 11971
Phone#: (631) 675-6593 Email:markleskol @ yahoo.com
Mailing Address:920 Pine Neck Road, Southold NY 11971
CONTACT PERSON:
Name:Katherine Samuels
Mailing Address:25235 Main Road Cutchogue, NY 11935
Phone#:631-235-1177 Email:kate@samuelsandsteelman.com
DESIGN PROFESSIONAL INFORMATION:
Name:same as above
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:TBD
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure RAddition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $ 100,000
Will the lot be re-graded? ❑Yes *No Will excess fill be removed from premises? Dyes RNo
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N
1
PROPERTY INFORMATION
Existing use of property: Residential Intended use of property: Residential
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R-40 this property? ❑Yes ®No 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 name): 1(•gerE S1NAuthorized Agent ❑Owner
Signature of Applicant: .-- Date:
STATE OF NEW YORK)
SS:
COUNTY OF`lel
e -Soll1i tjelsbeing duly sworn, deposes and says that (s)he is the applicant
(Name of individual s ing contract)above named,
(S)he is the AG P,IV
(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
ell
day of
Cc dJ cJ 2Q >9-- O
,
Nota r ublic w..
d Uj
PROPERTY OWNER AUTHORIZATION �« "� a "^ ktiOpIr
(Where the applicant is not the owner)
Mark & Karen Lesko residing at 920 Pine Neck Road
Southold NY 11971 y Katherine Samuels
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Digitally signedMark J. esko
Mark J. Lesko Date:2022.1227y15:58:26L05'00' 12/27/22
Owner's Signature Date
Mark J. Lesko
Print Owner's Name
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