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Home My WebLink About48852-Z ' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE �.� e, SOUTHOLD, NY 4 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 #: 48852 Date: 2/2/2023 Permission is hereby granted to: Gomez Jorge 126 Center St Greenport, NY 11944 To: construct alterations to existing single-family dwelling as applied for. At premises located at: 725 Bailey Ave Greenport SCTM # 473889 Sec/Block/Lot# 34.4-11 Pursuant to application dated 12/13/2022 and approved by the Building Inspector, To expire on 8/3/2024. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $272.00 CO-ALTERATION TO DWELLING $50.00 Total: $322.00 Building Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT M Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 ' Telephone(631)765-1802 Fax(631) 765-9502 littl)s://w%vw,soutli,oldtowniiyZov Date Received 1111.1 I II FPAPP ING PERMIT For Office Use Only a 4�NPERMIT NO. Building Inspector, DEC 13 2022 BUIUJINbJE . Applications and forms must be filled out in their entirety. Incomplete TOWN OFA(V FT&?+)s_Cx applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date: 8/17/2022 OWNER(S)OF PROPERTY: Name: Jorge & Martyna Gomez SCTM# 1000-34.-4-11 Project address: 514 Bailey Ave., Greenport, NY 11944 Phone#:631-574-5834 Email: JORGE@jggconstruction.com Mailing Address:514 Bailey Ave., Greenport, NY 11944 CONTACT PERSON: Name: Karen Szczotka, Agent Mailing Address:205 Bay Ave., Greenport, NY 11944 Phone#:631-477-9752 Email:karen@ribrownarchitect.com DESIGN PROFESSIONAL INFORMATION: Name: Robert I. Brown, AIA Mailing Address:205 Bay Ave., Greenport, NY 11944 Phone#:631-477-9752 Email:rob@ribrownarchitect.com CONTRACTOR INFORMATION: Name: owner doing work Mailing Address: Phone#: Email: DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition WAlteration ❑Repair ❑Demolition Estimated C t of Project„ ❑Other Will the lot be re-graded? ❑Yes W No Will excess fill be removed from premises? ❑Yes JkNo I k h PROPERTY 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 this property? Dyes Ig No IF YES, PROVIDE A COPY. @ Chedk lox Afteiir 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 220.45 of the New York State Penal Law. Application Submitted By(print arae): Authorized Agent El Owner Signature of Applicant;."" Date, 122- CONNIE D.BUNCH Notary Public,State of New York STATE OF NEW YORK) No.01 BU6185050 SS: Qualified in Suffolk County `r COUNTY OF SUFFOLK Commission Expires April 14, 244e�� - �� l M being duly sworn,reposes and says that(s)he is the applicant (Name of individual signing contract)above named, (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 qday of CP"'yl Notary Public Pit iIIICIII°,III i' Illi i I 'iZI .Where the applicant is not the ownePo Jorge & Martyna Gomezresiding at 514 Bailey Ave. Greenport, ill( Robert I. Brown Arhitect, PC and it's Agents Y ' do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date �6t.,f � w+ Z Print Owner's Name 2