HomeMy WebLinkAbout48923-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
' 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#: 48923 Date: 2/16/2023
Permission is hereby granted to:
D'A uino C Rev Liv Trust
356 Grove St
Oradell, NJ 07649
To: construct alterations to existing single-family dwelling as applied for.
At premises located at:
4065 Orchard St, Orient
SCTM # 473889
Sec/Block/Lot# 27.-2-2.7
Pursuant to application dated 2/2/2023 and approved by the Building Inspector.
To expire on 8/17/2024.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $242.00
CO -ALTERATION TO DWELLING $50.00
Total: $292.00
Buil ingnspector
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 littps://www.sotitlioldtownny.,gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only IID- C ill
PERMIT NO. LI-LI-OB Building lnspector.
Applications and forms must be filled out in their entirety.Incomplete IWI'I "O "
applications will not be accepted. Where the Applicant is not the owner,an 70WN0FS06W4&b
Owner's Authorization form(Page 2)shall be completed.
Date:1/24/2023
OWNER(S)OF PROPERTY:
Name:Orient NR LLC SCTM#1000-27-02-2.7
Project Address:4065 Orchard Street, Orient, NY 11957
Phone#:212.431-3650 Email:trina@rserra.com
Mailing Address: 173 Duane Street NYC NY 10013
CONTACT PERSON:
Name:Catherine McKeever
Mailing Address: 173 Duane Street NY NY 10013
Phone#:212.431-3650 Email:trina@rserra.com
DESIGN PROFESSIONAL INFORMATION:
Name:Melissa Cicetti, R.A.
Mailing Address:481 Van Brunt Street 7C, Brooklyn, NY
Phone#:718.870.1460 Email:melissa@studiocicetti.com
CONTRACTOR INFORMATION:
Name:EGCI
Mailing Address:275 Bayer Road, Mattituck, NY 11952
Phone#:631.834.9180 Email:edward.gatto22@gmail.com
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition WAlteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $60,000
Will the lot be re-graded? ❑Yes 1No Will excess fill be removed from premises? ❑Yes WNo
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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-200 this property? ❑Yes R No IF YES, PROVIDE A COPY.
9 Chel;:k Box After Readfing: 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): igAuthorized Agent ❑Owner
Signature Applicantle Date:
STATE OF NEW YORK)
SS:
COUNTY OF M4 W W i k )
tX4eA-Vq,r being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named, A
(S)he is the �'/t 4- I`� L-.t
(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
ibtl of J 2 0 2
day Q,VI !� , '�
Notary Public
NOT.ARI'PIBI1C.STATE OF NEW YOBS
(Where the applicant is not the owner) ReeisnarionNo.OIPE6309313
Qualified in Q.--n COWY
Com>oiuion 0�-11-Y0,,,�6
I, residing at
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described her eln.
Owner's Signature Date
Print Owner's Name
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