HomeMy WebLinkAbout49128-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#: 49128 Date: 4/14/2023
Permission is hereby granted to:
.0.............�. _.
Kensington RE HI dgs..LL .... ........... .. ......................... ..................
3 Greenacre Ct
Kensington, NY 11021
To: Construct additions and alterations ( to include attached garage addition) to an existing
single family dwelling as applied for.
At premises located at:
2650 Nassau Point Rd, Cutcho ue
..... ._.m............. �.. ........__.....___________.
SCTM.....#..473.8.8.9...... ...... ...... ..... ........... ._
Sec/Block/Lot# 104.-12-15
Pursuant to application dated 10/20/2022 and approved by the Building Inspector..
To expire on _...1m0/13/2024.
Fees:
CO-ADDITIONS TO ACCESSORY BUILDINGS $50.00
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $1,551.35
Total: $1,601.35
-- ........ ............... ...................._...................�..
Building Inspector
oe
r TOWN OF SOUTHOLD—BUILDING DEPARTMENT
. -
Town I-tall Annex �4�75 Main Road P. O. Box 1 179 Southold.N
Y 11971 0959
Telephone (631) 765-1802 Fax (631) 765-95021itt s: 4wxy-southoldtovnny goy'
Date Received
APPLICATION FOR BUILDING PERMIT
I
For Office Use Only
PERMIT N0., _ Building gnS +aCCor;
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date: to VOF
VOPERTY:
OWNER(S)
Name:Kensington Capital Partners LLC SCTM# 1000
Project Address:2650 Nassau Point Road, Cutehogue, NY 11095
Phone#:646-382-5153 Email:jmirro@kensington-cap.com
Mailing Address: 3 Greenacre Court, Great Neck, NY 11021
CONTACT PERSON:
Name:Justin MirroGulf A.
�"`
Mailing Address:3 Greenacre Court, Great Neck, NY 11021
Phone#:646-382-5153 Email:jmirro@kensington-cap.com
DESIGN PROFESSIONAL INFORMATION:
Name:Richard Mato 144"T lc�
Mailing Address:PO BOX 2284, AquebogueNY 11931
Phone#:631-523-5879 Email:rmatoarchitect@gmail.com
CONTRACTOR INFORMATION:
Name:Seifert Construction
Mailing Address:11780 Sound Avenue, Mattituck, NY 11952
Phone#:631-298-1036 1Email:seifertbuilders@gmail.com
DESCRIPTION OF PROPOSED CONSTRUCTION
[--]New Structure RAddition ❑Alteration ❑Re air ❑Demolition Estimated Cost of Project:
e p
❑Other $200.000
Will the lot be re-graded? Dyes LNo Will excess fill be removed from premises? ❑Yes RNo
1
PROPERTY INFORMATION
Existing use of property: 1 Family Residential Intended use of property: 1 Family Residential
zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
Property Code 210 this property? ❑Yes BNo IF YES, PROVIDE A COPY.
M Check Box Alter Readir1g: 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 buildingls)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):Richard Mat INAuthorized Ajent ❑Owner
lD 22
Signature of Applicant: r Date: j
STATE OF NEW YORK)
SS:
COUNTY OF Suffolk )
Richard Mato 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 therewith.
Sworn before me this
C
�� r.�day of �d h� 20 2 Z , '�
Notary Public
MARY INANA FOSTER
PROPERTY Nimry Pub0c,SWe of Now Yolllt
(Where the applicant is not the owner) No.5246W42
Ouslifted In 9Stf+Ik COMV
lar mWsion 1,20 0,
I JUStlrl MIrrO ,residing at
3 Greenacre Court, Great Neck, NY 11021
do hereby authorize Richard Mato to apply on
?befnhTown of Southold Building Department for approval as described herein.8/23/2022
nature Date
o
Print Owner's Name
2