HomeMy WebLinkAbout49604-Z '" rtt TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
t 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#: 49604 Date: 8/21/2023
Permission is hereby granted to:
Simicich, Richard
................ _...........1111-1-1... ..... ...........w.... mm......
.._.
14455 Route 25
PO BOX 319
Mattituck, NY 11952
To: Demolish existing garage and construct additions and alterations to an existing
single-family dwelling as applied for.
At premises located at:
14455 Route ww25,Mattituck
SCTM # 473889
Sec/Block/Lot# 140.-3-25
Pursuant to application dated 7/11/2023 and approved by the Building Inspector.
To expire on 2/19/2025.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $474.00
DEMOLITION $68.00
CO-ADDITION TO DWELLING $50.00
Total: $592.00
Building Inspector
sr 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.sotitholdtorA -,n % lo�v�
Date Received
APPLICATION FOR BUILDING I,
For Office Use Only 4 1 t., p I 7I
C
PERMIT NO. Building Inspector:
L. l 2023
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the owner,an
r.
Owner's Authorization form(Page 2)shall be completed. TCP
l t 12
Date:July 10, 2023
OWNER(S)OF PROPERTY:
Name:Rich and Debra Simicich SCTM# 1000-140-3-25
Project Address: 14455 Main Road
Phone#:631-298-2258 Email:dsimicich@hotmail.com
Mailing Address: 14455 Main Road, Mattituck, NY 11952
CONTACT PERSON:
Name:Michael Hand
Mailing Address:PO Box 1256, Mattituck, NY 11952
Phone#:631-965-1947 Email:michael@mchdesignservices.com
DESIGN PROFESSIONAL INFORMATION:
Name:Jim Deerkoski
Mailing Address:585 Deer Path, Mattituck, NY 11952
Phone#:631-774-7355 Email:jamesdeerkoski@yahoo.com
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure RAddition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other 150,000.00
Will the lot be re-graded? ❑Yes WNo Will excess fill be removed from premises? ®Yes El No
1
PROPERTY INFORMATION
Existing use of property:single family dwelling Intended use of property:single family dwelling
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R-40 this property? ❑Yes 8No IF YES, PROVIDE A COPY.
Check Box After Read iFl& 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 Z10AS of the New York State Penal Law.
Application Submitted By(print name):Annette Schumacher ®Authorized Agent ❑Owner
Signature of Applicant: ;,°� Date: v7 lD a
STATE OF NEW YORK)
SS:
COUNTYOF S4FF i ...k
4017 , / '1' 1AYWA = being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract) a ove 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
day ofU10- LA20
A)—
N t
Christine Vazquez
Notary Public-State of New York
PROPERTY OWNERAIJTIHORIZATION NO.0 1 VA6307026
applicant is not the owner �CualtliedinSuli"alk!County
Where the
p p ) My commission Expires ��P
I, residing at
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signature Date
Print Owner's Name
2
Building Department Application
AUTHORIZATION
(Where the Applicant is not the Owner)
1, Debra & Richard Simicich residing at 14455 Main Road PO Box 319
(Print property owner's name) (Mailing Address)
Mattituck NY 11952 Michael Hand
do hereby authorize
(Agent)
to apply on my behalf to the
Southold Building Department.
7-6-23
(Owner's Signatue) (Date)
Richard Simicich / Debra Simicich
(Print Owner's Name)
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