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Home My WebLink About49605-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT 4TOWN 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 #: 49605 Date: 8/21/2023 Permission is hereby granted to: Simicich, Richard _........... 14455 Route 25_ ._ _......... w.....� . ......... _........ _ �._.�._._... __ .n... ._ __...... ................... ..............__ _._._ PO BOX 319 Mattituck, NY 11952 To: Construct an accessory garage to an existing single-family as applied for. Must maintain a minimum setback of 15 feet. At premises located at: 14455 Route 25, Mattituck SCTM # 473889 Sec/Block/Lot# 140.-3-25 Pursuant to application dated _mITIT7/11/2023 and approved by the Building Inspector. To expire on 2/19/2025. Fees: ACCESSORY $253.60 CO-ACCESSORY BUILDING $50.00 Total: m................... $303.60 n, ----_.�........................... _._ Building Inspector 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 htt S://r WF.soL]t'ho�ldtovii' Dov Date Received APPLICATION FOR Bt JILDING PERMIT For Office Use Only I I PERMIT NO. ` �� Building Inspector: V J111 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 ltd i Owner's Authorization form(Page 2)shall be completed. To " Date:July 10, 2023 OWNER(S)OF PROPERTY: Name:Rich and Debra Simicich TSCTM # 1000-140-3-25 Project Address: 14455 Main Road Phone#:631-298-2258 Email:dsimicich@hotmaii.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 thtion ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ❑otheC $75,000 Will the lot be re-graded? ❑Yes ®No 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 I this property? ❑Yes RNO IF YES, PROVIDE A COPY. 8 Check IBox 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):Annette SchumacherINAuthorized Agent ❑Owner 11041 SApplicant: N � Signature of Date: *� a��1�)o�o STATE OF NEW YORK) SS: COUNTY OF SL1 FroLK ) AY)f) —'sr-4V being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the u k/ (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 44-11 �D day of L6 kA 20Q� Notary Christine Vazquez Notary Public-State of New York PROPERTY m...., OWNER AL)THORIZA"110N NO.01VA6307026 ...M Qualified in Sullolk County' (Where the applicant is not the owner) Myc°mmissi°neares Via(, 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) l 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 a 4.+ (Owner's Signatu ) (Date) Richard Simicich / Debra Simicich (Print Owner's Name)