HomeMy WebLinkAbout50127-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#: 50127 Date: 12/13/2023 mmmITITIT_
Permission is hereby granted to:
Soito, Ann Marie
500 Youpaq Rd
Orient, NY 11957 �����...... _._ . _..._ m..............mm... m
To; Construct additions and interior alterations to an existing single-family dwelling as
applied for.
At premises located at:
500 Youngs Rd Orient
SCM # 473889
Sec/Block/Lot# 18.-2-18
Pursuant to application dated 11/,15/2023 and approved by the Building Inspector.
To expire on www 6/13/2025.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $580.00
CO-ALTERATION TO DWELLING $100.00
..._ ......._www..........
Total: $680.00
Building Inspector
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TOWN OF 80UTHOLD —BUILDING DEPARTMENT
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Town Hall Annex 54375 ]Main Road P. 0. Box 1 179 Southold, NY 1 1971-0959
Telephone (Ci3l) 765-1502
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
y
PERMIT NO 012- ._� Building
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.
W
Date:10.18.23
OWNER(S)OF PROPERTY:
Name:Gary Karrass Trust SCTM # 1000-18-2-18
Project Address:500 Youngs Rd. Orient
Phone#:323-525-0760 Email:pM@dedalusinc.com
Mailing Address:1615 Stanford Street Santa Monica CA 90404
CONTACT PERSON:
Name:Joan Chambers
Mailing Address:PO Box 49 Southold NY 11971
Phone#-631-29_4-4241 Email:joanchamberslO@gmaii.com
DESIGN PROFESSIONAL INFORMATION:
Name:LOu Schwartz
Mailing Address:? Ridgewood! St, Bay Shore, NY 11706
Phone#:(631) 410-6838 :jEmail:tiderunnereng@gmail.com
CONTRACTOR INFORMATION:
George Simms North Fork Custom Name: m Carpentry
Mailing Address: (� 7U 7 0 At(IKF /V
-.
Phone#:516-768-0601 Ernail:NoFoCustomCarpentry@gmail.com
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition *Alteration ❑Repair LODemolition Estimated Cost of Project:
_Other screened porch ..
Will the lot be re-graded? ;]Yes No Will excess fill be removed from premises? _Yes No
1
PROPERTY INFORMATION
Existing use of property:Residential Intended use of property:same
Zone or use district in which premises is situated, Are there any covenants and restrictions with respect to
R-40 this property? ❑Yes WNo IF YES, PROVIDE A COPY.
19 Check Box 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. APPUCATION 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 buildings)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):JOan Chambers IRAuthorized Agent ❑Owner
Signature of Applicant: :
CO IL U. BUNCH
Notary Public,State of New`(cork
STATE OF NEW YORK) No. 01 PU61 85050
SS: ii�llfied in Suffolk County
Coa -npjissiori Expires April 14, 2
COUNTY OF
Joan Chambers 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
fPX
�J � I y� �...,'f
day of
c- � 2B®
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
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
PROPERTY INFORMATION
� use of property: sl rltl � _,.Intended use of property....�.�.�_,�..,�_....�, �.,.
C 'rtiro uta e
Zc)r.teo --- v4strict in which premises is situated: Are there any covenants and restrictions with respect to
this property? DYes *No IF YES, PROVIDE A COPY.
---------------
The ow+wraarlcontractorlmtestgn protawwsio0at is responsible for aii drainage and storm water issues as prouidw h
ht p t"r
0e "f~Code APPLICATION 15 HEREBY MADE to the Oullding Department iat fire fisuance of a 8allding Permit pursuant to the Ouilding 7one
ratr aaw0fNTo%motS4othotd,,Suffolk,County,New"torte and otherappticahirr taws,tardinancos of Regulations„for the corntruction of buildttop,
ctrtt tassr wtata�orms or for m^aMoval or deniotitiort as Iwerein rtwr crtbod.The applicant agrees to comply with all appilcahle laws,ordinances,building code,
iAstc� w p p building(s) , ,
m re uil�atiuros and to admit authuad�d ins�ectoas orw renis and Yra truitdiaa allow raecsaa tn�.cticrns,False statcrnwrwts made ha.reirt arc:
�of asps a misdemeanor orsawr¢wt to acttl�arn ltM aw wwsr tt pcnaU tar .
pa si straiat- a p
Appf ica-L'oSubmitted By(print name):Joan Chambers M'Authorized Agent OOwner
5igrlature OAppiicant: CONNIDAte5UNCH
Notary Public,State of New York
No. 01 BU6185050
STATE OF NEW YORK) Qualified in Suffolk County
S5: Commission Expires April 14 2
COUN-TY 0'
jo,q.�n , ...Chambers he is theapplicant being duly sworn, deposes and says that (s
)he
(Narn- ®f1diuidual signing contract)above named,
Agen
(S)he is the
(Contractor, Agent, Corporate officer,etc.)
Of Said oWfieror 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
da C�
y of �.__.. _._...__ 2® mm_._ .
_..._ _ mm._....._ M ....
Notary Public
w
(Where the applicant is not the owner)
l' iA residing at
da hereby authorize CJ¢k`-f? ( '31V to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner 5 Signature Date
Print O ner°s Name
2
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