HomeMy WebLinkAbout50170-Z TOWN OF SOUTHOLD
�Frta 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#: 50170 24
Date: 1/2 20
Permission is hereby granted to:
Pine West LLC
63 Railroad Ave
Center Moriches, NY.11934 .. .. ....._ �,._.__.
To: Construct a 12 x 12 accessory gazebo to a new single-family dwelling as applied for.
At premises located at:
5445 Great Peconic Bay Blvd.,Laurel
SCTM # 473889
Sec/Block/Lot# 128.-1-5
Pursuant to application dated 7/26/2023 and approved by the Building Inspector.
To expire on 7/3/2025.
Fees:
ACCESSORY $157.60
CO-ACCESSORY BUILDING $50.00
Total: _vww $207.60
............_. vv_... .....................
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 https://www.souilioldtowiiny.&Yov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only iD)
PERMIT NO, Building Inspector: JUL
Applications and forms must be filled out in their entirety. Incomplete BUILDING DEPT.
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed. )
Date: Z�
OWNER(S)OF PROPERTY:
Name:pine West LLC, Bill Schilling SCTM#1000--128-1-5
Project Address:5445 Peconic Bay Blvd, Laurel, NY
Phone#:516-250-8627 1 Email:bill@schillingcarpentry.com
Mailing Address:11 Smith Street Center Moriches, NY
CONTACT PERSON:
Name:Jeffrey Sands
Mailing Address:6 Evergreen Lane, East Quogue, NY 11942
Phone#:631-375-5997 Email:jeff@jsa-ny.com
DESIGN PROFESSIONAL INFORMATION:
Name:Jeffrey Sands Architect
Mailing Address:6 Evergreen Lane, East Quogue, NY 11942
Phone#:631-375-5997 Email:Jeff@jsa-ny.com
CONTRACTOR INFORMATION:
Name:TBD
i
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
@New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other New Gazebo 8,000(Gazebo)
Will the lot be re-graded? ❑Yes @No Will excess fill be removed from premises? RYes ❑No
1
PROPERTY INFORMATION
Existing use of property:Vacant land Intended use of property:Single family residence
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R40 this property? ❑Yes RNo IF YES, PROVIDE A COPY.
@ 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. 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 n e):Jeff r y Sands FNAuthOrized Agent ❑Owner
Signature of Applicant: Date: 7 1211
., `
STATE OF NEW YORK)
COUNTY F
4::,
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
11�&&ea
day of a _.20,-D-S
Not Public
JENNIFER M SIGNORELLI
Notary Public-State of New York
PROPER „ � Ii NO. in Suffolk
95C
Qualified in Suffolk County
(Where the applicant is not the owner) My Commission Expires Apr 30. Z024
Bill Schilling, Pine West LLCresiding at 11 Smith Street, Center Moriches, NY
do hereby authorize Jeffrey Sands to apply on
m t To 0 hold Department for approval as describederein
-,
wrier s Signature Date
Bill Schilling
Print Owner's Name
2
Building Department Application
AUTHORIZATION
(Where the Applicant is not the Owner)
residing at—ft—S
(Print property owner's name) Mailing Address)
do hereby authorize t
(Agent)
to apply on my behalf to the
Southold Building Department.
( w�ner's Signature) (Date)
tlU- SG141LLQ/ J Ll
(Print Owner's Name)
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SECTION 1
SEAL ARCHITECT PROJECT DRAWING TITLE SCALE DATE
1/4"=1'-0" 6-7-2023
JEFFREYSANDS DRAWING NUMBER
ARCHITECT
PINE WEST LLC GAZEB 0 PLAN,
6 EVERGREEN LANE 5445 PECONIC BAY BLVD ELEVATIONS &
EAST QUOGUE, NY 11942 LAUREL, NEW YORK
PHONE 631.375.5997
FAX 631.576.8916 FAX
A400A