HomeMy WebLinkAbout50817-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#: 50817 Date: 6/13/2024
Permission is hereby granted to:
Martin, Liam
PO BOX 165
............. ..........................
Orient, NY 11957
To: Construct an 8 foot deer fence with required pool barrier protection to an existing
single-family dwelling as applied for.
At premises located at:
1640 Calves Neck Rd, Southold
SCTM # 473889
Sec/Block/Lot# 70.4-39.1
pp ............4 and approved by the Building Inspector.
Pursuant to application dated 5/2/202 _w_
To expire on d. 6/13/2025.mmmmmm
Fees:
DEER FENCE $100.00
Total: $100.00
_.........................Js
Building Inspector
xta�sn ry rsaM
I tw TOWN OF SOUTHOLD—BUILDING DEPARTMENT
A Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
(141"s i�
Telephone (631) 765-1802 Fax (631) 765-9502 jitt s,//www.southol(Itownjiy.gov
Date Received"
APPLICATION FOR BUILDING PERMIT
iI C
r
For Office Use Only
PERMIT NO. ✓o�/ Building Inspector:A�1& MAY
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:
OWNER(S)OF PROPERTY:
Name: Liam Martin SCTM # 1000-70-4-39.1
Project Address: 1640 Calves Neck Road, Southold, NY 11971
Phone#:631-734-7923 (Agent) Email: Creativeenvdesign@yahoo.com
Mailing Address:
CONTACT PERSON:
Name:David Cichanowicz/ Creative Environmental Design
Mailing Address: P.O. Box 160, Peconic, NY 11958
Phone#: 631-734-7923 Email: creativeenvdesign@yahoo.com
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:Creative Environmental Design
Mailing Address: P.O. Box 160, Peconic, NY 11958
Phone#:631-734-7923 Email:creativeenvdesign@yahoo.com
DESCRIPTION OF PROPOSED CONSTRUCTION
[]New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other Deer Fence $
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:Residential
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes *No IF YES, PROVIDE A COPY.
H 0heck Box After Re:dh1g. 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,
David Cichanowicz/Creative Environmental Design
Application Submitted B (print name): Authorized Agent ❑Owner
Signature of Applicant: Date:
STATE OF NEW YORK)
SS:
COUNTY OF Suffolk )
David Cichanowicz 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
S day of , 2021-
Notary Pubficf
PENNY LOUI E MAIFFETONE
NOTARY PUBLIC,STATE OF NEW YORK
ry ,.._.. d_.ww N Registation No.01MA8402379
(Where the applicant is not the owner) Qualtfled In `*County
CommlBelon
residing at
do hereby
authorize David Cichanowicz/Creative Environmental Design
to apply on
my behalf to the Town of Southold Building Department for approval as described herein,
Owner's Signature Date
Liam Martin
Print Owner's Name
2
PROPERTY INFORMATION
m
Existing use of property: Residential Intended use of property:Residential
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes®No 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 220.45 of the New York State Penal Law.
David Cichanowicz/Creative Environmental Design
Application Submitted'R (print name): BAuthorized Agent ❑Owner
Signature of Applicant: Date: 51) J e o�L l
STATE OF NEW YORK)
SS:
COUNTY OF Suffolk ),
David Cichanowicz 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
Sd 10 '
� dayof 20 �/ ...
Notary Pubficf
PENNY LOUkSE MAFFETONE
,STATE OF NEWYORK
PROPERTY OWNER WJ°�1HORI T11 IN Nr�T gfta C to No.OIMA6402M
(Where the applicant is not the owner) old In Suftk County
'20V
I, Liam Martin residing at 640 Diedricks Road Orient NY
David Cichanowicz/Creative Environmental Design
do hereby authorize to apply on
my b6h If to the T,Ow o Vaut�ho,Id~ Ilding Department for approval as described herein.
1 May 1 2024
Owner's Signature Date
Liam Martin
Print Owner's Name
2
Suffolk County Dept.of
Labor,Licensing&Consumer Affairs
HOME IMPROVEMENT LICENSE
Name
DAVID J CICHANOWICZ
Business Name
INDIAN NECK CORP DBA
This certifies that the
bearer is duly licensed License Number H-29895
by the County of suffolk Issued: 12/13/2001
Jerulifer Cabrera, Expires: 12/0112025
Commissioner
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