HomeMy WebLinkAbout51412-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#: 51412 Date: 11/25/2024
Permission is hereby granted to:
Geoffrey R Schwartz
602 Bergen St
Brooklyn, NY 11238
To:
construct alterations to existing single-family dwelling as applied for.
Premises Located at:
22715 Route 25, Orient, NY 11957
SCTM# 18.-2-21
Pursuant to application dated 08/16/2024 and approved by the Building Inspector.
To expire on 11/25/2026.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $326.00
CO-RESIDENTIAL $100.00
Total 426.00
uilding Inspector
� sOvaa � TOWN OF SOUTHOLD—BUILDING DEPARTMENT
„ Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
a Telephone(631) 765-1802 Fax (631) 765-9502 l s:.//w°rvv so t:lioldtt)) iiiiv�. o�1
Date Received
PERMIT,APPLICATION FOR BUILDING
For Office Use Only
PERMIT NO. Building knspector;
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. p
Date:July 30 2024
OWNER(S)OF PROPERTY:
Name:Brooke Ellis and Geoffrey Schwartz FcTM#i000-18.-2-21
Project Address:22715 Main Road Orient NY
Phone#:646-275-2447 1 Email:margot@isaac-rae.com
Mailing Address:22715 Main Road Orient NY
CONTACT PERSON:
Name:Margot Coffey
Mailing Address:430 Main Street 2nd FI Greenport NY 11944
Phone#:646-275-2447 Email:margot@isaac-rae.com
DESIGN PROFESSIONAL INFORMATION:
Name:Isaac-Rae Studio (Margot and Clay Coffey)
Mailing Address:430 Main Street 2nd fl Greenport NY 11944
Phone#:347-276-6093 Email:clay@isaac-rae.com
CONTRACTOR INFORMATION:
Name: N/A
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition iWAlteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $200,000
Will the lot be re-graded? []Yes WNo Will excess fill be removed from premises? ❑Yes No
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PROPERTY INFORMATION
Existing use of property:single family residence 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
R-40 this property? ❑Yes No IF YES, PROVIDE A COPY.
19 hec* l iRox 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 me)' Clay Co @Authorized Agent ❑Owner
Signature of Applicant: �X"""� Date: �c' 2
y
STATE OF NEW YORK)
COUNTY OF flU
Ir74113-C C l' Y being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract) ve named,
(S)he is the QV1 VA6 , cic
(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
"
Clay of u U 20
otary Public
TRA EY 6..."„ D WN 1.
I)ROPERTY OWNER AUTHOR I- )
A^^MOTARY PUIBR.,IC,STATE Off'�,°
Where the applicant is not the owner) IE IIC E �,
( OLIFIED IN SUrFOt K CC1�
COMWISSION EX RE'S JU
Geoffrey Schwartz, Brooke Ellis residing at 22715 Main Road Orient NY
Isaac-Rae (Margot, Clay Coffey)
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
7/29/2024
wner's signaturV Date
Geoffrey Schwartz, Brooke Ellis
Print Owner's Name
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