HomeMy WebLinkAbout51414-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#: 51414 Date: 11/25/2024
Permission is hereby granted to:
Peter Treiber
310 Oyster Ponds Ln
Orient, NY 11957
To:
legalize "as built" portion of finished basement to existing single-family dwelling as applied for..
Additional certification will be required.
Premises Located at:
585 Peconic Ln, Peconic, NY 11958
SCTM#75.-5-4
Pursuant to application dated 09/20/2024 and approved by the Building Inspector.
To expire on 11/25/2026.
Contractors:
Required Inspections:
Fees:
As Built Alteration $859.00
CO-RESIDENTIAL $100.00
Total S959.00
Building Inspector
r°f
�tlee
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
p� Telephone (631) 765-1802 Fax (631) 765-9502 hRps://wwNv.so Litho lcho
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only �I
PERMIT NO. Building Inspector:
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. ay 501T,
Date:07/25/24
OWNER(S)OF PROPERTY:
Name:Peter Treiber sCTM#1000-75-05-04
Project Address:585 Peconic Ln, Peconic, NY 11958
Phone#:516-403-3434 Email:pstreiber@gmail.com
Mailing Address:
CONTACT PERSON:
Name:Mathew Smith
Mailing Address:PO Box 152, Mattituck, NY 11952
Phone#:631 603 9092 Email:msmith@amparchitect.com
DESIGN PROFESSIONAL INFORMATION:
Name:Anthony Portillo
Mailing Address:PO Box 152, Mattituck, N.Y. 11952
Phone#:631 603 9092 Email:aportillo@amparchitect.com
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑• Other Legalization of Full Bathroom at Basement $
Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ❑Yes ®No
1
PROPERTY INFORMATION
Existing use of property:Single Family Residence WI Accessory Aparlmnel Intended use of property:Single Family Residence WI AccessoryApartmnet
Zone or use district in which premises is situated:. Are there any covenants and restrictions with respect to
R-80 Non Conforming 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 appruant 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 ofthe New York State Penal Law.
Application Submitted By(printname):AMP Architecture RAuthoried Agent ❑Owner
Signature of Applicant: Date:. q I z y
STATE OF NEW YORK)
S
COUNTY OF
1 f(� being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the A
(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
day of ber- , 20 Gr +
NotrRegistration
Ic
AROE'E AU NER
Y PUBLIC,STATE OF NEW YORK
PROPERTYp UTH RIB TI No.0'1AU0019644
(Where the applicant is not the owner) ualified in Suffolk County
s January 9, 202'B
ission Expire,......
Peter Treiber -
I, residing at Sim D
o hereby authorize AMP Architecture to apply on
my behalf tot Town of Southold Building Department for approval as described herein..
�I
wner's Si, aturre Date
fl?,�L !`2—ze --
Print Owner's Name
Z