HomeMy WebLinkAbout51503-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#: 51503 Date: 12/23/2024
Permission is hereby granted to:
Jeffrey D Rogers
8200 Route 25
East Marion, NY 11939
To:
construct screened porch entry to existing single-family dwelling as applied for..
Premises Located at:
8200 Route 25, East Marion, NY 11939
SCTM# 31.-7-1
Pursuant to application dated 10/29/2024 and approved by the Building Inspector.
To expire on 12/23/2026.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Addition&Alteration $294.50
CO-RESIDENTIAL $100.00
Total S394.50
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 soutli ldtowi1qy.., ry
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. 5715 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.
Date:10.16.24
OWNER(S)OF PROPERTY:
Name:Jeffrey Rogers SCTM#1000-31-7-1
Project Address:8200 Rte 25 East Marion
Phone#:631-456-3056 Email:jeffreydylanrogers@gmail.com
Mailing Address:8200 Main Rd. Easy Marion NY 11939
CONTACT PERSON:
Name:Joan Chambers
Mailing Address:PO Box 49 Southold NY 11971
Phone#:631-294-4241 Email:joanchambers10@gmail.com
DESIGN PROFESSIONAL INFORMATION:
Name:Lou Schwartz
Mailing Address:7 Ridgewood St, Bay Shore, NY 11706
Phone#031)410-6838 ]—EM-
ail:tiderunnereng@gmail.com
I
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure INAddition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑other screened entry porch on existing masonry patio.
Will the lot be re-graded? ❑Yes ANo Will excess fill be removed from premises? ❑Yes NXINo
1
PROPERTY INFORMATION
Existing use of property:Single family 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 ❑■ No IF YES, PROVIDE A COPY.
51 Check Box AftellY', Readirlig. 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 name):Joan Chambers ®Authorized Agent ❑Owner
Signature of Applicant: Date:
CONNIE D.BUNCH
STATE OF NEW YORK) Notary Public,State of New York
No.01BU6185050
SS: Qualified in Suffolk County
COUNTY OF ) Commission Expires April 14,2 -
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
day of �i
Notary Public
'PRQRImMTY OWNERI IIII )Z ")C
(Where the applicant is not the owner)
Jeffrey Rogers
I, ,residing at
do hereby authorize Joan Chambers to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signature Date
Jeffrey Rogers
Print Owner's Name
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