HomeMy WebLinkAbout51736-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#: 51736 Date: 03/13/2025
Permission is hereby granted to:
Daniel Watts
2 Pierrepont PI
Brooklyn, NY 11201
To:
Construct a rear covered porch addition to an existing single-family dwelling as applied for..
Premises Located at:
605 Village Ln, Orient, NY 11957
SCTM#25.-2-20.21
Pursuant to application dated 01/31/2025 and approved by the Building Inspector.
To expire on 03/13/2027.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Addition&Alteration $522.50
CO Single Family Dwelling-Addition /Alteration $100.00
Total $622.50
lj� &Z'
�� Building Inspector ��
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
1 Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 lift , .souihold'lowrqU�(,1
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only Ix "
PERMIT NO._e.m✓ �.J Building Inspector:M ` �.. ....._... _..
.......... - J A N
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an
Owners Authorization form(Page 2)shall be completed.
Date:1.30.25
OWNER(S)OF PROPERTY:
Name:DANIEL WATTS SCTM# 1000- 25-02-20.21
Project Address:605 VILLAGE LANE ORIENT, NY 11957
Phone#:917-586-9637 Email:DANIEL.C.WATTS@OUTLOOK.COM
Mailing Address:2 PIERREPONT PLACE, BROOKLYN, NY 11201
CONTACT PERSON:
Name:KATHERINE SAMUELS
Mailing Address:25235 MAIN ROAD CUTCHOGUE, NY 11935
Phone#:631-734-6405 Email:KATE@SAMUELSANDSTEELMAN.COM
DESIGN PROFESSIONAL INFORMATION:
Name:ABOVE
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:TBD
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure [)(Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $150„000
Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ❑Yes ®No
ff
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
R-40 this property? I]Yes iX 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 210.45 of the New York State Penal Law.
Application Submitted By(print name): KATHERINE J SAMUELS nAuthorized Agent ❑Owner
Signature of Applicant: �1 es� �P . � "�—�� Date: 30th January 2025
Florida Rg
STATE OF W:Aftbc)(QW
SS:
COUNTY OF Miami-Dade )
Katherine Jean Samuels being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the Authorized 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• an
that the work will be performed in the manner set forth in the application file therewith. 4 �P d¢ RISABRANA
Notary Public-State of Fbrida
K commission#ms07ss9
20YB April p
F ires o onnl 12,
Sworn before me this o�
30th day of January 20 25 x
Commission Expires 04/12/2028 a Brana 4ot Public
Notarized remotely online using communication technology via Proof.
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
Daniel Watts residing at 605 Village Lane,
Orient do hereby authorize Kate Samuels to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
pa ze-W 6 )a&W, January 30, 2025
Owner's Signature Date
Daniel Watts
Print Owner's Name
2
Albert J. Kru ski, Jr. � �sQ STORlMMAT]ER
SUPERVISOR �� '� MAN A&G]E MI ENT
SOUTHOLD TOWN HALL-P.O.Sox 1179
53095 Main Road-SOUTHOLD,NEW YORK 11971 7Town of Southold
CHAPTER 236 - STORMWATER MANAGEMENT REFERRAL FORM
( APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT
ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER. )
APPLICANT: (Property Owner, Design Professional, Agent, Contractor, Other)
NAME: _ ww. . m� _ Date:
(Print)
G�;�a r��luur�._
Contact Information
(E-Mail&Telephone Number) Y
Property Address / Location of Construction Site:
_. 0..5 ......1 .. . _.. ' fi.. wW � w S.C.T.M. #: 1000
District
......
� WWmm �WWWmmmm�rvnµµ Section Block Lot
TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT
Area of Disturbance is less than 1 Acre. No S.P.D.E.S. Permit is Re wired !
❑ - Project does Not Discharge to Waters of the State. No S.P.D.E.S. Permit is Re wired !
❑ Area of Disturbance is Greater than 1 Acre& Storm-water Runoff Discharges Directly
to Waters of the State of New York. THE APPLICANT MUST OBTAIN a S.P.D.E.S. Permit
DIRECTLY From N.Y.S. D.E.C. Prior to Issuance of a Building Permit.
❑ - Area of Disturbance is Greater than 1 Acre & Storm-water Runoff Flows Through Southold
Town's MS4 Systems to Waters of the State of New York. THE APPLICANT MUST OBTAIN
a S.P.D.E.S. Permit throe h the Southold Town Erti` irteerin De artment
Prior to Issuance of a Buildin Permit.
_._._....... ._...... _ ..._M m..S
Reviewed By: Date:
FORM # SMCP-TOS December 2024 , , r ,3 1 `