HomeMy WebLinkAbout51813-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#: 51813 Date: 04/07/2025
Permission is hereby granted to:
Douglas Bradford
3705 Bay Shore Rd
Greenport, NY 11944
To:
construct additions and alterations to existing single-family dwelling as applied for.
Premises Located at:
3980 Bay Shore Rd, Greenport, NY 11944
SCTM# 53.-6-32
Pursuant to application dated 02/27/2025 and approved by the Building Inspector.
To expire on 04/07/2027.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Addition&Alteration $93&00
CO-RESIDENTIAL $1M=
Total $1,038.09
aiding Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
r,
; Telephone (631) 765-1802 Fax (631) 765-9502 n o
Date Received
APPLICATION FOR BUILDING PERMIT
L7 :a
7
For Office Use Only
PERMIT NO. �� 3 Building Inspector:
FEB2 7 2 z
Applications and forms must be filled out in their entirety.Incomplete
1�
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date:02/27/2025
OWNER(S)OF PROPERTY:
Name:Douglas Bradford scTM# 1000-53-6-32
Project Addresses -Bay Shore Road, eenport
Phone#:914-557-9097 [E:mai�kgreenmenverizon.net
Mailing Address:3705 Bay Shore Road, Greenport
CONTACT PERSON: -
Name:Brooke Epperson
Mailing Address:PO Box 152, Mattituck, NY 11952
Phone#:631 603 9092 Email:bepperson@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:
329,000
❑Other
Will the lot be re-graded? ❑Yes WNo Will excess fill be removed from premises? @RYes ❑No
1
PROPERTY INFORMATION
Existing use of property: Single Family Residential Intended use of property: Single Family Residential
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R40 Non-Conforming this property? ❑Yes SNo IF YES, PROVIDE A COPY.
N,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 15 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 n P Architecture ■Authorized Agent []Owner
Signature of Applicant: Date:2/27/25
STATE OF NEW YORK)
SS:
COUNTY OF Suffolk
AMP Architecture (Anthony Portillo) 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 1
2 day of 20
ublic
DARCEE AUFENANGER
PROPERTY OWNER AUTHOR-1ZATION
NOTARY PUBLIC,STATE OF NEW Y+ K
Registration No. 01A000196 '
(Where the applicant i5 not the owner) Qualified in Suffolk County
Commission Expires January 9, 20 .6
1, Douglas Bradford residing at 3705 Bay Shore Road, Greenport
do hereby authorize AMP Architecture to apply on
my behalf to.t fe �l wl .arf-�outhold Building Department for approval as described herein,
-- 2/27/25
Owner's Signature Date
Douglas Bradford
Print Owner's Name
2 '