HomeMy WebLinkAbout52520-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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#: 52520 Date: 12/05/2025
Permission is hereby granted to:
Sinclair SP Revoc Trt
PO BOX 489
Orient, NY 11957
To:
Construct a new garage accessory to an existing single-family dwelling as applied for.
Premises Located at:
29827 Route 25,Orient, NY 11957
SCTM# 14.-2-1.8
Pursuant to application dated 10/22/2025 and approved by the Building Inspector.
To expire on 12/05/2027.
Contractors:
Required Inspections:
Fees:
Accessory-New Structure $485.00
CO Accessory Structure $100.00
Total $585.00
JA 4D
Building Inspector
TOWN OFSOUTHOLD - BUILDING DEPARTMENT b�
' Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold, NY 11971-0959
Telephone(631)765-1802 Fax (631) 765-9502 htt : /W .SoWhPldtewnn �
Date Received
APPLICATION FOR BUILDING PERMIT
v
For Office Use Only �`F
PERMIT NO. Building Inspe+ctor:
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;t
Applications and forms must be filled out in their entirety. Incomplete r
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date: `CJ 2 Z
OWNER(S)OF PROPERTY:
Name:S:�llnal S( na l 41, r SCTM #1000- ..
Project Address: Qq lr?
Phone##: l Email: Q 1
MailingAddress!-?n 130,evq dlvti-'n let' III"
CONTACT PERSON:
Name:
Mailing Address: ?- a o ` � fro A
Phone#: 5F b - -7 0 a — 106 Email:
DESIGN PROFESSIONAL INFORMATION:
Name: d6lio
Mailing Address: �rl - },epMl Ill e?o
Phone#: JIEmail:
CONTRACTOR INFORMATION:
Name: I e,% F( SKex- BU( a In + 'Kawaur-hrio, WC
Mailing Address:
Email:
Phone#: ,�.
�l(o-70Q-- (Upe q t�1
DESCRIPTION OF PROPOSED CONSTRUCTION NJ
l ew Structure ❑Addition ❑Alteration ❑Repair ❑Demolition i E! a d Cost of Project:
❑Other $
Will the lot be re-graded? ❑Yes LIKO Will excess fill be removed from premises? ❑Yes Lilo
PROPERTY INFORMATION
Existing use of property: �r � Intended use of property: Fes( en+
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes ❑No IF YES, PROVIDE A COPY.
yu
El Check 6 of te o the
Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by
Chapt 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): Authorized Agent ❑Owner
��j -
Signature of Applicant: Date: �� ,
STATE OF NEW YORK)
C.
COUNTY OF (As \
being duly sworn, deposes and says that(s)he is the applicant
(Name �indriidual signing contract)above named,
(S)he is the .: J ' ✓,
(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 20
Nota�Pubr�ic
CHRISTOPHER B BONDARCHLIK
AUTHORIZATIONPROPERTY OWNER \OT.\R) PURI R ST•\Tl OF\FW YORK
Regislraunn\o 111801IfI19944
( pp M�Commisaion Expire ('rro rrrol .
Where the applicant is not the owner) Qualified 1n 5ullirolV
P
I, ma
S0,MX-om Sinclair residing at �9�-� /✓ e►J� �(
Rio hereby authorize to apply on
my behalf to the Tow -f Southold Building Department for approval as described herein.
2z 2a2s
Owners Signature Date
Print Owner's Name
Albert J. Kru ski, Jr. �'7C'�O)][�. M[WALT]EIK
p MA\ Av.G IEl� LENT
SUPERVISOR �,
SOUTHOLD TOWN HALL-F.0.Box 1179 old
53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of Southold
CHAPTER 236 - STORMWATE,R MANAGEMENT REFERRAL FORM
( APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT
ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER. )
APPLICANT: (Property
p y Owne r, Design Professional, Agent, Contractor, Other)
NAME: Hideaki Ariizumi Date:
.a„(r Nov. 18, 2025
k"�ti�praM1u�r
Contact Information: '
(E-Mad d Telephone Nunhed 631 32.3 1426
Pro2erty Address / Location of Construction Site:
29827 Main Road, Orient, NY 11957 S.C.T.M. #: 1000
District
14 02 1.8
.. "
Section Block Lot
N10V
l
TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT
❑ - Area of Disturbance is less than I Acre. hlo S.P.D,E»S. Permit is R aired 1
- Project does Not Discharge to Waters of the State. No S.P D E S.Permit is R aired d
❑ - Area of Disturbance is Greater than I Acre&Storm-water Runoff Discharges Directly
to Waters of the State of New York. THE APPLICANT MUST OBTAIN a P.D.E.S Permit.
D1R 'CTLY From N.Y.S. D.E.C. Prior to Issuance of a Buildirt Perrstit.
Area of Disturbance is Greater than I Acre&Storm--water Runoff Flows Through Southold
Towns MS4,Systems to Waters of the State of New York, THE ApPLICANT MUST OBTAIN
a&PD.E.S. Permit throuarh the Southold Town En ineerin De artrnent
Prior to l5suance of a Buildin Perrnit.
Reviewed By: Date:
FORM * SMCP-TOS December 2024 I '"