HomeMy WebLinkAbout52564-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#: 52564 Date: 12/19/2025
Permission is hereby granted to:
John Boyle
48-11 37th St
Long Island City, NY 11101
To:
legalize "as built" alterations to an existing single-family dwelling as applied for. Additional
certification may be required.
Premises Located at:
24435 Route 25, Orient, NY 11957
SCTM# 18.-2-34
Pursuant to application dated 10/29/202S and approved by the Building Inspector.
To expire on 12/19/2027.
Contractors:
Required Inspections:
Fees:
As Built Alteration $599.00
CO-RESIDENTIAL $100.00
Total S699.00
Building Inspector �� �
✓d rear.„
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 htt —o
d.
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. Building Inspecton
a a
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is Owner's Authorization form(Page 2 shall be completed.not the owner,an YP
y �,
Date:10/29/25
OWNER(S)OF PROPERTY:
Name:Mark Breen SCTM#1000-18-02-34
Project Address:24435 Main Road, Orient
Phone#:347-355-1746 Email:247sunny247@gmail.com
Mailing Address:
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:
D Other As-Built interior room $0
Will the lot be re-graded? Dyes ®No Will excess fill be removed from premises? ❑Yes iQNo
1
i
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
R80 non-conforming this property? Dyes ®No IF YES, PROVIDE A COPY.
8 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): r�' '"��Y�2
) � BAuthorized Agent []Owner
Signature of Applicant: Date:
STATE OF NEW YORK)
SS:
COUNTYOF� �0k—
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the
(ContrVtornAgent,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
tart'Public ��
NOTARY PUBLIC,S M CiI�N W+�tl YO _,..
PROPERTY OWNER AUTHORIZATION i � a t � AIlqC��
(Where the applicant is not the owner) RorgnaVafion fINO, 01AI 0019644
Quad fled un Suffolk Courity
mrn�ssion Exp4es 9 2028
I, residing at
do hereby authorize AMP Architecture to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner'sSi Signature )01-2 OZ
`
g ure Date
Print Owner's Name
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