HomeMy WebLinkAbout47186-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#: 47186 Date: 12/7/2021
Permission is hereby granted to:
10898 Main Road Inc
5240 Jessica Ln
Cookeville, TN 38506
To: legalize "as built" shed as applied for.
At premises located at:
10780 Route 25, Mattituck
SCTM # 473889
Sec/Block/Lot# 143.-3-4.1
Pursuant to application dated 9/28/2021 and approved by the Building Inspector.
To expire on 6/8/2023.
Fees:
AS BUILT-ACCESSORY $372.00
CO-ACCESSORY BUILDING $50.00
Total: $422.00
uilding Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
b �7 Telephone (631) 765-1802 Fax (631) 765-9502
Date Received
APPLICATION FOR BUILDIN
PROPERTY INFORMATION
Existing use of property:business Intended use of property:busineSS
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
B this property? ❑Yes 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 buildings)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(pri name): Authorized Agent Downer
—'� (A 04
Signature of Applicant: Date: 9_2S-2v2 A
STATE OF NEW YORK)
SS:
COUNTY OF )
Arlbeing duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the & )t-
(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 o
20
j NoNo
Pbli
PROPERTY UTHRIATON(Where the applicant is not the owner)
I, residing at
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signature Date
Print Owner's Name
2