HomeMy WebLinkAbout47657-Z � TOWN OF SOUTHOLD
BUILDING DEPARTMENT
°fi° 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#: 47657 Date: 4/8/2022
Permission is hereby granted to.
Hardman, Dale w.....w ._.ww_.ww.
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2405 Marratooka Rd
Mattituck, NY 11952
To: alter an existing accessory garage to an unfinished accessory storage building as
applied for.
At premises located at:
2405 Marratooka Rd, Mattituck
SCTM # 473889
Sec/Block/Lot# 123.-2-6
Pursuant to application dated —3/11/2022 and approved by the Building Inspector.
To expire on _www-1µ0l8/2023.
Fees:
ACCESSORY $100.00
CO-ACCESSORY BUILDING $50.00
Total: $150.00
Building Inspector
* . . 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 IIit 2 � � :�Il,ticllrl° Y
Date Received
APPLICATION FOR IING PERMIT
CO
IJ E For Office Use Onlykh 3 `
1. -
PERMIT NO. Building Inspecter., ww_ Mg— �3 2022g
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Applications and forms must be filled out in their entirety.Incomplete nRtl
applications will not be accepted. Where the Applicant is not the owner,an pd�V LDING DEPT
Owner's Authorization form(Page 2)shall be completed.
TOy9N OF SOUTHOLD
Date: .
OWNERS OF PROPERTY:
Name:-,>�� c� � SCTM#1000-
Project Address: (Il 7� M 1%4,147001<tJ 171t), ! V+M-rVC1< Ivy 11 y 6 Z
Phone#: _ t - 3 Email:�� �IO�r tM c�vl 00C0
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Mailing Address: 21,105 1",41WAT001<n
CONTACT PERSON: /
Name: -�.a � f�01vGf!/�►c+!✓I ... ..._....�..�,-� �...
Mailing Address: Z !05- M39g-fl-e 0kI Pkm , !VIT7 l7416Ar AV
Phone#: I 6 J � —A539 ) - Email:G�a "� �ln��t M�.� � < C�
DESIGN PROFESSIONAL INFORMATION:
Name: U
a
Mailing Address: 1
�
Phone#: �
�� � �' I .. L__JEmail: (' Gt? 0Ah '4 YVJ
CONTRACTOR INFORMATIOgN:
Name: �.,..,..�,-.-.. .... 1�" a
-- VCJ.L_tJA
Mailing Address: ,2 y 0� /Vr�►2/'L, �d �Tjl (,{.( A/
)/ -DEPhone#: L7)/ -
DESCRIPTION
SCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $__ 0d0 (rV --_ -
Will the lot be re-graded? ❑Yes o Will excess fill be removed from pre ises? ❑Yes 1911b
1
PROPERTY INFORMATION
Existing use of property: Gar a it Intended use of property: 571vi-"e, (-0ovLt
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
)2--e s-l'c p44 f this property? E]Yes VNo IF YES, PROVIDE A COPY.
Riia tfing, The owner/contrattor/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): 'N IV, HoWdAvAo CAuthorized Agent M15/wner
Signature of Applicant: Date: Z—Z
STATE OF NEW YORK)
SS:
COUNTY OF
OL 19, qa ndnse-qn being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the C&h .,,Cr'7LV
(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
22 day of 20
otary-Public
CounM,L Mwto
NowyPubho'stwo(Nowullill;
PRONI�RTYOWNER At JT1�10R1ZAT101Y OU11fied to Sufrolk Coui"
I
(Where the applicant is not the owner)
1, residing at 7—4 o 5
R
Z- do hereby authorize J � to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
ZZ 22
= 1 -2—1
—24Signatui
Ow r's Signature Datk
Hpwj
Print Owner's Name
2 —j
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TOWN OF SOUTHOLD
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GRAPHIC SCALE NI'�R ��'RLi'�"1' -------
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r� GUARANTTO:� THE SECURITY TITLE GUARANTEE CORPORATION
OF BALTIMORE
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SUFFOLK TAX MAP NO.
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1000-12300-0200-006000 SURVEY Aq- OF PROPERTY
r JOB No.S20-4370 SITUATE
MATTITUCK, TOWN OF SOUTHOLD
a n d surveying DATE SURVEYED: 02/27/2020 SUFFOLK COUNTY, NEW YORK
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