HomeMy WebLinkAbout48329-Z F01 TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERKS 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 #: 48329 Date: 9/23/2022
Permission is hereby granted to:
McGreen, Matthew
4660 Deep Hole Dr
Mattituck NY 11952
To: legalize "as built" finished basement to existing single-family dwelling as applied for.
Additional certification may be required.
At premises located at:
4560 Deep Hole Dr., Mattituck
SCTM # 473889
Sec/Block/Lot# 115.-17-2.1
Pursuant to application dated 8/9/2022 and approved by the Building Inspector.
To expire on 3/24/2024.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $1,139.20
CO-ALTERATION TO DWELLING $50.00
Total: $1,189.20
Building Inspector
Ftl
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) 765-950211 s:// ww w sout�1 cildto� o . `o
Date Received
BUILDINGAPPLICATION FOR
For Office Use Only El
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a
PERMIT NO. Building Inspector: ALIG 0 9 2.02.2. 1
BUiLDiw0 DEPT
Applications and forms must be filled out in their entirety.Incomplete FC31.D-4G C),
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date:8/8/2022
OWNER(S)OF PROPERTY:
Name:Mathew McGreen SCTM # 1000-115-17-2.1
Project Address:4660 Deep Hole Drive, Mattituck
Phone#:(646) 637-1142 Email:nymagoo@gmail.com
Mailing Address:4660 Deep Hole Drive, Mattituck, NY 11952
CONTACT PERSON:
Name:Michael Hand
Mailing Address:PO 1256, Mattituck, NY 11952
Phone#:631-965-1947 Email:michael@mchdesignservices.com
DESIGN PROFESSIONAL INFORMATION:
Name:James Deerkoski, PE
Mailing Address:260 Deer Drive, Mattituck, NY 11952
Phone#:631-774-7355 Email:jdeerkoski@yahoo.com
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: LEmLa :
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
0 Other As Built $
Will the lot be re-graded? ❑Yes MNo Will excess fill be removed from premises? ❑Yes MNO
1
PROPERTY INFORMATION
Existing use of property:Single family dwelling Intended use of property:Single family dwelling
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R-40 11
this property? Dyes MNo IF YES, PROVIDE A COPY.
❑ Checks Box,A t r Reading: The owner/contractor/design professional is responsible for all drainage and stone water issues as provided by
Chapter 231,of the Town code. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Lone
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 210AS of the New York State Penal law.
Application Submitted By(print name): U� �` ?Authorizes!Agent ❑Owner
Signature of Applicant: Date: M l
STATE OF NEW YORK)
SS:
COUNTYOF )
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the ,
(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
(d day of + v �.` 20-Z L_
Notary Public
NIALL D WOOD
NOTA[tY pUgLIC,STATE OE NEW YOR .: WNER AUTHORamriON
t� 8s�tr
tlort OrW06388422 here the applicant Is not the owner)
*LMy '
c1filiioll�' ��' �, �
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
Building Department.Application
AUTHORIZATION
(Where the Applicant is not the Owner)
L (�
l'1�2�� .residing at o liw LL,,,4
�
(Print property owner's name) (Mailing Address)
N IS)-- do hereby authorize f4( -D
(Agent)
to apply on my behalf to the
Southold Building Department.
(O ner's Signature) (7 te)
We- 67`1-ems`
(Print Owner's Name)