HomeMy WebLinkAbout48781-Z TOWN OF SOUTHOLD
* BUILDING DEPARTMENT
t 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#: 48781
Date: 1/23/2023
Permission is hereby granted to:
loannou, Harry
30 Old Pine Dr _
Manhassetm NY 11030
To: Construct additions and alterations to an existing single family dwelling as applied for.
At premises located at:
635mmStanlev......Rd.M,....Mattituck �................................_ ��m...........__.........mm� —�.........._..... _�.......�... __.......
SCTM # 473889
Sec/Block/Lot# 106.-8-14
Pursuant to application dated 11/18/2022 and approved by the Building Inspector.
To expire on _.. 7/24/2024. mmmmm
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $1,438.80
CO-RESIDENTIAL $50.00
Total: ..___._.................. $1,488.80
Building Inspector
sut N 0,P' f�IJ'1.IA OLD—131.11LD1N(i llJH YAK-1 M�;N1-
1�D''4�"
X ,
Town hall Annex 54375 ^lam-Road P. 0.Box 1179 Southold, NY 11971-0959
l.elephone(631) 765-1802
1`ax(631) 765-950 h1t : I r s 1 r 1 1 Y
APPLICATION FOR BUILDING PERMIT Date Received
For Office Use Only
PERMIT NO. Building Inspector: UV
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization farm(Page )shall be completed
Date: H1
OWNER(S)OF PROPERTY:
Name: 'j'
SCTM#1000- 6
Project Address:
Phone#: Email:
Mailing Address: 3o 0 tz P/W6- 1)P
CONTACT PERSON:
PERSON: l J
Name:
io)' �.
Mailing Address:. 3
Phone#: 01-0
Email: �
15 p...�„ rV� h1
DESIGN PROFESSIONAL INFORMATION: L.
Name:..
Mailing Address:
Phone#:
Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#:
Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
El New Structure ddi++tion ❑AlterationRepair ❑Demolition
❑Other Estima ed'Cost of Project:
le
Will the lot be re-graded? ❑Yes . No Will excess fill be removed fromremises? ❑Y
p es No
1
PROPERTY INFORMATION
FEing use of property. Intended use of property:
or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes ONO IF YES, PROVIDE A COPY.
eck Box After Reading: The owner/contractor/design professional Is responsible for all drainage and storm water issues as providedbyr 236 of the Town Code.APPLICATI ON 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 fpri t name): " +
❑Authorized Agent �tiwner
Signature of Applicant:
Date:
ONNID, I1 �
STATE OF NEW YORK) Notary Public,Male of New York
No.OIBU618505
SS: Qualified in Sufroik County
COUNTY OF Cornmission ExpiresApril 14,2._�-� �
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
day of__.. " *mow .... —..,, 2D
Notary Public
9 ERTY OWNER AUTHORIZATION
(Where the applicant is not the wn-
I' residing at
-- �..�.�do hereby authorize
to apply on
e own o uthold Building Department for approval as described herein,
g re .......00-
Owner's Signature Date
Print Owner's Name
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