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HomeMy WebLinkAbout48801-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT Exp TOWN CLERK'S OFFICE SOUTHOLD, NY o 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 #: 48801 Date: 1/25/2023 Permission is hereby granted to Hardman Dale 2405 Marratooka Rd Mattituck, NY 11952 To: Construct additions and alterations to existing single family dwelling as applied for. At premises located at: 2405 Marratooka Rd, Mattituck SCTM # 473889 Sec/Block/Lot# 123.-2-6 Pursuant to application dated 12/6/2022 and approved by the Building Inspector. To expire on 7/26/2024. Fees: CO-ADDITION TO DWELLING $50.00 SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $664.40 Total: $714.40 Building Inspector } .a TOWN OF SOUTHOLD-BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 ,: . Tel 6 1 765-9 Telephone 631 765-1802 Fax 3 502 https://www.south'oidtowilily.gov I C AtN" Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only E F � V E PERMIT NO. � � Building Inspector:_ Applications and forms must be filled out in their entirety.Incomplete BUILDING DEPT. applications will not be accepted. Where the Applicant is not the owner,an TOWN OFSOUT HOLD Owner's Authorization form(Page 2)shall be completed. Date: /2- - 06 - 7-o 2Z OWNERS)OF PROPERTY: Name: D ftE Ylgfl-0 41A?l� SCTM#1000- -;5 . Project Address:2&tGS MttfLM-"60M FV Mery rvcAc /V y 1125-2 Phone#: 6 3 16 Email: Jo,Ie t bard Yttift-- Q AAR . Co Mailing Address: 2 y0 S Mtf1z-ft1q f-1 0k)qgp Mtfll NCk CONTACT PERSON: Name: P A-(- �/r{21�f1T/1VJ Mailing Address: .SI�11'Z1,� /"0✓t° Phone#: 63�` 6 f �1 - 5 3 Email: av-J nnwn GUIn011 DESIGN PROFESSIONAL INFORMATION: Name: rA G/A A v--b Mailing Address: q6 VIL-I-AGF_ (,fi-FE1,J P/-. SGJ'r�IAMP-MrJ N Phone#: 5b - Email: r' Q cies t h wOrKS • r-OAA5 � ��0 g 8 33 g a✓I-� g CONTRACTOR INFORMATION: Name: Mailing Address: Phone#: Email: DESCRIPTION OF PROPOSED CONSTRUCTION Mew Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $ S 'T O V . '0 Will the lot be re-graded? ❑Yes XNo Will excess fill be removed from premises? ❑Yes ANo 1 PROPERTY INFORMATION I Existing use of property: Q,S, Z� �I Intended use of property: res I�JZw�(� Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to 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 Chapter236 of the Town Code. APPUCATION 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 210AS of the New York State Penal Law. Application Submitted By(print name): -PG►k HAtrC/I'IkO ❑Authorized AgentJwner AA Signature of Applicant: Date: STATE OF NEW YORK) SS: COUNTY OF ) V' being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the i/" (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 6_CPM10R_V_ ,20Motor Fabill ZZ Irunncy C Marroia Notary Public.Sufic of Noir Yodt No.O]MA6210202 Qualified in Suffolk CMq PROPERTY OWNER AUTHORIZATIO commissionENpi Au0uolo0 20 (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 f v�Y ` +1 L71j C2, � zL Luci w �c 1 16 Id M 12 LAI T TI h- o Y a: W o a— z e3a LA— _3:z s O ��� '.< U J 4Ca 4. W k3 N CA J.. F t E _ D dx Sir �: z V) rl- XE— C6� N+"N33 NNil NtlHN.b T �^ F.r899s �i ,}' I <a,ir3 � NtlN V I �af U C' E © I o .. 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