HomeMy WebLinkAbout48895-z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
a 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#: 48895 Date: 2/13/2023
Permission is hereby granted to:
North View LLC
5173 Merrick Rd
Massapequa, NY 11762
To: legalize as-built finished basement and construct alterations to existing single-family
dwelling as applied for. Additional certification may be required.
At premises located at:
1505 Nau les Dr, Mattituck
SCTM # 473889
Sec/Block/Lot# 99.4-27.1
Pursuant to application dated 12/12/2022 and approved by the Building Inspector.
To expire on 8/14/2024.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $390.00
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $1,480.80
CO-ADDITION TO DWELLING $50.00
Total: $1,920.80
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 lir ://wv ,sot,ithol t�owlin1. kl—v
p Date Received
PP � l � I Liu PRSIIII° ,
�qq6'For Office Use Only
PERMIT NO. Building Inspecto
DEC 12 2022
Applications and forms must be filled out in their entirety. Incomplete )
applications will not be accepted. Where the Applicant is not the owner,anco
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: SCTM# 1000- 0�_
A2A S L) — 9
Project Address: 505 LJ A V 6 L Zr, 5
®r'--
Phone#: Email:
Mailing Address:
CONTACT PERSON:
Name:
Mailing Address: D
Phone#: Email: S c r , e. o
DESIGN PROFESSIONAL INFORMATION:
Name: Z/
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition_ Alteration ❑Repair ❑Demolition Estimated Cost of Project:
Other 79
/ O ..�- ..- $
Will the lot be re-graded? ❑Yes Will excess fill be removed from premises? ❑Yes o
1
_..........
PROPERTY INFORMATION
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�n n use dl tnrY n which remises Is situated o h r pect to
,hisro erty? Ives No IF IES PROV DC Is COPY
any covenants end r sin Ll,l ns wit l�
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Adlllo K ra lfu nc or/nrmmavel or dem Ifu .MAY p y d rllr.d.rhr epplfr t gmn..to comply with nil n,,I cable laws,
n 1116 cod d regulat�una and to admll. Ifi K rd r.p e ..cn Pr�� i urw In buildinglsl for eresssry InspCtl�oro.Falk ctntrment�mixle Rrn+n{p..i�,n G i
A tl+^A'%1YANfJS �V CI A misCen,eanar pursuant to Section�Wf9 ry+"y.of the New Vorh Strte Penal Law.
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Application Submitted By(print nalrrr,); FC�� �� Tom..Authorized Agent Downer
Signature of Applicant.
CONNIE D.o6MCN
STATE OF NEW YORK) 5 v 14�'r c fG Notary Public,State of NewYork
SS: No. 01 BU6185050
COUNTY OF Qualified in Suffolk County
)
Commission Expires April 14. 20--
mm_rz being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named„
5 h
( ) �� (t`� rtI°actor A
ent,c
e is the... . m _ ,
orpor'l e 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
y ofw20V,
Notary Public
ANJ IFo E U .: . „�.,..
(Where the applicant is not the owner)
_-residing i
��.
ding at
do hereby authorize
�...� �_.__ �� . .. M.�....__. .N. to apply apply on
my behalf to the Town of Southold Building Department for approval as described herein,
fw✓t�r���� flatt,�o�e o���`` tee
a
Print Owner's Nanie
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