HomeMy WebLinkAbout49278-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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 #: 49278 Date: 5/18/2023
Permission is hereby granted to:
Philli s, Peter
6 North Dr
Malba, NY 11357
To: relocate an existing accessory building as applied for.
At premises located at:
1055 Stanley Rd, Mattituck
SCTM # 473889
Sec/Block/Lot# 106.-8-54.4
Pursuant to application dated 4/18/2023 and approved by the Building Inspector,
To expire on _11/16/2024.
Fees:
ACCESSORY $156.00
CO-ACCESSORY BUILDING $50.00
Total: $206.00
Building Inspector
TOWN OF SOUTHOLD—BUILDING DFPAATIVLIGNT
Town Halt.Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
+ � Telephone(631)765-1802 Fax(631)765-9502 litt L//vDvwsotitlioldto�viiiiy.gov
Date Received
APPLICATION FOR BUILDING PERMIT
Ilii
For Office Use Only n... G,V u �,WLJ
,
LITNO. BuildingInspector �.. x APR 18 2023
APPlic trans a6d forir ,rnaist b filled 4tlt lri tIKbirentire 1pcomplete " t"in rlP 11lNn i SMI 1 1
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l faltc t�or7svt ilnotb crept d uVbcretkie.' pllrant'l not dtier,a,
C wir r"s Air rl lori foriia 1P a shall be v nafaleted "
Date:3128!23
O!all'� j�.� l°t" 'PROPRTY; ;'
Name:Peter,Phillips SCrM#1000-106-8-5
Project Address165 Dogwood Lane, Mattituck
----
Phone#:917--374_2832 Email:pphillips@phillipsbrockerage.com
Mailing Address:
165 Dogwood Lane, Maftituck" .-..a
-
Cf� ITC� P �CSON:."
Nam e:Megan Carrick
Mailing Address: O Box 877,,,Jamesport NY 11947
P _
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Email:megan.c-m arc_ Itectumm r. @g
mall.comPhone#:631-804-3796 .
p0 N PRPff lel ALINl= l lw nc l; .
Name:Charles Thomas
Mailing Address:
PO Box 877, Jamesport NY 1.1947 _ ..
Ph
one#: Email:cdthomas63@aol.com _ W
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Name:TBD
Mailing Address:
Phone#: Ei�rall:
l76CRIPTION 0FR PPS D `ON TRU T'lt l
77777
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
DOtherMOving of existing shed to conforming location
Will the lot be re-graded?
g ded? ❑Yes BNo Will excess fill be removed from premises? ❑Yes ®No
Z
PRQPFR"i Y:I PORMATICIN
Existing use of property:Single Family Residential Intended use of property:Single Family Residential
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
-
11 R-40COPY.m�® this property? Yes_®No IF YES,PROVIDE A
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Cisaptde za6 of tete Town Cade.ADPL CATION➢S NFRF8 �a1Arr�Rar tl4e arm➢➢d➢rcrg l�elaarRnaorn4 fsrr 4lae�sra�rr� of a Bu 141 permit psusuant to the Building?.'brio
6rdiro n eai$Nral wraofSeuk➢aold,Suffolk,ceounty,lin York and otherPppl,➢ceblete s�'orcli! mr �srrrpejuletlens,for tile tonsti4cilo'nofbolldInss,
add ikio,ns,`aalteratPons or for,retoavaI er't1en',011 06 os here n rl�;erlNaa�l,Tiro,�ppllc��tt�agrees ta'c�arsply wikh all a Alia stole laws'ordCraance's,bulldlnd tole,
ietiusiakg ar4sM regulat➢eras and to clrirltaut orize lrrspectors era prariroisds end 1n buildinr�(si fir aretassary.insglert➢'ons,Falsestaterrrsatitxrtitadax �rePrr are
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Application Submitted BY(print
�nar: e)
.Megan Ca�rrick,w, ®Author�ized�Agentent ClOwneor
Signature of AppllcantCate, ,.
..
. .
STATE OF NEW YORK)
COUNTY OF Stl )
a
II 1 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
" r 20 93
day of --L4::t
Notary Public
Lisa Rheaurrlp,
Notary Public,State of New York
PROPERTY OWNER AUTHORIZATION No.01RH6386151
(Where the applicant is not the owner) Certified in Suffolk county
Commission Expires: 01/22/20
Peter Phillips165 Dogwood Lane,
I, .residing at MattltUC1C
NY 1052 do hereby authorize Mega A. Carrick to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
\\- 03/29/2023 -
Owner's Signature Date
Peter Phillips
Print Owner's Name
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