HomeMy WebLinkAbout49301-Z TOWN OF SOUTHOLD
F04BUILDING DEPARTMENT
j 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#: 49301 Date: 5/23/2023
Permission is hereby granted to:
Spieler, Michael
11 Sherman Ave
Rockville Centre, NY 11570
To: construct outdoor shower as applied for.
At premises located at:
145 Old Field Ct, Mattituck
SCTM # 473889
Sec/Block/Lot# 120.-3-8.19
Pursuant to application dated 4/25/2023 and approved by the Building Inspector.
To expire on 11/21/2024.
Fees:.
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00
CERTIFICATE OF OCCUPANCY $50.00
Total: $250.00
Building Inspector
r a 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 lett .�a rvw asaa iil of ltow� � . Dov.
Date Received
APPLICATION
For Office Use Only
PERMIT NO. Building Inspector:
ector: APR 2 5 2023
� l
Applications and forms must be filled out in their entirety.Incompletea^
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: � � SCTM#1000-
w
y
Project Address•. ZVI f;
- 1�t �
Phone#: 5 Z�, Email. p le ` C4 L41
r
Mailing Address: �� � " Ile (i&/�e A&Ils
CONTACT PERSON:
Name: LA " . e
Mailing Address: _ i tie -To
Phone#: 41!�toEmall: 1 jam"
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address: Capeco
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Emap °
D RIPTION OF PROPOSED CONSTRUCTION
J
..New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑other
Will the lot be re-graded? ❑Yes VNo Will excess fill be removed from premises? ❑Yes 51�0
1
PROPERTY INFORMATION
Existing use of property: Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes [ETNo IF YES, PROVIDE A COPY.
Ed Check Box f''fer Rex h1g: The owner/cofactor/design professional Is responsible for all drainage and storm water issues as provided by
Chapter 236 of the Town Code. APPLICATION 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 bullding(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)
C6 o Z ( I c ❑Authorized Agent "wrier
Signature of Applicant: . ". Date: IV
")D
SPIER�C'P I
STATE OF NEW YORK) NOTAFlypUBUC STATE0FIaEVVYM
SS: NMSAU!COUNTY
COUNTY OF N ti'S�j ) UC.*018PSOMIS
COMM.l
I I�Q 4 � being
dui sworn deposes and says that she is the applicant
(Name of individual signing'contract)above named, //nn
(S)he is the 1I Ch4t I�I r_� VW"qtr
(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
1
day of � r� \. 20
Notary Public
(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
sgs-rm's
-
JOB No. FRMV 17.. TAX I.D.No. 1000-120-03-4.' 9�' -
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LOT 18 Z. N LOT 16
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A S5*A..%4.tT„Ij'RJ.,,rDEN'
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LOT 15
THE LOCATION OFWELLS,.WATERS VICE
The sea.; s ci3;t.c•a±w.�tis :e:s• IN Hkizs at rr.=.s
LINES, SEPTIC TANK5'AND CES OOLS inspacEL•c:eusl�re,c:at' ; ri a's:'.,;, rtma 4,.•.a� c:,.::�� •�:r. t
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SHOWN HEREON AAE:>°,FIELD tB ERVA bcsa,is±csror}F:,;::�.,�:�,;,:;,,., ,:�:r.,,���;:Is.
TIONS AND OR DATA OBTAINS FROM ` r ,s„a >, . -,.c•s..
OTHERS. s�rj Yt
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U;fcc of a, r'd`.4:>sttmau:&Ima$c:n;nt '
C C KN LNK
S 70°1930V 125.00'
LOT 12 LOT 13
FILE MAP NO.8808 9/1/89
tlnaultardad aft eratlorl or Wditn'W this document Is a v10130cm of Section 7209
0f the Nero Yak%t6 Eduption Law
cefu cabOPS ir;diCated.hareon Shall run onlyto the pa mon for whom Rig pte;ww SURVEY OF: LOT 17
and an his behalf to ft TO Company,Gmemrnentlii Agency and Landing
InSdUalon IAodhomm,and toIheasslgneeeofthe lendJnginsah c4sor - MAP OF FARMVFI.1 ARRMIATPC
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