HomeMy WebLinkAbout50238-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
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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 #: 50238 Date: 1/22/2024
Permission is hereby granted to:
Bailey, Edward
300 Bennetts Pond Ln
Mattituck, NY 11952
To: construct unconditioned accessory garage as applied for.
At premises located at:
300 Bennetts Pond Ln Mattituck
SCTM # 473889
Sec/Block/Lot# 113.-13-4
Pursuant to application dated 12/14/2023 and approved by the Building Inspector.
To expire on 7/23/2025.
Fees:
ACCESSORY $487.50
CO-ACCESSORY BUILDING $100.00
Total: $587.50
Building Inspector
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TOWN OF SOUTHOLD—BUILDING DEPARTMENT
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Town Hall Annex 54375 Main Road P. O.Box 1179 Southold NY 11971-095
Telephone (631) 765-1802 Fax(631) 765-9502 t :/ ww. out o1dtowon .&o
Date Received
APPLICATION FOR BUILDING PERMIT
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PERMIT NO. � Building Inspector- MEC 1 4 '02,
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 form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: x SCTM#1000-
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Project Address:- Aon k
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Phone# _ / Email; r '. ' nel "k
Mailing Address:
CONTACT PERSON:
Name:
Mailing Address:
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
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Mailing Address: ad ) Al
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Phone#» �. � � E
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CONTRACTOR INFORMATIO m
Name: tv
Mailing Address:
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Phone#:bol _3N -JPC? : Email: r
DESCRIPTION OF PROPOSED CONSTRUCTION
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'ew Structure ❑Addition ❑Alteration ❑Re air ❑Demolition Estimated Cost of Project:
❑Other
Will the lot be re-graded? ❑Yes El No Will excess fill be removed from premises? ❑Yes ❑No
1
PROPERTY INFORMATION
Existing use of property: hvoeazltes Intended use of property:
Zone or use district in which premises is situated: Are there any covenants d restrictiils with respect to
, l/n this property? ❑Yes LIdIVo IF YES,PROVIDE A COPY.
�T_hecic.Box Aftel Reading: The owner/contractor/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 buiklingls)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(,print name : �i9/lei ❑Authorized Agent ❑Owner
Signature of Applicant: Date: ��/�s- �6 2j
g pp CONNIE D. BUNCH
Notary Public,State of New York
No.01 BU6185050
STATE OF NEW YORK
Qualified in Suffolk County
$S: Commission Expires April 14, 2_1)o-y
COUNTY OF
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 n �,
�� lay of 20_ �j 1 ► '�� L
Notary Public
1 11 OIIA ' :III TYIE ALS"I-1-10I I °IIS I O
Where th....�
( e applicant is not the owner)
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
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