HomeMy WebLinkAbout50463-Z r u' ti. TOWN OF SOUTHOLD
BUILDING DEPARTMENT
fi TOWN CLERK'S OFFICE
i
kw
� 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#: 50463 Date: 3/20/2024
Permission is hereby granted to:
Ford, Aaron
210 Fairview Rd
Palm Beach FL 33480
To: construct interior alterations (interior demolition) to existing single-family dwelling as
applied for. Additional approvals/permits will be required.
At premises located at:
1775 Pt Pleasant Rd, Mattituck
SCTM #473889
Sec/Block/Lot# 114.-1-6
Pursuant to application dated 2/16/2024 and approved by the Building Inspector.
To expire on 9/19/2025.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $250.00
CO-ALTERATION TO DWELLING $100.00
Total: $350.00
Building Inspector
4
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold N
P Y 11971-0959
+• Telephone 631 765-1802 Fax 631 765-9502 htt s: /www.soudioldtownn gov
Date Received
APPLICATION FOR BUILDING PERMIT I
For Office Use Only
I k '24
PERMIT NO. � Building Inspectar:
Applications and forms must be filled out in their entirety.Incomplete P'i el `
applications will not be accepted. Where the Applicant Is not the owner,an i•>
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: � e ZZ(!-, SCTM#1000- //Z/-. —�G
Project Address: .
eeV
Phone#:Iffl
Email: e
Mailing Address: ,✓
CONTACT PERSON:
Name;
Mailing Address:
Phone#: �' °�'" � Email: �v
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORM NON:
Name:
Mailing Address:
Phone#: -- `� Email: a* re ,
DESCRIPTION OF PROPOSED CONSTRUCTION
. ro ect.
Estimated ted Cost
s ima
^/ ation ❑Pair ❑Demolition I
Il❑d'ONthertructur/e L�Addlt�n ®Alter L � $
Will the lot be re-graded? ❑Yes P<0 Will excess fill be removed from premises? ❑Yes o
1
PROPERTY INFORMATION
Existing use of property: Intended use of property:
Zone or use district in which remises is situated: Are there any covenants a d restrictions with respect to
this property? Dyes o 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
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,Newyork 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 210.45 of the New York State Penal Law.
Application Submitted By(print na ): 1 ,4
❑Al t ttari2ed Argent ner
Signature of Applicant: � , " .. Date: •,
CO NIE 0,BUNC)i
INQtatY Public,Stater of NOW York
STATE OF NEW YORK) No.01OU61660 0'
SS: p County �
COUNTY OF )
OornlTrlsSloln In�oa AIkrII 7� P ..
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
day of
� 20 l!i n—P IV�L!"1 11�1
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the 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