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�o�SUFFa��.co� TOWN OF SOUTHOLD
BUILDING DEPARTMENT
y x TOWN CLERK'S OFFICE
"o 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#: 50642 Date: 4/11/2024
Permission is hereby granted to:
Hinden, Randall
505 Oak St
Mattituck, NY 11952
To: demolish existing swimming pool as applied for.
At premises located at:
505 Oak St, Mattituck
SCTM # 473889
Sec/Block/Lot# 141.-1-20
Pursuant to application dated 3/6/2024 and approved by the Building Inspector.
To expire on 10111/2025.
Fees:
DEMOLITION $125.00
Total: $125.00
Building Inspector
o`°SUFFOIK�o 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 https://www.southoldtow-nny.gov
mxz
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only �.
PERMIT NO. Sys Building
Inspector I
t MAR - 6 2024 {
Applications and forms must b'e filled.out,in their.entirety..lncomplete{ Ri
'applications'will not be'eccepted. Where.the,Appl cant is"notlFie owner",,an
_.Owner's Authorizetion'.form(0age.2),shallbe)' ro _` -own nsr�c+pthr;�
Date: m a, ` 2-o zy.
OWNER(Sj_OF PROPERTY: .
Name: I�.A40(_ l _ Q-t1 SCTM#1000- y ?p
Project Address ,►1,
Phone#: <1
Email
Mailing Address: IS44,4A
4`'CONT ACT PERSON: ,
Name: OL
Mailing Address:
Phone#: Email:
DE5IGN.PRO„FESSIONA ANFORMA_TION '�'.,..
f „
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR}INFORMATION:
Name: _V1 .Or
Mailing Address. •,�� ,fMw ~tl
Phone#: ��'� _a3� _3 u3 Email:
DE
:...r.., r mj .
SCRIPTION O,F,=PROPOSED''CONSTRUCTION.
a :..
❑New Structure ❑Addition ❑Alteration ❑Repair VDemolition Estimated Cost of Project:'
❑Other f1I 1 f\ 7001 $
Will the lot be re-graded? ❑Yes $No Will excess fill be removed from premises? ❑Yes VNo
1
PROPERTY INFORMATION:
Existing use of property: 000I y ho 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 "o IF YES, PROVIDE A COPY.
Check.Box After R@ading: •The'owner/contractor%deslgn•piofesslonal Is responsible for all'drainage and sform'water issues as provided by~
Chapter 236 of the Town Code.APPLICATION IS HEREBY MADE,to the;Buildingg DepartmentI for the,Issuance of a Building Permlt pursuant t' the Building Zone.
Ordlnance`of the Town of Southold,Suffolk,county,New York and
other Ordinances or Regulatlons,.forthe construction of buildings,
additions,alterations or for removal'or demolltlomas herein described.The.applicant agrees to comply with all applicable laws,ordinancesi,bullding code,..
housing code an®ulations_and to adrn'Wauthorized.inspectors on.piemises and in'building(s)for nece;sanj Inspections.False;tatements made herein are
punishable as a Class A misdemeanor pursuant ib section.21O.Wof the New,York State Penal Law..,
Application Submitted By(print name): I , �� ❑Authorized Agent L�dOwner
_
Signature of Applicant: Date: 3 J r�a
1
STATE OF NEW YORK)
����,��
SS�S.+.+-�
COUNTY OFSt =ffb IKLI
being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)�ab-ove named,
( hoe the W /l
C41-
(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 �!
Est
Sworn before me this Notary Pubf e, StateTOfNNew York
/- No. 01 TA6086001
(D day of 20 a Qualified In i=Yr,;Suffolk County
Co �es
Notary Public
PROPERTY OWNER AUTHORIZATION
(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
+
SURVEY OF:
PROPERTY LOCATED AT MATTITUCK
TOWN OF SOUTHOLD
SUFFOLK COUNTY. NEW YORK
S.C.T.M. 0 1000-141-1-20
SCALE: 1'-30'
NOTE: THE OF RIGHT OF WAYS.
WETLANDS AND/ORNCE EASEMENTS OF RECORD
IF ANY. NOT SHOWY,ARE NOT GUARANTEED.
APPA V D AS NOTED
DATE: I B.P.
FEE � BY:-' Q;
NOTIFY BUILDING DEPARTMENT AT
631-765-1802 8AI I TO 4PM FOP THE w
FOLLOWING INS ECTIONS:
1. FOUNDATIO -TWO REQUIRED t-
FOR POURE CONCRETE ��e
2. ROUGH-FR MING&PLUMBIN"a
3. INSULATION
4. FINAL-CON TRUCTION MUST `rA�
BE COMPLETE FOR C.O. s �,
ALL CONSTRUC ION SHALL MEET THE
REQUIREMENTS )FTHE CODES OF NW N/F ,ram h °°o?OF
YORK STATE. N T RESPONSIBLE F NW,,
a,9. '
DESIGN OR CON TRUCTON ERRORS ° ��*
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COMPLY WIT ALL COE)E,S RAYMOND
THILBERG R
NEW YORK ST E&TOWN COD
AS REQUIRED A D CONDITIONS
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nr.xnmaonnIC.TTO/xrt Inr nexsoueu TO,=NVAL SURVEYED BY:
MTOMK
CERTIFIE"t°`"TOj4 PAUL BARYLSKI LAND SURVEYING
CERTIFIED E PATCHOGUE NY 11772
RANK OF HINDE A, N.A. PHONE 631-294-6985
RANDALL HINOEN
FALLYN HINDEN FAX 631-627-3I66
FIRST AMERICAN TITLE INSURANCE COMPANY PAULBARYLSK1oYAHOO.COM
2974 NOVEMBER 24. 2017