HomeMy WebLinkAbout51482-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#: 51482 Date: 12/16/2024
Permission is hereby granted to:
Philip Guertin
41 Beacon Hill Rd
Port Washington, NY 11050
To:
Legalize the conversion of a porch into a habitable den and install new windows and slider door to an
existing single-family dwelling as applied for.
Premises Located at:
405 Ruth Rd, Mattituck, NY 11952
SCTM# 106.-7-21
Pursuant to application dated 09/30/2024 and approved by the Building Inspector.
To expire on 12/16/2026.
Contractors:
Required Inspections:
Fees:
As Built Addition/Alteration $660.00
CO Single Family Dwelling-Addition /Alteration $100.00
Total $760.00
Building Inspector��
, �r 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 httvs.//www.southo1dtowngoy
Date Received
APPLICATION FOR BUILDING PERMIT
25
For Office Use Only
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�� � �24
PERMIT No. 5 L (..) � Building Inspector.
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Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an 'TOWN, �� b4 A ° LI°')'[ m,
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: � y � SCTM#1000-
Project Address: aw
Phone Email: - C.r
Mailing Address:. 0.
CONTACT PERSON:
Name:
C,L—
Mailing Address: L.0 (,1 .�.� 3^S` l c1
Phone > I A --� � Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: a TTMTl : CN("-q-V% JW
.—
CONTRACTOR INFORI�ATION:
Name:.
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other "��. 00,1� S CA '" $
Will the lot be re-graded? ❑Yes CXqNo Will excess fill be removed from premises? ❑Yes ❑No
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 LINO 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,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 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 name): Authorized Agent ❑Owner
Signature of Applicant w Date:
STATE OF NEW YORK)
SS:
COUNTY OF
. 6
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
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'CrouY'hfidP,�-w w,y arr I j
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
?off
_2 residing at
do hereby authorize rX 4,NqNP_� to apply on
my behalf to the of Southold Building Department for approval as described herein..
2 "
Owner's Signature Date
Print Ow er's Name
2