HomeMy WebLinkAbout51499-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#: 51499 Date: 12/20/2024
Permission is hereby granted to:
Eugene Allen
4075 Aldrich Ln
Mattituck, NY 11952
To:
demolish existing accessory barn as applied for.
Premises Located at:
4075 Aldrich Ln, Mattituck, NY 11952
SCTM# 120.-3-14
Pursuant to application dated 10/29/2024 and approved by the Building Inspector.
To expire on 12/20/2026.
Contractors:
Required Inspections:
Fees:
DEMOLITION $1,131.80
Total $1,131.80
. __. Building Inspector
fir : 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 ( tt s:f/www. outholdtown , Gov
Date Received
APPLICATION FOR BUILDING PERMIT
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For Office Use Only e. w "• �� i �
PERMIT N0. Inspector.
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Building Ins
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:Eugene Allen SCTM#1000-120000300014000
Project Address:4075 Aldrich Lane, Laurel, NY 11948
Phone#:631-903-1886 Email:euallenO5@gmail.com
Mailing Address:4075 Aldrich Lane, Laurel, NY 11948
CONTACT PERSON:
Name:Eugene Allen
Mailing Address:4075 Aldrich Lane, Laurel, NY 11948
Phone#:631-903-1886 Email:euallen05@gmail.com
DESIGN PROFESSIONAL INFORMATION:
Name:N/A
Mailing Address:
Phone M Email:
CONTRACTOR INFORMATION:
Name:N/A
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair WDemolition Estimated Cost of Project:
17
❑Other 00.00
Will the lot be re-graded? igYes El No Will excess fill be removed from premises? iRYes ❑No
1
PROPERTY INFORMATION
Existing use of property:Workshop Intended use of property:Workshop
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
Residential this property? ❑Yes RNo IF YES, PROVIDE A COPY.
N 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 210AS of the New York State Penal Law.
Application Submitted By(pri name):Eugene Allen ❑Authorized Agent ROwner
Signature of Applicant: Date: 10/29/2024
STATE OF NEW YORK)
SS:
COUNTY OF Suffolk
°f AIL,+1 being duly sworn, deposes and says that(s)he is the applicant
(Name ndividual 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 Pelozel- 20 2 /
Notar* Public
KONSTANTIN SHESTAKOV
NOTARY PUBLIC STATE OF NEW YORK
SUFFOLK COUNTY
PROPERTY OWNER AUTHORIZATION LIC. #01SH0029382
COMM. EXP. 10/01/2028
(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
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S.C.TAX No. 1000120000300014000
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JOB No:20-896
DATE:NOVEMBER 1212,2020