HomeMy WebLinkAbout51973-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#: 51973 Date: 06/05/2025
Permission is hereby granted to:
Gary N Hygom
37 Harper Rd
Baiting Hollow, NY 11933
To:
install a deerfence, construct additions&alterations and to legalize the "as built"finished basement
to an existing single-family dwelling as applied for. Additional certification will be required.
Premises Located at:
705 Knollwood Ln, Mattituck, NY 11952
SCTM# 107.-6-7
Pursuant to application dated 02/06/2025 and approved by the Building Inspector.
To expire on 06/05/2027.
Contractors:
Required Inspections:
Fees:
DEER FENCE $100.00
Single Family Dwelling- Addition &Alteration $703.00
As Built Alteration $362.00
CO-RESIDENTIAL $100.00
Total S1.265.00
--I --
Building Inspector ��
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TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
�x Telephone (631) 765-1802 Fax (631) 765-9502 1i1i)s://",,%vW.So
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only ;
PERMIT NO. v 1 Building Inspectors_. d
_Applications and forms must be filled out in their entirety.Incomplete "w
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date:2/6/2025
OWNER(S)OF PROPERTY:
Name:Mary Hygom SCTM #1000-107-6-7
Project Address:705 Knollwood Lane, Mattituck, NY 11952
Phone#:631-745-1558 1 Email: garyhyn2@gmail.com
Mailing Address:705 Knollwood Lane, Mattituck, NY 11952
CONTACT PERSON:
Name:Darcee Oppici
Mailing Address:PO BOX 152, Mattituck, NY 11952
Phone#:631 603 9092 Email:doppici@amparchitect.com
DESIGN PROFESSIONAL INFORMATION:
Name:Anthony Portillo
Mailing Address:PO BOX 152, Mattituck, N.Y. 11952
Phone#:631 603 9092 Email:aportillo@amparchitect.com
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure FliAddition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $120,000
Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ®Yes [:]No
1
PROPERTY INFORMATION
Existing use of property: Residential Intended use of property: Residential
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R-40 NC this property? E]Yes ®No IF YES, PROVIDE A COPY-
0 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,forthe construction of buildings,
comply with all applicable laws,ordinances,building code,
es to P are P
.rn e applicant PN
additions,alterations or for removal or demolition as herein described pp g
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(pr',t f�we):.
AMP Architecture Authorized Agent []Owner
Signature of Applicant: Date: 2/6/2025
STATE OF NEW YORK)
S :
COUNTY OF 1 )
Shania Gordon being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the Agent
(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 IU(-uGry 2oZ5
�rtary Public
rRegistration
RCEEAOFENANCrE'R
PUBLIC,STATE OF NEW YORK
( 0 ) No.01A0001964(Where the applicant is not the owner) alified in Suffolk County
sion Expires J,Wrruary 9,2028
r residing at O _
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AMP ARCHITECTURE
PAoL `(�j L do hereby authorize to apply on
my behalf to the wn of Southold Building Department for approval as described herein.
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