HomeMy WebLinkAbout52069-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
`�oU .�
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#: 52069 Date: 07/08/2025
Permission is hereby granted to:
Daniel E Letteriello
1690 Elijahs Ln
Mattituck, NY 11952
To:
construct deck addition to existing single-family dwelling as applied for,
Premises Located at:
1690 Elijahs Ln, Mattituck, NY 11952
SCTM# 108.-3-5.13
Pursuant to application dated 06/05/2025 and approved by the Building Inspector.
To expire on 07/08/2027.
Contractors:
Required Inspections:
FOOTING/REBAR, FRAMING/STRAPPING , DRAINAGE, FINAL,
Fees:
Single Family Dwelling- Addition &Alteration $476.00
CO-RESIDENTIAL $100.00
Total S576.00
��� a Iding Inspector
A qW
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 litt:s-//Nvww.souilioi towomy,&;o
p Date Received
BUILDINGAPPLICATION FOR
For Office Use Only
PERMIT NO. Building Inspector, JUN 02
Applications and forms must be filled out in their entirety.Incomplete Building D parimont
applications will not be accepted. Where the Applicant is not the owner,an 'own ®f SOuthold
Owner's Authorization form(Page 2)shall be completed.
Date'
OWNER(S)OF PROPERTY:
Name: Sri r- K vAac-r-i Ze'r r-c-fz i&t-c o SCTM#1000-
Project Address: I qC) C'�--tsL.4,kS L v�� rMiq�Tk TV C, , N
Phone#: S/G - 7--? C( - 7 c1 V 3 Email:
Mailing Address:
CONTACT PERSON:
Name: S�41\z% i)VA-CC'-J5
Mailing Address: iS4r1 j,"r+« Rc 14,0 Q ,Cv
Phone#: 2-7 6 -3 3 3 Email: C P7-S 71-1 0 re-
DESIGN PROFESSIONAL INFORMATION:
Name: GrScr4-5,--e
Mailing Address: 1"1 2S /4
Phone#: S j 6 g(-g °- S t f Email:
CONTRACTOR INFORMATION:
Name: {A VvkS 0-- Cl-o-"CU t�f
Mailing Address: S cnn vo� � r� VZGv�J> c Gy�:• y
Phone#: 3 l `-"1 `3-S3 Email: C �T S
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration LRepair volition Estimated Cost of Project:
❑Other 1��`w l2 (r) Eli $
Will the lot be re-graded? ❑Yes ElNo Will excess fill be removed from premises? ❑Yes CaWo
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 ONO IF YES, PROVIDE A COPY.
❑ Check Box After) eadin6: 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(print name): r N-CC� Authorized Agent ❑Owner
Signature of Applicant: , Date:
CONNIE D.BUNCH
Wo Notary Public,State of New York
�(junoO S Y pelillenp No.01BU6186050
STATE OF NEW YORK) 050981, 60'oN Ouallfled In Suffolk County
SS: NJOA MaN;o ate nd AJe10N Commission Explrea April 14,Z
COUNTY OF ) HONFI 0 31NNOO
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
, of 4—
''
Notary Public
(Where the applicant is not the owner)
J residing at1 ��
do hereby authorize ,r/. 7 YCu j to apply on
my behalf to the Town Southold Building Department for approval as described herein.
Owner ig,nature Date
Print Owner's Name
2
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