HomeMy WebLinkAbout52120-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#: 52120 Date: 07/22/2025
Permission is hereby granted to:
Peter R McDonnell
PO BOX 1168
Mattituck, NY 11952
To:
construct a sunroom addition and to legalize an "as built" deck addition and finished second floor of
an existing single-family dwelling as applied for. Additional certification will be required.
Premises Located at:
210 Raccoon Rd, Mattituck, NY 11952
SCTM# 106.-10-7
Pursuant to application dated 04/04/2025 and approved by the Building Inspector.
To expire on 07/22/2027.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Addition &Alteration $347.50
As Built Addition/Alteration $880.00
CO-RESIDENTIAL $100.00
Total S1.327.50
Building Inspector ~
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
G+ Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
' Telephone (631) 765-1802 Fax (631) 765-9502 http : '/° ww outb&toNy gy
r�
Date Received
For Office Use Only
PERMIT NO.5' i—mb— Building Inspector; APR
Applications and forms must be filled out in their entirety. Incomplete BuIlIdIng 06WMOnt
applications will not be accepted. Where the Applicant is not the owner,an 1rOwD of Southold
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: pe+,el, Me V0#1yIGIt' I
SCTM#1000- /V_ 7
Project Address: 2.k Raccoon VOc d , MA,44i'lucK ivy
Phone#: Email: Tyihmcdonnei Io0 ma.i(• cc v✓n
Mailing Address: Po f x wo8 a +CK l�l f 05-2-
CONTACT PERSON:
Name:
Mailing Address: o q-1 W 0r'- AIr /
Phone#: 631-80Y- 37`(v Email: r1'le 4Q Gh?f'u.� AK4— XAW
DESIGN PROFESSIONAL INFORMATION:
Name: {1PLY kS I hpylact s
Mailing Address: y0 BOX 677 ) JArnespOr-r
Phone#: 51( _702 35-19 Email: G411hoMq& /03(�06t0 I• Lai-"
CONTRACTOR INFORMATION:
Name: `rgD
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
El New Structure JgAddition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $
Will the lot be re-graded? ❑Yes KNo Will excess fill be removed from premises? ❑Yes Flo
1
4;
PROPERTY INFORMATION
Existing use of property: t��\L Fes,,,,, L Intended use of property: S i y,-bk t 'FoL-v--1LA
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? DY0,93b IF YES,PROVIDE A COPY.
E,may
the lk Box;Aftell"Read"ng': The owner/contractor/design professional Is responsible for all drainage and storm water issues as provided by
Chapter 236 of the Town Code.APPIRATION 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,Now 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 appBnble 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): M ,t C C V-.ri CJV-- -SAuthorized Agent ❑Owner
Signature of Applicant: Date: 9! q/2r
STATE OF NEW YORK)
COUNTY OF U
being duly sworn,deposes and says that(s)he is the applicant
(Name of WOVIdual signing contract)above named,
(S)he is the
(Contracto,Agent orporate Officer,etc.)
of said owner or owners,and is duly authorized to rm 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
+h �I
day of Anrj ,2'0
ary Public
TRACEY L. DYER
PROPERTY Off) '(,THOR M NOTARY PUBLIC,STATE OF N YORK
(Where the applicant is not the owner) NO.OIDW6306900
OWLIFIED IN SUFFOLK COW ITY
C f SSION EXPIRES JUNE:�4�, 31J (.� 2LO lJ 1
residing at ,.. ,
_do hereby authorize Megan Carrick to apply on
m eh If to the:Signatt=
ng Department for approval as described herein.
Owner's Date
Print Owner's Name
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