HomeMy WebLinkAbout52172-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#: 52172 Date: 08/11/2025
Permission is hereby granted to:
Alyse Ticker
1 3rd Ave Apt 1022
Mineola, NY 11501
To:
Demolish, per town definition,and construct single family dwelling as applied for,with DEC NJ,
Trustees#10755,ZBA#7959, and septic certification as applied for. Additional certification may be
required.
Premises Located at:
1685 Westview Dr, Mattituck, NY 11952
SCTM# 107.-7-8
Pursuant to application dated 05/22/2025 and approved by the Building Inspector.
To expire on 08/11/2027.
Contractors:
Required Inspections:
Fees:
As Built Addition/Alteration $1,796.00
CO Single Family Dwelling-New $100.00
Single Family Dwelling- Addition &Alteration $987.00
Total $2,883.00
Building Inspector
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 Liq L VV11,11
�!��,,',s(>qtln.q d o y
Date Received
I'd
For Office Use Only
MAY 2 2 2025
PERMIT NO. Building Inspector:.. ....
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.
JD a 1:7e: a
OWNERS)OF PROPERTY:
Name: SCTM#1000- 10 7-
A 1-,,4 5 #1000:10 1
Project Address: -+V
Phone#: 631 I Email:,J)-ae-f5 a++. Yi eA-
-1) 3 .............
Mailing Address:
CONTACT PERSON:
Name: t� 4
Mailing Address:
7
Phone#: Email
-
DESIGN PROFESSIONAL INFORMATION:
Name: A
/1 /16 Af- A64600(
Mailing Address:
Phone#: JEmail:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
E]NewStructure IXA.ddition gAlteration EIRepair ElDemolition Estimated Cost of Project:
00the $
Will the lot be re-graded? Dyes X_No Will excess fill be removed from premises?X'yes El No
PROPERTY INFORMATION
Existing use of property: Slti CCU r Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
/r o this property? ❑Yes ONO IF YES, PROVIDE A COPY.
yr 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 pass A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
Application Submitted By(print name): � �C Lc/� �� 4uthorized Agent ❑Owner
Signature of Applicant: Date: el 2 Z/2,J
STATE OF NEW YORK)
COUNTY OF
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the
�(iC�ont�rator,�Agg ,Corporate Offic r,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 ,20_
Notary Public
(Where the applicant is not the owner)
residing at
�1�vi
ev
�� do hereby authorize ,. SC, to apply on
my bell;Owne
Town of o thold Building Department for approval as described here[*,
Signature Date
Pri t Owner's Name
2