HomeMy WebLinkAbout52213-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#: 52213 Date: 08/25/2025
Permission is hereby granted to:
Oregon 4690 LLC
672 Dogwood Ave#169
Franklin Square, NY 11010
To:
Construct accessory garage at existing single-family dwelling as applied for,with SCHD approval.
Premises Located at:
4690 Oregon Rd, Mattituck, NY 11952
SCTM#95.-3-2
Pursuant to application dated 07/21/2025 and approved by the Building Inspector.
To expire on 08/25/2027.
Contractors:
Required Inspections:
Fees:
Accessory-New Structure $1,265.00
CO Accessory Structure $100.00
Total $1,365.00
Building Inspector
r,
y"
`bra TOWN OF SOUTHOLD —BUILDING DEPARTMENT
Al
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959
" « Telephone (631) 765-1802 Fax (631) 765-9502 htt sa)w ,rw.southoldtowtxo . o
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only E C E E
PERMIT NO. � �/� Building Inspecto'n
I. 21 2025
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an Buiiding Department
Owner's Authorization form(Page 2)shall be completed. Town of Southold
Date: -4-111 Z5'
OWNER(S)OF PROPERTY:
Name: 0a1� 0t,) q6qo ttL SCTM # 1000- �S v3 ��, Z
Project Address: 1/19® cruA"1 1Z D_ � � � 11135-
Phone#: 91}—��3—310' Email:A4tcKAV-1, IJlvtt 0 UI3uc ,core,
Mailing Address:
CONTACT PERSON:
Name: •o 01&AJAJXi,
Mailing Address: 1-7,00 V i ;
Phone#: ��?— bSU -6666 Email: TG/llle�'1ti1-
DESIGN PROFESSIONAL INFORMATION:
Name„
Mailing Address:
Phone#: (53�- 657-o— 6 Email:
CONTRACTOR INFORMATION:
Name: mad"V,
I-
Mailing Address: -Bo Z23
Phone#: � Erinail: A4 PAX 40k' wry I
DESCRIPTION OF PROPOSED CONSTRUCTION _J
❑New Structure ❑Addition [--]Alteration ❑Repair ❑Demolition Estimated Cost of Project:
lh�Clther 60 $
Will the lot be re-graded? ®'Yes ONO Will excess fill be removed from premises? ❑Yes ANo
1
PROPERTY INFORMATION
Existing use of property: 0V,k -,q(, Intended use of property: Res toe i,-)f,t4L-
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
AG this property? ❑Yes XNo IF YES, PROVIDE A COPY.
❑ 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 210.45 of the New York State Penal Law.
Application Submitted By(print name : 1'2-)Do 0 C'0/✓'A/'C C L WrAuthorized Agent ❑Owner
Signature of Applicant: Date: ���l Z
STATE OF NEW YORK)
SS:
COUNTY OF )
1-00n E v/u AZ 0-L being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
( ) t Pu' J00,111i
S he is the Frl� 101 ,
(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 e 20 2-1�
ARE N M�'ND Nota I"
NOTARY PUBLIC,STATE OF NEW YORK
I " p g011'1%•01IMM11938
r w I 0
%
commission lath 202 r (Where the applicant is not the owner)
I, cB( k � 'h �► k� residing a4S N AcIg Ln Ae-& ,q4 -y,N7
do hereby authorize 000 1C0A11 G to apply on
my behalf to the Town of Southold Building Department for approval as described herein,.
g/g/ 11O 60r-'s,/Signature (( Date
of tv04V h'e'�"5"N a'ri�Es°lfcNry
2
Building Department t Al2RUcation
AUTHORIZATION
(Where the Applicant is not the Owner)
on y6go,��c . �• ,,�f�b«
Orr Ma ,Jk�
I, residing at a5 /Y:A rk 1, 7 4�,(.N7/fly�
(Print property owner's name) (Mailing Address)
do hereby authorize 0 D 0 d(CynJAJ 9-C G
(Agent)
to apply on my behalf to the
Southold Building Department.
2"6/r c��d .57
(Owner's qSig, ure) � (Date)
A-C 44,e f A /+:V�-,
(Print Owner's Name)
a r'.
Town Hall Annex Telephone(631)765-1802
;; 631
54375 Main Road Fax(�� i )765-9502
P.O. Box 1179
Southold, NY 11971-0959 G� 1 0
w5 �
6
BUILDING DEPARTMENT
NOTICE OF UTILIZATION OF TRUSS TYPE CONSTRUCTION PRE-ENGINEERED
WOOD CONSTRUCTION AND/OR TIMBER CONSTRUCTION
Date:
Owner:
Location of Property: _V OO OLg� ,o rt ,&,qa v v,,l........ l l
Please take notice that the (check applicable line):
New commercial or residential structure
Addition to existing commercial or residential structure
Rehabilitation to an existing commercial or residential structure
to be constructed or performed at the subject property reference above will utilize
(check applicable line):
Truss type construction (TT)
Pre-engineered wood construction (PW)
Timber construction (TC)
in the following location(s) (check applicable line):
Floor framing, including girders and beams (F)
Roof framing (R)
ITITITITITITITITw Floor an roof framing (FR)
Signatur
Name (person ubmitting this form): ..__../oob O'(OxIr/�Lc-
Capacity(check applicable line):
Owner
Owner representative
TrussReg15.docx Effective 1/1/2015
WELL AND LATER_, MUST EE I`�IFFZ YE E,�) n o✓ v
SHOWN ON FINAL SURVEY' v � I c✓✓ o =cc�c _occ _-s =- - „
cLw
�� � ✓ ✓ \� /%�A_ � O CO NNEIL,AIA
n✓F� -�_`. /._ _-�\�� n —\ o✓ .^i 1]iO Wm'nm MIrx¢w.a'..4aq YMgrrwM
Ate'\• "F/J`=F-`� ='r. _� Sun.130
Hauppauge,NV 11Jg8
�o Ifl A c�� I G� '• � �pti;. ,�-�,__ — � -�`.� �..�__.�. 'F✓'=F PI631I6666667
wOtd 7 o.9 I .�.....:,.— I ®.....�..I__ G _ __�..�.• ��✓ "o✓_ f___ - _ CI61616560325
c-_� -- v o c�
P 1� � � �......�....... r "pltl�. �✓=05=i G->F�,v- O� _ —aF�
`"
000
tl r O ECTNC WATE9 kp
U OATIQN( 40 deep) / _m:._ E COUf�F - _
rf) --_ -_ _ - �aF:=_c
w DVNt �, 4 _: 1"SOc d
r.MI ago — ALIM D r (�
��-- � o
b
`^
o M,, PROPOSEDr _ V� A.A. PpOL � a GARAGEED ��m.l� Lin
V V
CABANA— I <' F-
;r' I\F FL.EL.51.65') _,.. _m, l (F.FL.EL 50 5') I L P. P NOTE CHANGES.., n
( E BATHRDDN) {"u 1"� tl ' F M4 ' i \r tl I�•ust prwd E'U P I nin, F O
w „�`, .. 1 .,,, "� 6Epuahor bet en lea., z
\,.,° I �� �r ;rp•d r�"✓ \\\ _ ,,, r:.i pool and stai._s�
w eA1. I\Ee
r is
A eA
loon
��
L.P. 15C"tll so,U \"wM '
Ik... ✓ i —
-�•� r � ,
.�_ rA +n f I „✓ ` ,ti _G FG--�--� —Fo`� —
rd / _ 5_Go� c c =qo� —.: on = ._i _'<ov i 0
d 'Di \all -
,�
1 1
� ,,., �
1� ✓ : E ��nv__�
FM.bri`'M"da 2 STORY f y .
�' �:,. 1• � `^�� �,. RESIDENCE 9 � I
w- r IIn
3 — ��m, F.F.FL.:54.6' .� .,_., -..L....e ,,, � _ _ __i ^✓F o_/G= �—�-- `<C l D_7.GOA fuo
\} $
W
II '��a ~M Farrel �ra "A'...-AG „2="- ✓ � = o-s,—O\c
LU
ANT.ED -TT
\�",yE P(5092) M. I) _ax.M +,. 'ob •"6 IL'V
_ O
'~4 m APPROXIMATE
- ozs w•.„m.-.,... LOCATION OFlij SLACKE TEST BORING_....
4: ," «_:.. \• PLANT BED, _.
'�BiNRrMYGN � v EXISTING SANITARY
55' TEST HOLE
w uuEANELE O 0 Dvieizaz1
.. ,. c
E �\ dNN•MY �, 1 w"r
tl fA
ILIrLq"id w M�' BI J FINE DARK BROWN 5Wb
s I' "..� sGw icy° wDhtl 57� ^ rl "��.n,"q' � EL,40,25_saatlN' ORGANICS&GRAVEL
3 1 ' p A.V 4l .. �..r• FINE TO COURSEBROWN AND TRACE OFF W 0
I \ rM A 9 \ RP �.yyy °M """"'� BRwvN SILTY SAND TRACE OF ORGANIC _
°�}yab yd yy., aq. DAP 1 TRACEOF 6MALLGRAVEL B:AEAN S J
SAND SOME LARGE GRAVEL I SMISN I 0
-��. ,J.M, .....w.. ��-�,..., \\ a Ef Y N N" "M,w. ,,,r".•", ,,, \ 1 - :- _ _7.0' IN 0 O
ELA3.25
FINE TO COURSE LIGHT BROWN a PA
J Le B. Q z
a V tl .. ...,,e..Wb ........... ...�........,,,. 6MALL GRAVELl I I %CLE )
� gy��
BRGNM CLEAN SAND 60ME FINETO
tt l ' ' k n w .. I ., ..... 'SW 100 PN W
jaL (s 6v ,x LEGEND ry ID
Ld
O
tl
TEST HOLE EL,38.25' 12.0' ..
YI _ _ r
O BROWN GLEAN SAND SOME FINE TO
PROPERTY LINE BROWNFINE TO CEANSAOURSE IGHTBRONM&PALE n
Y TCIS LINS�� LARGE GRAVEL ISM ODDiIS CLEPNI �
t (AMM % d ""� N I O µ y L.P. PROPOSm LEACHING POOL
Nrl f%J ` ........ - rr YY-.... ..... ...
' �N
— _:....:.�- ...-.-.. ----_—__ i o_ EL 3325'FINE TO COURSE LIGHT OWN
O ^P � H..�.... �\� \ 6.T. FROPOEED EEPrIG TANK ��.w
=Jn CLEM
——— �O O PROPOSED EO%E%PANTION TAN EM�GRAVELSSW 11101Y FILEAN 1 � ��Y 1
K
tl 1tu
Y b I 7 R20POSED DRYhELL (3 w
V •a„: Y I STAKE _ EL,20,25' 22.0'
DIE�1-1-N Box 7'', ,n IL
W
1a �' ... .. .. �- .. .... ��.� -..�. .. ... .fix.
„ti N*n �e�
FIND_ ' '4 �"i a- —. ...."" is' -- _ -- � _ NOTE: �O
END, E � �--....,.....—....�^-' — _ _ ----- ---_ _ LP ExlsrwaLEAc we Pool NO WATER ENCOUNTERED lIl 'n
Ld
—E—E E E—E E _- PROPER ... ( BELOW SURFACE Q V
�vbuTY ...._. _
POLE T22,DELEV 2B �I
w c 0
Lu
�.,. � UP �I ,p WM1M¢Rr a.M t7 hL l�r^'�904*9N1�}' TIES R � xmrmm � r
A .,�.I I,FiC3 B PRIVATE rA�h,"E,'
SxAtlk aR 'H4amlapo ru'r�wt. O
o
����
a..
Call(631I ss2-5759 48 hours in... ,Iieensed Pl Aa L�'vvfl" .. 1
o B193!L5 .... ..,... ......m.,....,..� O _
— ...............�
- _.... ......._ .. ...... _ ," advance,t.8
o schedule inepection(aJ. �. ry
S. .w. CIDiLPS 42Br27 .f z
I ,......,......,—.............._ �l
Sl Fu.h i..,l.T�DEFAFTf,EM 0=HE..LTH$ERIIL 5 —
.... _.. . .. ... ...... .... ..... 1., ... ,._. _.... .. ... ... .... PEFr,a�F H ��Or CJ6$7, IpG F;=A K
& "_Fw,-IL, R-EIL NCE AND O
I ...................... ,.�w.......I.......n ww....w,...... ,..............� b a d 9
....,.....,-....—.,.
Dc, P I S 1�r I ta4'._n R�cu cc C G
SEE ATTACHED SP....� C.h....L CONDITION,
or c II s Tr•Ds�o<<I sv�i r arzerzl «auLiE sO�FRtl}0z-lro z
rGFADING PLAN AND/OR PLAT PLAN r° A--pi
TTIqJw ,.
................. �TLOT PLAN-- F.0 V4L QF�n�
...
�OO
Qu_
z
_