HomeMy WebLinkAbout52232-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#: 52232 Date: 09/04/2025
Permission is hereby granted to:.
Brian McCleery
PO BOX 1713
Mattituck, NY 11952
To:
construct alterations to an existing single-family dwelling as applied for.
Premises Located at:
840 Cottage Way, Mattituck, NY 11952
SCTM# 122.-2-23.14
Pursuant to application dated 08/25/2025 and approved by the Building Inspector.
To expire on 09/04/2027.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $250.00
CO-RESIDENTIAL $100.00
Total S350.00
.%,
Building Inspector
TOWN OF SOUTHOLD- BUILDING DEPARTMENT
7 Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959
` Telephone 631 765-1802 Fax 631 765-9502 hti ://rvwutboldtownno
Date Received
ApLICATION FOR BUILDING PERMIT
For Office Use Only E EI
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
Owners Authorization form(Page 2)shall be completed. Building (:Department
Town of Southold
Date: 'a L, /� .2U� S
OWNERS) OF PROPERTY:
Name: rji2l-1 rI IL JI-11ne /1/1cGf SCTM # 1000-
Project Address: 8 0 �� � � �17
Phone#: Email:
Mailing Address: ENO e01441e tl"" , Aot->`!4tick--
CONTACT PERSON:
Name: pjI a tl Meelg t: • "
Mailing Address: �O(1pl Akave-
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name: P �,�A(arro
Mailing Address: 1111el- P01'7-✓ 6Y-eeri r-1"
Phone#: 5��- Email: /Clk A}OaZZG.4,-ro 0 VLPrl-" rl /le
s�-.5�9�
CONTRACTOR INFORMATION: f
Name: , 0 ��� �Q.'�Z�rtiVllllec
Mailing Address
Phone#: JEmail:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure I-In,l,fitinn MAlteratinn r7Renair E]Demolit�on Estimated Cost of Project:
XotheijA�� $ 50 000
Will the lot be re-graded? ❑Yes JgNo Will excess fill be removed from premises? ❑Yes,�%o
1
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PROPERTY INFORMATION �1
Existing use of property:Sf fC -00l(V11� Intended use of property:Sf +d�pVt�p
Zone or use district in which premises is situated:. Are there any covenants and restrictions with respect to
this property? ❑Yes No 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 rather applicable lags,ordinances or Regulations,for the construction of buildings,
additions,alterations or for rermoval 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.
T
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Application Submitted Mprint name): ❑Authorized Agent ❑Owner
Signature of AFlplican .- Date:
STATE OF NEW YORK)
COUNTY OF 5
4 1
LIP) YWQ AA C G I-ife , being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the �01111,e a /7ef
(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 20-25�
pu
Publorlow�
Aqy Notuy Public,State of New York
* PuMc i*m No.01OR6290392
PROPERTY OWNER AUTHORIZATw ,•' t alil xlbl
�aan�ertaww comm' IM 6/136-21
(Where the applicant is not the owner)
I, residing at
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein,
Owner's Signature Date
Print Owner's Name
2