HomeMy WebLinkAbout52241-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#: 52241 Date: 09/08/2025
Permission is hereby granted to:
Jon Johnnidis
140 Zena Rd
Mattituck, NY 11952
To:
legalize "as built" alterations to an existing single-family dwelling as applied for. Additional
certification may be required.
Premises Located at:
1150 Ruth Rd, Mattituck, NY 11952
SCTM# 106.-5-26
Pursuant to application dated 07/29/2025 and approved by the Building Inspector.
To expire on 09/08/2027.
Contractors:
Required Inspections:
Fees:
As Built Alteration $500.00
CO-RESIDENTIAL $100.00
Total $600.00
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 ht S:/. VWW.SOL1th ldl wnn joy
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
L
PERMIT NO. Building Inspector';
Applications and forms must be filled out in their entirety. Incomplete „�, ®i�,
appllications:will'not be accepted. Where thiApplkant,i's not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)0 PRO ERTY;
Name:. ( b, w SCTM# 1000- W
Project Address: � d
. 11 i��i-
Phone M Email:
Mailing Address:
CONTACT PERSON:
Name;
Mailing Address: le,
Phi (o)f"nAM f ff, 1.co I
DESIGN PROFESSIONAL INFORMATION:
Name: M
,OtL.i /
Mailing Address: Cr(�
Phone#:� Email:
-
CONTRA TOR INFORMATION;
Name:
Mailing Address:
Phone#'° Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
Project:
❑New Structure ❑Ad Itlon ❑ P
Alteration ❑Re air ❑Demolition Est im ted Cost of 1
ect:
then $
Will the lot be re-graded? ❑Yes hlo Will excess fill be removed from premises? ❑Yes o
1
PROPERTY INFORMATION'
Existing use of property: �I Intended use of property:
Zone or use district in which premises is ated Are there any covenants d r rictio with ect to
tLl
this property? ❑Yes eNo 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. APPUCATION 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 is a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
pp name ( KJ� ALlthorized Agent ❑Owner
Application Submitted B t
Signature of Applicant: Dater
STATE OF NEW YORK)
(°I SSp
COUNTY OF , _A
�6� ej LA being duly sworn, deposes and says that(s)he is the applicant
(Name of individual sigrii g 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 applgatin-file therewith.
Sworn before me this
—day of , 20o
Notary Public
,Rol PR tWAUTHORIZATIONO,N
e applicant is not the owner) j
I, �A) II I residing at
I �'
_do hereby authorize ._.� / � Of f d"Yl ( to apply on
my beh to the-T-own,of Southold Building Department for approval as described herein. t
+gin �i nature Date
Print Owner's Name
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LAND SURVEYING
15 FROWEIN RD — SUITE E2
8 2—W CENTER MORICHES, NEW YORK 11934 &„
57609 VOICE: 631.674.0156
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