HomeMy WebLinkAbout52597-Z TOWN OAF SOUTHOLD
BUILDING DEPARTMENT
a
SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT CAN THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 52597 Date: 01/07/2026
Permission is hereby granted to:
Vincent Dioguardi
22 Lydia Ln
Garden City,, NY 11530
To:
legalize "as built" alterations(inclusive of an "as built" accessory apartment)to an existing single-
family dwelling as applied for per SCHD approval. Additional certification will be required.
Premises Located at:
4890 Sound Ave, Mattituck, NY 11952
SCTM# 121.-3-7.3
Pursuant to application dated 08/05/2025 and approved by the Building inspector.
To expire on 01/07/2028.
Contractors:
Required Inspections:
Fees:
As Built Alteration $1,677.00
C00-,RESIDENTIAL $100.00
Total $1,777.00
Building Inspector
Grp
10
BUILDING DEPARTMENT
TOWN OF SO HOLD
Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold NY 11971-0959
Telephone(f31)765-1802 Fax(631) 765-9502 1
V
.................................................................................
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. 5( 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.
Date:
..............................
OWNER(S)4 PROPERTY:
Name: SCTM#1000- ., . ..-
Loi 70
..........
Project Address: sci±'
Phone#: It Email
Mailing Address:
CONTACT PERSON:
Name:
VA,tR' Se�Z c e 5
Mailing Address: n
jl \J e. �u.�.+�.�. , � � 7
Phone M Email:
i
—TV el`�0 �
DESIGN PROFESSIONAL INFORMATION: 1A 'WC
Name.-
Lo J� t
Mailing Address: 3
d-�q�,�2:� .........
Phone#:6 ,311.,7r, Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email-,
DESCRIPTION OF PROPOSED CONSTRUCTION
..........................................................
F-1 ew'St ure RAdditio FlAlteration L]Repair Ellemoliti. 11 Estimated Cost of Project:
Tl:�
$
JIII, iA Ce oj..�
NrOther
Will the lot be re-graded? F_1Yes ego, Will excess fill be removed from uses? E]Yes 1:1 No
.... .....................
..........
------------
NOW ........
PROPERTY INFORMATION
....... ..........
Existing use of property: Intended use of property:
, e ............
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this prope E]Yes El No IF YES,,,PR,WIDE A COPY.
tL_
El Checic Box After Readings' 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.
Authorized,Agent 0Owner
Application Submitted B e)
C�.
;L4
Signature of Applicant: Date.
STATE OF NEW YORK)
As-
cz) C-1 d
CO U NTY OF J
il-P................%
being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
4,
(S)he is the A-0
- . L
10 (Contractor,Agent,Corporate Oflicer,etc.) q
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
app lication;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
of ubl"ic
vAARX F O'RSIE'Sl New York
t4'0'.,0jjF,16,62'97,
PROPERTY OWNER AUTHORIZIMON f ebi,
(Where the applicant is not the owner)
41
GA_�.f I �
residing at,,,,,
do,hereby authorize 110-k 10 r to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signature Date
�bff
al -f At
Print Owner's Nafne,
2 —---- .........
HEALTH OEPARTMENT USE
N
MAY
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SURVEYOR'S CERTIFICATION
VILE HEREBY CERTIFY TO V/I N C E NT D I 0 C LJ A y
D 10 D U A R D 1 THAT THI5 SURVEY WAS PREPARE
THE CODE OF PRACTICE FOR LAND SURVEY5 AbOP E
STATE ASSOCIATION OF PROFESSIONAL LANDS j
HOWARD W.YOUNG,N. L.S.NOvr89
bANIEL A.WEAVER,N.Y.S.L.S.NO.50771
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IN A i moo WON
SURVEY FOR
� R" I A.
MARIAE)IOGUARDI
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0'`�' at Mattituck
(v C\ , Town of Southold
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Suffolk County,New York
e (A! ..���.. m.., FINAL SURVEY
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