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Home My WebLink About52717-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT 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#: 52717 Date: 03/05/2026 Permission is hereby granted to: Lizbeth Jansen 260 Sailors Needle Rd Mattituck, NY 11952 To: Demolish an existing dwelling and constructa new single-family dwelling with breezeway to accessory garage to include an outdoor shower and HVAC system as applied for per Trustees, DEC and SCHD approvals. Floodplain development permit is required. Premises Located at: 260 Sailors Needle Rd, Mattituck, NY 11952 SCTM# 144.-5-27 Pursuant to application dated 11/20/2025 and approved by the Building Inspector, To expire on 03/04/2028. Contractors: Required Inspections: Fees: Single Family Dwelling-NEW $2,864.00 CO Single Family Dwelling-New $100.00 Flood Permit $150.00 DEMOLITION $764.00 Total $3,879.00 Building Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 TCIi."hvii� kv3II 7v5-i VvZ- I kv3 it I v., 9-v4 Y l 1 l 7 Date Received APPLICATION FOR BUILDINGPERMIT For Office Use Only r 4 PERMIT NO. �1 � _ i Building Nraspector. 1'u TV Applications and forms must be filled out in their entirety. Incomplete . annlicatinns will not hp arrentPd. Where the Annlicant is net the owner_an Owner's Authorization form(Page 2)shall be completed. Date: ( 20 2 OWNER(S) OF PROP` Ft f T: Name: SCTM#2000- 144 , 2 Project Addre Phone#: O . G, Email: Mailing Address: CONTACT PERSON: Name: HA WA ifT.Z= Mailing Address: ( " Phone# 134 . J e5- Email: DESIGN PROFESSIONAL INFORMATION: Marne: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: Mailing Address: Phone#: Email: DESCRIPTION OF PROPOSED CONSTRUCTION New Structure ❑Addition ❑Alteration ❑Repair Demolition Estimated Cost of Project: ❑Other $ I1, Will;excess riiun be relluveu rn._un_s NreiliseS? es ED'N uvviu��e �0i uc ie-g"aueur uteS —No 1 PROPERTY INFORMATION Existing use of property: Intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑YesNo IF YES, PROVIDE A COPY. C ieck IBox After N eadiing: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by pter 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 210AS of the New York State Penal Law. Application Submitted By(print name): �� '"° �� uthorized Agent Downer Signature of Applicant: Date: I 7D STATE OF NEW YORK) CONNIE D.BUNCH SS: / . Notary Public,State of New York COUNTYOF a aL J L v ;2� No.01BU6185050 Qualified In Suffolk County /xCommission Expires April 14,2bc ly sworn,deposes and says that(s)he is the applicant (Name of in ividual signing contract)above named, (S)he is the kcff 71 lam'"' (cone actor,Aketit,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 b day of ILN n Ve/YL , 20� t -7 '��—P L Notary Public (Where the applicant is not Nthe owner) I, residing at �� 62 do hereby authorize �IGtP to apply on e a 'o tGTnSouthold Building Department for approval as described herein. wner Date Print Owner's Name 2 kar: TOWN OF SOUTHOLD—BUILDING DEPARTMENT 10 Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 k t y;LN"k . outlt al it w lnyi . ,,o Floodplain Development Permit Application PROPERTY INFORMATION: Flood Zone: �„ FIRM Panel: Address: City: l Zip; CONTACT PERSON: Name: `/1/r � , Phone#: Mailing Address: 17e 60--y'- U �" PROJECT DESCRIPTION: pt:tVU j w° /1J6tA-3 U,Jj SECTION A:STRUCTURAL DEVELOPMENT(CHECK ALL THAT APPLY) Type of Structure Type of Structural Activity Residential (1 to 4 families) )A New structure ❑Residential(more than 4 families) emolition of existing structure ❑ Combined use ❑Replacement of existing structure ❑Non-residential ❑Relocation of existing structure ❑ Elevated ❑Addition to existing structure ❑ Flood proofed(attach certification) ❑Alteration to existing structure ❑Manufactured Home ❑Other: ❑ Located on individual lot ❑ Located in manufactured home park SECTION B: OTHER DEVELOPMENT(CHECK ALL THAT APPLY) ❑Clearing of trees,vegetation or debris ❑ Mining ❑ Grading ❑ Drilling ❑ Dredging Connection to public utilities or services 4,45 ❑ Paving ❑ Placement of fill material E9 Drainage improvement(including culvert work)FQ&I' ❑ Roadway or bridge construction ❑ Fence or wall construction 0#10 u/Ig7T ❑Watercourse alteration(attach description) ❑ Excavation (not related to a structured development) ❑ Other development not listed(specify): By signing below I agree to the terms and conditions of this permit and certify to the best of my knowledge the information contained in this application is true and accurate. I understand that no work may start until a permit is issued.The permit may be revoked if any false statements are made herein.If revoked,all work must cease until permit is re-issued. Development shall not be used or occupied until a Cert.of Compliance is issued.The permit will expire if no work is commenced within one year of issuance.Other permits may be required to fulfill regulatory requirements.Applicant gives consent to local authority or representative to make reasonable inspections to verify compliance. Application Submitted By(print name): to 2 Signature of Applicant: Date: le-3 m as 'aA71A"P h'W�,MAaW.Y SECTION B-B VIEWT'—s•� .�"„."" SaaPbnarp6a4laacro�'pklmanelaec S'�"I wxwre,AaGmaN Aarmca0bl�P'4Plrarettud C„knDaabaa �4iS r� �+P� Aa�r uw'raNAop Awrabar. pmrwnaa �aa4aft bca m SCYM MPF Aaa✓�A"C" mKoeo'9 r CYLINDER CIaS'kdkGaadalPoM T",ba9akbaro P y, (OPTIONAL) L"lLTNJATat',b9k0 a%'4I4CP "0VWtV PIPE "TUYRP`'�NNPuAIM12 1G JA SPI:;CtlRUTPc_. An arobT a,W71, &"P S PE ...........,,,_,. MOW A,aa ur'rc arc Aar'pPrka MaAPara "4P%PE RP 'Fp ZA P :9PPd'PF A aaaacrAa'aa Ptaa<Icaaa l," SCALE: 1:20 bPariaa a AaAA« ao" DESIGNER: TAO raA a, DATE,. 10-06-2025 CEN-7 I/A OWTS w/ANTI-BUOYANCY NTS OR RESIDENTIAL STRENGTH WASTEWATER UP TO 700 GPD. DESIGN FOR 'D. 'COVERS TO BE INSTALLED UNDER ALL TREATMENT UNIT COVERS. /♦ ♦~�� -ED ON LEVEL COMPACTED SAND OR GRAVEL BASE AND PROPERLY \♦ %� 4UFACTURER RECOMMENDATIONS. R BLOWER AND FUJI CLEAN CONTROL PANEL. INSTALLATION TO BE ENGINEERING PC. III CLEAN AUTHORIZED INSTALLER ONLY. ACE TO BE PERFORMED BY A FUJI CLEAN AUTHORIZED SERVICE PROVIDER HOMEPORT ENOINEERINQ P.C. THOMAS A O'DWYER, PE LIC. NO. 094873 CIRCUIT BREAKER NOTES: PO BOX 1 1 1 1 MAIN B�, ELECTRICAL PANEL, pun CONTROL PANEL HOUSE PANEL SETAUKET, NY 11733 CB L l-20 AMPS-120VAC CB-LI BI 631-223-8752 info@homeportengineering.com FUJI CLEAd -�;-' „.m, rw �LE LINE WIRING DIAGRAM SCALE:NT5 •, OF NEWP" UFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES"" x PERMIT FOR APPROVAL OF CONSTRUCTION FORA 00 " SINGLE FAMILY PESIDENGE ®NLY 5 sly DATE.-_ .10/27/25 , S. R-250335 APPROVED ' FOR MAXIMUM CE w 6 BEDROOMS EXPIRES THREE FEARS FROM DATE OF APPROVAL s rl�■I '