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HomeMy WebLinkAbout52958-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT o� >� SOUTHOLD, NY r00y� BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH +Q1VE SET Of APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 52958 Date: 05/07/2026 Permission is hereby granted to: Nikki Dubinsky PO BOX 1856 Amagansett, NY 11930 To: construct alterations to an existing single-family dwelling as applied for. Premises Located at: 35 N Riley Ave, Mattituck, NY 11952 SCTM# 143:4-14 Pursuant to application dated 03/27/2026 and approved by the Building Inspector. To expire on 05/06/2028. Contractors: Required Inspections: Fees: Single Family Dwelling- Alteration $280.00 CO-RESIDENTIAL $100.00 Total 380.00 Building Inspector p( If py,4gly I' y BUILDING DEPARTMENT TOWN OF SOUTHOLD Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold,NY 11971-095 9 Telephone 631 765-1802 Fax 631 765-9502 lit, .,s: , s,,o h r Date Received APPLICATION FOR itRUILDINGPERMIT f ti q C For,Office Use only PERMIT NO. wilding 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: C) 0 9,Z OWNER(S)OF PROPERTY: Name: - SCTM# 1.000-Jill -t C Ci Project Address Email. Phone#: I� � ,�,, I �— 5QC .0 A�4C3 0 - 60 11111 Mailing Address: CONTACT PERSON: Name: Mailing Address: \"10\A' ,0, 1+e_Aq> Phone# .— Email: P 0 F 0(3U/L�..' 0-12 044 It y DESIGN PROFESSIONAL.INFORMATION: Name: a e.&-s�t _:S0057 Ict w Phone#: Email:. o.o CONTRACTOR J F , ' N a me�� .. Mailing Address PRO Phone#: Email. DESCRIPTION OF PROPOSED CONSTRUCTION dditior� ��4ration �Re air ❑Demolition Estimated Cost of Iolect: CJNewStructure ❑Ap ❑Othe r $. ....................Moo Will the lot be re-graded? FlYes o Will excess fill be removed from premises? C_lYes �No i I .......... 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 I this property? 7Yes FNo IF YES, PROVIDE A COPY. 1:1 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 Cade. 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,Su,"k,County,New'York and other applicable Laws,Ordinances orRegutations,for the construction of buildings,, additions,alterations or fog,re�mbfjaI,6?,*deMi"Jition as herein described.The applicant aigrees,to comply wilth all applicable,laws,ordinances,,buildib g 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;Efs a Class A misdemeanor pursuant to Section 210.45 of the blew York State Penal Law. Application Submitted By(print name)*� uthori`zed Agent Downer 7 �f Signature of Applicant: Date, STATE OF NEW YORK) COUNTY OF being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the ............ (Contrac r, Agent., orporate Officer, etc.) rn of said owner or owners, and is duly authorized to P 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 brw 1 20 I'ARJ A tarry,Public TRACEY L. NOTARY PUBLIC,STATE OF NEW yORK NO.01 DW6306900 PROPERTY OWNER AUTHORIZATION Oij,10,11FIED IN Gllr-FOLKCQIJ�M (Where the applicant is not the owner) COMO iON UNE 30t residing at a K, do hereby authorize to apply on my be 'if to t Tow Southold Building Department for approval as described her in,., 17, 0 1, Owner's Sign at, Date ct ........................... Print Owner's Name 2 .......... EAS71 SURVEY OF PROPERTY SITUATED AT ROAD MATTITUCK TOWN OF SOUTHOLD 4� SUFFOLK COUNTY, NEW YORK a m S.C. TAX No. 1000-143-04--1 4 OF S 7GS5 too,, - SCALE 1"-203 XVr � JUNE 24, 2005 O AREA = 9,346.57 Sq. fi. 0.215 ©c. ' � NATIONAL CITY UD AMERICAN HOME MORTGAGE ACCEPTANCE, Inc. e ;w► 9'7 j t'' COMMONWEALTH LAND TITLE INSURANCE COMPANY - e NIKKI DUBINSKY QAS 66 R ROW WM' MIErER - _-� OVERHEAD WIRES NOTE: STORY FRAME HOUSE FOR LOT NUMBERS SHOWN REFER TO MAP OF z A�. fib YYILLIAM T. AND QANIEL T. RILEY FILED IN THE Al OFFICE OF THE CLERK OF SUFFOLK COUNTY AS MAP NUMBER 186 ON NOVEMBER 27, 1928. LQ ' U-9 ROOF OVER ENCLOSED . CQNC;.PATIO PRE -$U!N ACOOMMAW WfN THE LOW L - FOR%K:" STATE LAND 0 ivy 40 UNAUTHORIZED ALTERATION OR ADDITION M THIS SURVEY IS A WRATION OF osephuio A. kVewl o Za OF THE NEW YQIlC STATE LJi►N. COIIn QF im Smu MW WT BEAFi" Land 'PC I"SLIME WS lNKM sm OR _ SEAL SFWl W EX COWADEM TO 9E A VlILlQ TRUE CO" _ cmFK'a aM MICATM HEREON%WJ-RUN ONI~Y M TM PERSON FOR 1MMM TW%*M CorwtrUcwn toyrwt M PAC"#D.MO ON M WIM.F TO THE (631)727-20H Fax (631)727-1727 nMON.a�t1TW MO ARC WT T14AiMOMMLE..