HomeMy WebLinkAbout53011-Z TOWN OF SOUTHOLD
I A I
BUILDING DEPARTMENT
SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT OWN THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 53011 Date: 05/21/2026
Permission is hereby granted to:
Stacy Ann Wickham Martin
PO BOX 548
Mattituck, NY 11952
To:
legalize "as built" alterations and repairs to an existing seasonal dwelling as applied for with flood
permit.
Premises Located at:
710 Park Ave Ext, Mattituck, NY 11952
SCTM# 123.-8-28.5
Pursuant to application dated 05/13/2026 and approved by the Building inspector.
To expire on 05/20/2028.
Contractors:
Required Inspections:
Fees:
As Built Alteration $500.00
Flood Permit $150.00
CO-RESIDENTIAL $100.00
Total 75�, 00
Building Inspector
TO OF SOUTHOLD--BUILDING-DEPARTMENT
Town Hall Annex.54375 Main Road P. 0. Box 1179 Southold,NY 11971-0959
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Telephone(631)765-1802 Fax(631) 765-95 02 �� � ����,�� .l lfl �o l'dtow p�
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Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
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PERMIT NO Building Inspector:
Applications and forms must be filled out in their entirety.Incomplete
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applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date:May 4, 2026
OWNER(S)OF PROPERTY:
Name:Leigh Penn Wickham SCTM#1000-123.-8-28.5
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ProjectAddress:71 p Park Ave Ext Mattituck
Phone#: 56 1 34126 Email:lei hwickham @ hotmail.com
20 �
MailingAddress:5 Belleau Ave Madison, NJ 07940
CONTACT PERSON:
Name:Peter Allocca
Mailing Address:5 Belleau Ave Madison, NJ 07940
Phone#: p
Email: alloccaggmail.com
9734799496
DESIGN PROFESSIONAL.INFORMATION:
Name:
Mailing Address:
Phone#: Email
CONTRACTOR INFORMATION:
Mattituck PluMbingName: and Platinum Electric
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
New Structure ❑Addition ®Alteration Repair n Demolition Estimated Cost of Project:
�,
C1 Other 20,000
Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ❑Yes 8 No
PROPERTY INFORMATION
Existing use of property:Sump er Cottage Intended use of property:Summer Cottage
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? OYes F�No IF YES, PROVIDE A COPY.
0 Check Box After Readi r1g.1 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 Lwn..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 buildings}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.
J�'ietro Allocca RAuthorized Agent ElOwner
Application Subm itted By(p,041 1 ,
Signature of Applicant: Date: 5/4/2026
STATE OF NEW
SS:
COUNTY OF
T�P,�r 0 f-���o C, being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the
(Contractor,.Agent,Corporate Officer,etc.)
of said owner or owners,and is duly authorized to per-form 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.
I I I to,001?
Sworn before me this Z I 1W
Ito
day of I/--------------- 20
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Notary Publi c
low,
01 4*1 00
PROPERTY OWNER AUTHORIZATION yk ''
(Where the applicant is not the owner)
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Le,- �'V\ Nle)ct-ci residing at
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do hereby authorize to apply on
my behalf to the Town of Sl fhold Building Department for approval as described herein.
o�d
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Owner, i, pia tu re Date
Print Owner's Na�r,41
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