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HomeMy WebLinkAbout53103-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT 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 WORD AUTHORIZED) Permit#: 53103 D ate: 0C/30/2026 Permission is hereby granted to: John C Vassil 138 Sherman Rd Greene, IVY 13778 ©,-, legalize "as built"window replacements to an existing single-family dwelling as applied for with flood permit. Premises Located at: 495 Rochelle Pl, Mattituck, IVY 11952 SCTM# 144.4-11 Pursuant to application dated 06/15/2026 and approved by the Building Inspector. To expire on 0 /29/2028. Contractors: Required Inspections: Fees: As Built Alteration $500.00 Flood Permit $150.00 CO is IDENTIAL $100.00 Total 750.00 )krirffing Inspector MXM M 1111` q e: M MMMM TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold, NY 11971-0959 1 7+ 5-180 Fax(631) 7 5-9502ht AO w, �� � ld o �yTelephone (6 Date Received APPLICATION FOR BUILDING PERMIT D E C E For office Use Only PERMIT NO. 01 Building I ',� �, JUN 15 201,26 .................. Applications and forms must be filled out in their entirety.Incomplete 8011ding,lD ae nit applications will not be accepted. Where the Applicant is not the owner,an Town OfOUtho Owner's Authorization form(Page 2)shall be completed. Date:__±1 �] --ii OWNER(S)OF PROPERTY: SCTM# 1000L4- - Name; �✓ Project Add ss Phone#. 0 "--9 c73 Email.,. Mailing Address. 06 W�I r/u, r., �. . e_1 CONTACT PERSON: i Name: Mailing Address Phone#: Email: DESIGN PROFESSIONAL INFORMATION: Name Mailing Address: - P h 0 n e"#.4,�.�:,,- Email.�; � WNT A I F , Name* Mailing Address; Phone#:� Email [DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure Addition DAlteration EI Repair I Demoilition Estimated Cost of Project: ❑other -.-C...... Will the lot be re-graded? Oyes El No Will excess fill be removed from premises? ❑Yes ❑No ......................... PROPERTY INFORMATION Existing use of property: intended use of property.: Zone or use district in which premises is situated- Are there any covenants and restrictions with respect to this property? E]Yes RNo IF YES., PROVIDE A COPY. El Ch�eck,B�ox,,,Afte,r,,,R,'�eao,"*Ilil,g,�,,,,Thleowner/contractort,4esi,,gn professional is responsible for all drainage,and'storm water issues provided by, chapter 236 ofthe,Tot'n 1� e,�6� 6 tm,ent for th, uildlng Permit porsuant to theBuilding Zone . TION IS HERESYMADE'tothe Building Depar e issuance of a 8 "T otdina0ce the own of Southold,,Suffolk,County,New York and other applicable,Laws,;Ordinances or Regulations,for the,construction 0f`huJW addition 1$,,afterations or for removal or demlition as herein describled.The applicant agrees tocomply With all applicable,laws,ordinances,building code, housing"Clodeand,regulations an,d to admit authorized lbspectorson premises and in building(s)for nexessary,Inspertions.False,statements made herein are puni'sba.ble as a Class A mi5demea ugotto Section 210.45 of the New York State Penal Law. Application Submitted By(print name): A. I ElAuthorized Agent Owner Signature of Applicant: Date: (o-- 15- 2 STATE OF NEW YORK) SS: C 0 U N TY OF R 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 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 day of vl� 20 N ,to Public PROPERTY OWNER AUTHORIZATION T9,, ACEY L DWYER WTAFIY PLOWC,STATE OF NEW YORK (Where the applicant is not the owner) NO.01 OW6306900 04 IFIED IN SUFFOLK COUNTY la" 2.0240 COM, 'SStON EXP11RE%JUNE 30, residing at do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2