HomeMy WebLinkAbout53109-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD, NY
pC�Ca1fN1^�•'�``�
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#: 53109 Date: 07/07/2026
Permission is hereby granted to:
Jose Huertas
30 Horton Ave
Mattituck, NY 11952
To:
construct an accessory garage as applied for.
Premises Located at:
1150 Factory Ave, Mattituck, NY 11952
SCTM# 142:1-10.2
Pursuant to application dated 04/20/2026 and approved by the Building Inspector.
To expire on 07/06/2028.
Contractors:
Required Inspections:
Fees•
Accessory-New Structure $689.00
CO Accessory Structure $100.00
Total 789.00
Building Inspector
90
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�ro �� TOWN�T off' C LTT LOIN)—BIJI DING DEPARTMENT
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Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold, NY 11971-0959
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Telephone 631 765-1802 Fax 631 765-9502 b ps, w sou .o : own
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Date Received
APPLICATION FOR BUILDING PERMIT
Y W
For Office Use Only
R 2 0 C} Building Inspector:.
26
PERMIT N III
ientirety.
Applications and farms must be filled out in their 1 ncc�rr�Incomplete
op! l o s,will not be ce ed, Where the Appti nt is not the t wr er,an
awn es A t� or,6,tion form page 2)-shall be completed.
Date:
OWNER(S)OF PROPER IT,Y*
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N a m e,, �� � '� µ '� „ � � SCT11�! # 1000- 0
Project Address- [::Auro
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Phone a
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Mailin Address:
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CONTACT PE
Name,
Mailing Address." "'"'�� �y i ' � �IW... ^i��
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Phone#: Email.-
DESIGN PROFESS[O,NAL,INFORMATIO�N,-
Name:
Mailing Address:
Phone#: Email:
Name.
Mailing Address
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCT10N
*ewStructure ❑Addition DAlterartion F Repair ❑Demolition Estimated Cost of Project:
F7 Other
11V11I the lot be re-graded? ❑Yes )(No will excess fill be removed from premises? DYes KNO
PROPERTY INFORMATION
Existing use of property; Intended use s e of property: ;—
'., Or) �j-k
i or uS+ district in 1r`vhich� pre iScs i situ@+ r r�' then:' any,, ;,rc�. an t�s and restrictions with
th rp.spArt to
this property? ❑Yes ❑No IF YES, PROVIDE A COPY.PY.
owner/contractor/design professional is responsible foralt drainageand storm water, vided
Chaloter 236 of the'down Code. APPLICATION 1,51 HEREBY �, '
OrdJwnce of the To I 'wn of l " gZ
appilcable Laws,,ordinances or Regulations,for the construction of buildings),
additions,atterationsor for removal or demolition as hereJh described."The ! li agrees, ,comply w h all applicable laws, r� e ,.'bull ���
housing code and regulations,end � � � it authorized inspectors onens,pections. herein'ements's made
puffillsl Y � om usestat
u S ct '� � S f h New Yoh Stave al
Application Submitted B
rant r�,ame�� ❑A
y ' ` uthorized Agent own
u g er
Signature of Applicant:
E, BUNCH� Date: 10,
-.-�.
ry PU Ia a of New York
STATE OF NEW YO R K) No.01 SU6185050
Qualified In Suffolk County
Commission Expires April 14 2
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
(Contractor, Agent, Corporate Officer, etc.
of said owner or owners, and is duly authorized to perform or have performed the said work
k and to make and file this
application;that all statements contained in this application are true to the best of his/her kno
wledge and belief; and
that the work will be performed in the manner set forth in the application file therewith.
Sworn before me this
ay of i0
Notary Public
PROPERTY OWNER AUTHORIZATION
(where the applicant is not the owner
I� residing at
do hereby authorize
to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
m
Owner's Signature Date
Print Owner's Name
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