HomeMy WebLinkAbout53235-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#: 53235 Date: 08/26/2026
Permission is hereby granted to:
Daniel Bishop
650 Blossom Bnd
Mattituck, NY 11952
To:
Construct alterations and additions to an existing single-family dwelling to include a HVAC system and
outdoor shower as applied for.
Premises Located at:
650 Blossom Bend, Mattituck, NY 11952
SCTM# 115.-6-25
Pursuant to application dated 08/13/2026 and approved by the Building Inspector.
To expire on 08/25/2028.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Addition&Alteration $250.00
CO Single Family Dwelling-Addition /Alteration $100.00
Total $350.00
JA ou
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 lames:r"/"www.soLitLioldLo y V. cLy
Date Received
APPLICATION FOR BUILDING PERMIT .
For Office Use Only
5 PERMIT NO. 53__—
OS - Building Inspector;_J . . w_. _
Applications and forms must be filled out in their entirety.Incomplete Bts11din I e aar m nt
applications will not be accepted. Where the Applicant is not the owner,an Ta rn Of Southold'
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: `,0 .� ° + 4 SCTM# 1000-
Project Address: � \1�C. `3 2_
Phone#: � ( �� �Z Email: �- �/� '5
Mailing Address: jw_a' "
CONTACT PERSON:
Name: .
vv ��vv
Mailing Address:
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name: t
A& k'V c
Mailing Address: U Q' q
Phone#: coS „_ Si CJ Email:.
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑lN�
, New Structure ❑Additio ❑ an ❑ ��
Alteratlo Repair Demolition Estimated Cost of Project:
L°!IOther I c�
Will the lot be re-graded? ❑Yes ❑No [A5 W111 excess fill be removed from premises? ._Yes ❑No
1
PROPERTY INFORMATION
Existing use of property: Intended use of property:
Zone or use district in which premises is si iated: Are there any covenants and restrictions with respect to
this property? ❑Yes ❑No IF YES, PROVIDE A COPY.
❑ 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 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 210.45 of the New York State Penal Law.
Application Submitted By(print e): � "l ti Q t ❑Authorized Agent Owner
Signature of Applicant: NNIE D.BUNCH Date:
o Iy Public,State of New York
No.01 BU6185050
STATE OF NEW YORK) Qualified in Suffolk County �j
SS: Commission Exoires April 14, 204;
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 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 �C�
I `��day of � 1"`1 .� , 20
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
l residing at
da 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