HomeMy WebLinkAbout47548-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
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 #: 47548 Date: 3/15/2022
Permission is hereby granted to:
of Southold
Town..............�...�.�.�.�.�.�........................._.____wwwwwww......................................�.... �.
53095 Route 25 _-.....................................................�.....................................................__......
..._........_._._._.__._..__ _...__._._ _...._.. ._........... _ ..
PO BOX 1179
Southold, NY 11971
To: construct bathroom alterations to existing recreational building.
At premises located at:
970 Peconic Ln., Peconic
SCTM # 473889
Sec/Block/Lot# 75.-1-15.2
Pursuant to application dated 2/3/2022 and approved by the Building Inspector.
pi 9/14/2023.
To expire on
Fees:
Total: ...w.................._._a.......��.........$0.00
.:m. ... .........................
Buil wing „
Inspector
TOWN OF SOUTHOLD-WELDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
«• Telephone (631) 765-1802 Fax (631) 765-9502 h :/dmwr .oolatboldtowian . g
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. Building 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 ``�'�� 0!
Owner's Authorization form(Page 2)shall be completed.
Date: ® �
OWNER(S)OF PROPERTY:
Name: �+. SCTM#1000- 07.5.00 -04 400 - 415.002—
Project Address:
Phone#: 631-765-1560 Email: mich el.ccllin town. outheld.ny.us
Mailing Address: 53095 Route 25 Southold Y 11971 Michael
CONTACT PERSON:
Name: Michael Collins P.E., Southold Town Engineer
Mailing Address: 53095 Route 25 Southold Y 11971
Phone#: 631-765-1560 Email: micheel.colli S kta ri.SOut t l .ri .tai
DESIGN PROFESSIONAL INFORMATION:
Name: —)AG6)V4FS-
Mailing Address: L�La ' 15,P427%/ W40-10
Phone#: 6 3/ Email: �G�¢,P •(r�
CONTRACTOR INFORMATION:
Name: TO BE DETERMINED
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition XAlteration []Repair ❑Demolition Esti gated Cost of Project:
❑Other ��" --
Will the lot be re-graded? ❑Yes/kINo Will excess fill be removed from premises? ❑Yes VNo
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