HomeMy WebLinkAbout50178-Z s' 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#: 50178 Date: 1/3/2024
Permission is hereby granted to:
First Southold Co
Route 25
PO BOX 1468
Southold, NY 11971
To: install window replacements to existing commercial building as applied for.
At premises located at:
54655 Route 25, Southold
SCTM # 473889
Sec/Block/Lot# 61.-5-2
Pursuant to application dated 10/12/2023 and approved by the Building Inspector.
To expire on 7/4/2025.
Fees:
NEW COMMERCIAL, ALTERATION OR ADDITIONS $300.00
CO-COMMERCIAL $50.00
Total: $350.00
Building'Inspe for
ti
TOWN OF SOUTHOLD—BIDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
�4 Telephone(631)765-1802 Fax (631)765-9502 ,: y
�r R-
Date Received
IIIA° IIS,
A 71
For Office Use Only U
5I I� Buildin Inspector,.PERMIT NO. 6 p 0 C1 1 202
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an Building Department
Owner's Authorization form(Page 2)shall be completed. Town of Southold
Date:9/29/23
OWNER(S)OF PROPERTY:
Name:Second Southold Company, LLC SUM#1000-
Project Address:54655 Main Road, Southold, NY 11971
Phone#:617.763.0365 1 Email:mike 0secondsoutholdcompany.com j
Mailing Address:54655 Main Road, Southold, NY 11971
CONTACT PERSON:
Name:Michael D Rose
Mailing Address:54655 Main Road, Southold, NY 11971
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:DJP Home Improvement
Mailing Address:677 Herricks LN, Riverhead, NY 11901
Phone#:631.875.5476 Email:davidjimenezl931@hotmail.com
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure [--]Addition ❑Alteration RRepair ❑Demolition Estimated Cost of Project:
❑Other v✓i'#1cl 0-'45 $18,000
Will the lot be re-graded? ❑Yes W No Will excess fill be removed from premises? ❑Yes 'WNo
1
PROPERTY INFORMATION
I,
Existing use of property:Office / Retail Intended use of properly:Same
Zone or use district In which premises is situated: Are there any covenants and restrictions with respect to
Hamlet Business this property? ❑Yes 8'No IF YES, PROVIDE A COPY.
R Check III Ox After Reding: 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 210AS of the New York State Penal Law.
Application Submitted e)•Mi ael ROSe ❑Authorized Agent @Owner
Date:-8/29/28 IC 1*q123
Signature of Ap;plica II 0
STATE OF NEW YORK)
SS:
COUNTY OF Suffolk )
Michael D Rose being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the Owner
(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
j' �
�.,,�,�
day of 20k"
Notary Puc
QFB PAAN A.WOJCIK
PROPERTY AUTHORIZATION Notary P'ulal 901 of New Yo
rk
No. 9�tdk
_ .„�.... Qualified in Suffolk Count
(Where the applicant Is not the owner)
commission Expires Dec.30„ ..,�..
I, 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