HomeMy WebLinkAbout51452-Z a , 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#: 51452 Date: 12/06/2024
Permission is hereby granted to:
Scaglione KA Rev Trt
195 Railroad St
Bayport, NY 11705
To:
install window replacements to existing single-family dwelling as applied for.
Premises Located at:
1155 Main St, Greenport, NY 11944
SCTM# 34.-1-9
Pursuant to application dated 10/15/2024 and approved by the Building Inspector.
To expire on 12/06/2026.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $250.00
CO-RESIDENTIAL $100.00
Total S350.00
Building Inspector
,40,, V 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 litt s,//www.soutl oldtowii.i v
Date Received
APPLICATION FOR BUILDING PERMIT
r0
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 okra "d
Owner's Authorization form(Page 2)shall be completed.
Date: 9/30/24
OWNER(S)OF PROPERTY: n
Name: Kim Stahl 0q.00c7
Project Address: 1155 Main St 10co,C)m 'OD 01 0 o-c" d 0 ".0Ov
Phone#: 516-819-2730 Email: Kstahi15@aol.com
Mailing Address: 195 Railroad St Bayport NY 11705
CONTACT PERSON:
Name: Kim Stahl
Mailing Address: 195 Railroad St Bayport NY 11705
Phone#:516-819-2730 Email: Kstahl15@aol.com
DESIGN PROFESSIONAL INFORMATION:
Name: N/ A
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name: Renewal By Andersen Li / LiCC
Mailing Address: 2029 New Highway Farmingdale NY 11735
Phone#: 631-843-1713 x 2255 Email: Cvalente @rba long island.corn
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition W Alteration IR Repair ❑Demolition Estimated Cast of Pr j ct:
❑Other $_.a-.® � Rai
Will the lot be re-graded? ❑Yes @*No Will excess fill be removed from premises? ❑Yes WNo
1
N
PROPERTY INFORMATION
Existing use of property: Residential Intended use of property: Residential
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes iiNo 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 name): Kim Stahl ❑Authorized Agent ®Owner
Signature of Applicant: Date:
STATE OF NEW YORK)
S.
COUNTY OF � � �C)
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 October 20 24
Notary Public
(Where the applicant is not the owneCNOTARY
j1,T"o Y�a�aa 4 :idYl»Y'7
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
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