HomeMy WebLinkAbout51459-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#: 51459 Date: 12/10/2024
Permission is hereby granted to:
28970 Main Rd LLC
78-12 Horseblock Rd
Yaphank, NY 11980
To„
Construct alterations to an existing commercial building as applied for.
Premises Located at:
28970 Route 25, Cutchogue, NY 11935
SCTM# 102.-6-22
Pursuant to application dated 09/26/2024 and approved by the Building Inspector.
To expire on 12/10/2026.
Contractors:
Required Inspections:
Fees:
Commercial- Alteration $660.00
CO Business $100.00
Total $760.00
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
I'DTelephone(631) 765-1802 Fax (631) 765-95021�tt s:llw�w^w.southoldtowna .
Date Received
APPLICATION FOR BUILDING PERMIT I 17--�N
For Office Use Only
PERMIT NO. � _._. Building Inspector: A -� S F.P 2 6 q_=,
Applications and forms must be filled out in their entirety.Incomplete r't. ', C prpm
applications will not be accepted. Where the Applicant is not the owner,an X SOT17"R 1
Owner's Authorization form(Page 2)shall be completed. TOE
Date:09.24.24
OWNER(S)OF PROPERTY:
Name:North Shore Window Inc. SCTM#1000-102-6-22
Project Address:28970 Main Rd, Cutchogue, NY 11935
Phone#:631.676.4800 Email:darenm@NORTHSHOREWINDOWINC.COM&ni&b@NORTHSHOREWINDOWINC.COM
Mailing Address:78 Horseblock Road, Unit 12 Yaphank, NY 11980
CONTACT PERSON:
Name:Zackery E. Nicholson, RA
Mailing Address: 1250 Evergreen Drive - Cutchogue, NY 11935
Phone#:631.513.6589 Email:ZENicholson.Arch@gmail.com
DESIGN PROFESSIONAL INFORMATION:
Name:Zackery E. Nicholson, RA
Mailing Address:1250 Evergreen Drive - Cutchogue, NY 11935
Phone#:631.513.6589 Email:ZENicholson.Arch@gmail.com
CONTRACTOR INFORMATION:
Name:TBD
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition liAlteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $200000
Will the lot be re-graded? ❑Yes W No Will excess fill be removed from premises? ❑Yes *No
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PROPERTY INFORMATION
Existing use of property:MERCANTILE - GROUP M Intended use of property:MERCANTILE - GROUP M
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
HB this property? ❑Yes ®No IF YES, PROVIDE A COPY.
M Check Box After Receding: The owner/contractor/design professional is responsible for all drainage and storm water Issues as provided by
Chapter Z36 of the Town Code.APPLICATION IS HEREBY MADE to the Building Department for the Issuance of a Building Pennit 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 Section210A5 of the New York State Penal law.
Application Submitted By(print name):Zackery E. Nicholson, RA (i"J:Authorized Agent ❑Owner
Signature of Applicant: Date: Z6, Z V
STATE OF NEW YORK)
COUNTY OF .. I —)
,znc�cw I being duly sworn, deposes and says that(s)he is the applicant
(Name of in 'vid al signing contract)above named,
(S)he is the
(Contra, , Agent, orporate Officer, etc.)
of said owner or owners, and is duly authorized top 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
rh h day of 5PL-A( M bCL .202
ary Public
TRACEY L. DWYER
NOTARY PUBLIC,STATE OF NEW YORK
1 WI PIUwIIII Wir OWNER UTI.1 IIZ TI '� 1' � 900
„, NO.�rBD'N�' �i
. . - ..... O ALIFIFD IN'SUFFOLK COUNTY
(Where the applicant is not the owner) CC)m SSION E pj1AESJUNE30.,
I Nicholas Bohlen 9
residing at 35795 Main Rd - Cutcho ue, NY 11935
do hereby authorize Zackery E. Nicholson, RA to apply on
my behalf to the Town of Southold Building Department for approval as described herein,
09.24.24
Owner's Signature Date
Nicholas Bohlen
Print Owner's Name
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