HomeMy WebLinkAbout51906-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#: 51906 Date: 05/09/2025
Permission is hereby granted to:
Frances A Decarolis
1 Old Farm Rd
East Hills, NY 11577
To:
legalize "as built" interior alterations to existing single-family dwelling as applied for. Additional
certification may be required.
Premises Located at:
1900 Glenn Rd, Southold, NY 11971
SCTM#78.-2-36
Pursuant to application dated 04/01/2025 and approved by the Building Inspector.
To expire on 05/09/2027.
Contractors:
Required Inspections:
Fees:
As Built Alteration $585.00
CO-RESIDENTIAL $100.00
Total S685.00
Building Inspector
TOWN OF SOUTHOLD-BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. 0.Box 1179 Southold,NY 11971-0959
Telephone(631)765-1802 Fax(631)765-9502 htt vM.southoldtow . n
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 Building
of Southold
rling Upat tfrrtent
Owners Authorisation fonts(Page 2)shall be completed.
Date: 3 a S
OWNER(S)OF PROPERTY:
Name: SUM#1000-
lI — -3 6
ProjectAddress: L feivi 17 1
Phone M 5 6 1 - 3 Email: FA,AM AA-r D 0,JC /ncq cal,
Mailing Address: Lb F*9M k) ' - 7
CN'ACr PERSON:
Name: fA61U,S ' ,
Mailing Address: '
Wig EL
Phone#: 5'1(0 Email:
1
1 AY
e(a/..ID G'rti i fvdtth MU 9rrt Ri ,r 'I RIViIATi MON:
Name: .w» r . . _-Te MRt
Mailing Address:
Phone#: Email: C � wyle•'L-A2ki►Tot LTIJ-�1.
Name:
Mailing Addr : Alet
Email Phone#: \ . t'( "" 50� :_30.e 03 (A STUM�)u IV t
DESCRIPTION OF
ONew Structure OAddiidon"4fteration ORepair ODemolitlon Estimated Cost of Project:
00ther $ S 0ICU
Will the lot be re-graded? CYes o Will excess fill be Medl from premises? OYes ONo
P
I
PROPERTY INFORMATION
Existing use of property: Din rlq Intended use of property: i Di-/V fAIL
i Zone or use district in which premises Is situated: Are there any covenants and restrictions with respect to
this property? Dyes PINo IF YES,PROVIDE A COPY.
❑Check Box After Reading: TMrrsoW profes kmWbrespomlblaforaMdrsUapandstormwaleIMMasprswtdrdby
Ch1pW 2N oHha Teem Gods APRIRJITRDN 15 HUM MADE to ft Mjaft Dsvo rent for the bsuaroe oft kdft Pan*pwan"to do&Oftzww
Wftwa of the Town of Southold,S M A4 C ",Nm Yank and other laws, or R gpbdm for the aonserrretlon of
eddldons,Ntwadons or for re re ml or danollft a basin desalbed.The appkm apses to=npy wkh aA sppAable laws,erd WWK,W14*osde,
soda and and to adMt autliorbad ktspadors on prembas and In bu WW9)for nimaryinspeOW&FWn W&do ih*us
aesiaMlnor pu>suantm seoZlon 210.45 Mtla tttwwYark State f+e1 leer,
Application Submitted By(print name): l"" DP r�l�.r ❑Authorized Agent KOwner
Signature of Appil t: Date. 3 C 7 �
STATE 0.
�S
COUNTY OF ,
�' Sbe to Q L S being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the .Q
(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
Notary Plid Mr c e ce
�` Ce mrrSrCr.44
Y
C
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
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