HomeMy WebLinkAbout52040-Z # TOWN OF SOUTHOLD
4
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
`� N ; `
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#: 52040 Date: 06/26/2025
Permission is hereby granted to:
Thompson AH Rev Trt
PO BOX 1248
Cutchogue, NY 119350883
To:
install window and door replacements to existing single-family dwelling as applied for..
Premises Located at:
355 Praity Ln, Cutchogue, NY 11935
SCTIVI# 109.-5-14.3
Pursuant to application dated 05/22/2025 and approved by the Building Inspector.
To expire on 06/26/2027.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $250.00
CO-RESIDENTIAL $100.00
Total $350.00
�Wftlj_ng Inspector
sffFur TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box H 79 Southold,NY 1 1971-0959
V Telephone (631) 765-1802 Fax (631) 765-9502
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
b � .
I�
PERMIT NO. v Building Inspector:
Applications and forms must be filled out in their entirety. Incomplete Builds fe ar"ti e t
applications will not be accepted. Where the Applicant is not the owner,an """own Of Southold
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: Ann Thompson SCTM#1000-
Project Address: 355 Praity Lane
Phone#: 631- ci g —7 — g 4, 7 Email. Thompsonann13@gmail.com
Mailing Address: PO Box 1248
CONTACT PERSON:
Name:Ann Thompson
Mailing Address: PO BOX 1248
Phone#:631-734-8177 Email:thompsonann13@gmail.com
DESIGN PROFESSIONAL INFORMATION:
Name: N/A
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name: Renewal By Andersen LI
Mailing Address: 2029 New Highway Farm NY 11735
Phone#: 631-843-1713 x 2255 Email: cvalente@rbalongisland.com
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure❑Addition RAlteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other Replace 2 windows and 3 doors $ 51854
Will the lot be re-graded? ❑Yes 10No Will excess fill be removed from premises? ❑Yes *No
1
PROPERTY INFORMATION
Existing use of property: Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes *No 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 pass A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
Application Submitted By(print name):Ann Thompson ❑Authorized Agent @Owner
Signature of Applicant: _ Date:
STATE OF NEW YORK)
SS:
COUNTY OF Suffolk
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 t '9J.
BARBARA H. TANDY
Sworn before me this Notary Public, State Of New York
No. 01 TA0060001
Aday of Ma 25uallfled In Suffolk County
,20 � iaalort �xr�ir "�' a7
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
q 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