HomeMy WebLinkAbout52150-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#: 52150 Date: 08/06/2025
Permission is hereby granted to:
Lockman Family 2023 Irr Trt
PO BOX 2
Laurel, NY 11948
To:
Legalize alterations to an existing single-family dwelling to convert half story to habitable space as
applied for. Additional certification may be required.
Premises Located at:
1420 Laurelwood Dr, Laurel, NY 11948
SCTM# 127.-5-6
Pursuant to application dated 05/23/2025 and approved by the Building Inspector.
To expire on 08/06/2027.
Contractors:
Required Inspections:
Fees:
As Built Alteration $1,197.00
CO Single Family Dwelling-Addition /Alteration $100.00
Total $1,297.00
Building Inspector
o 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 https:,//www.sotil�hold.towriny.gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. 01 ✓ ® Building Insp ctor; fi)-- M ' 2 3 2025 �
Applications and forms,,must be filled out in their entirety. Incomplete BLsilding Department
applications will not be accepted, Where the,Applicant is not the owner,an Town of Southold
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY;
Name: (kb4-fA - A Ovwoxm 1 SCTM# 1000- a'� -
ProjectAddress: 1470 „ ��� Q' _'lLQLis
Phone#: ��l- �q 3 Email rbo 'r�"I . C_A9
l `t
Mailin Address: ttic �k
g I�,O CCU .
CONTACT PERSON:
Name: O�d�,Q*
Mailing Address: �„Q, ',Z QqLW
Phone#: &*a7t- �2-qlzr- 4SJS-05 Email ) ° �
DESIGN PROFESSIONALINFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address: �, ,{�— (Jj,
Phone#: Email:
DESCRIPTION OF,PROPOSED CONSTRUCTION
❑New Structure ®Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
Other iVYVI ale t VA. 'Qfty htd .cl-± $ KVt
Will the lot be re-graded? ❑Yes-)-6-`No Will excess fill be removed GYn premises? ❑Yes ❑N
1
PROPERTY INFORMATION
Existing use of property: A Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? Dyes Xlo 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 comp ty with all applicable laws,ordinances,building code,
housing code and regulations and to admit authorized inspectors ori` remises and in bugding(s)for necessary Inspections.'False statements made,herein are
punishable is a Class A misdemeanor pursuant to Section ilO.'0 of the New York State Penal`law.
Application Submitted By(print name): 1�'b�3C>t l'0�� "' ❑Authorized Agent ,,'Owner
Signature of Applicant: Date: /%2 2V6—
CONNIE D. BUNCH f
Notary Public,State of New York
STATE OF NEW YORK) No.01BU6185050
SS: Qualified in Suffolk Countyca:�
COUNTY OF ) Commission Expires April 14,2
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 kj ,20
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
L, 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