HomeMy WebLinkAbout52161-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#: 52161 Date: 08/08/2025
Permission is hereby granted to:
Peconic Landing @Southold
1500 Brecknock Rd
Greenport, NY 11944
To:
Unit#54-Construct additions and alterations to an existing single-family unit as applied for.
Premises Located at:
1205 Route 25, Greenport, NY 11944
SCTM# 35.-1-25
Pursuant to application dated 06/02/2025 and approved by the Building Inspector.
To expire on 08/08/2027.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Addition&Alteration $666.00
CO Single Family Dwelling-Addition /Alteration $100.00
Total $766.00
Building Inspector
G' SV
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
x " Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959
r
Telephone (631) 765-1802 Fax (631) 765-9502 httys://www.sout,holdto mp . o
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. 5RI6� Building Inspector, JUN .. 2025
Applications and forms must be filled out in their entirety. Incomplete StilldInig Del artment
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: R SCTM # 1000- 3S
Project Address: C.hrcv,;,Aeo NN 19 `-FL4
Phone#: �03� _t�-��(_3p Email:
Mailing Address:
CONTACT PERSON:
Name: t-r )O1 I i Mailing Address:
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address: _
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address: oZ O ( �J�n .-.Un -F f�jpn�GOn�o►�Y�q_, /) 1 79
Phone#:
"ocSO -� DaO(o Email: ( SS�tI�Ch�tre 1 Con'Irnc r u .
DESCRIPTION OF PROPOSED CONSTRUCTION
[--]New Structure Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $ rl o,0 d 0
Will the lot be re-graded? ❑Yesjk'N-'o Will excess fill be removed from premises? ❑Yes yNo
1
PROPERTY INFORMATION
Existing use of property: � 1w� intended use of property:1_�5,pk e,,mAw_A
Zone or use district in which premises is situated: Are there any covenants d 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 Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
Application Submitted By(print name)jo�0e(,-J 5,trPN gAuthorized Agent ❑Owner
Signature of Applicant: .---- Date: -02-,3
STATE OF NEW YORK)
SS:
COUNTY OF Ir
ter 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
291 day of , 20 2__�D
Notar Y
Pub I
LISA QUINN
NOTARY PUBLIC-STATE OF NEW Yl
PROPERTY OWNER AUTHORIZATION No. O1 QU6222447
Quallfiad in Suffolk County
(Where the applicant is not the owner) Commission Expires May 24, 20,
1, residing at YS0 0 � .- � N-1
do hereby authorize -e ,f, -g co t" "t apply on
my behalf to the Tovin of Southold Building Department for approval as described herein.
VaIA� __§L-)-a wlf�_
Owner" nature Date
Print Owner's Name
2