HomeMy WebLinkAbout52208-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#: 52208 Date: 08/22/2025
Permission is hereby granted to:
6955 Route 25 Corp
PO BOX 199
Mattituck, NY 11952
To:
Construct additions and alterations to convert an existing commercial retail building into a multi-use
commercial building with full sprinkler system to include retail and 3 apartment units as applied for
per SCHD approval.
Premises Located at:
6955 Route 25, Laurel, NY 11948
SCTM# 122.-6-36
Pursuant to application dated 04/09/2025 and approved by the Building Inspector.
To expire on 08/22/2027.
Contractors:
Required Inspections:
Fees:
Commercial-Addition & Alteration $2,515.50
CO Commercial-Addition/Alteration $100.00
Total $2,615.50
Building Inspector
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Fat* 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 littl)s://www.,sotitholdtowniiy.ggv
Date Received
APPLICATION FOR BUILDING PERMIT [ C [ 0
l
a
For Office Use Only
bJ'
PERMIT NO. Building Inspector: t -61)- i
Applications and forms must be filled out in their entirety. Incomplete 1 OWT1 0, 'Snu,.i� bd1
applications will not be accepted.-Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date::
OWNER(S)OF PROPERTY:
Name: �qrs i uk e ZS Corp scTM# s000- 122- NO- Vo
Project Address: (0 5-5- It jtt. -.�7►n.c,Je_' IVY
Phone#: Email: dawlll i 1 00 id'A . Atf-
Mailing Address: t fps- 66,J� Pwf, Ma+44Rtle- NY 119!�-2
CONTACT PERSON:Name: JqC V1 C0.m C
Mailing Address: 120 BOX 5 1-1 Jama or+- IV ll / 7 -7
Phone#: �31_eay_ 37y Email: dYl.CYVC�0.YG�l+�C'IUr{�tJ rYlGC��•If
DESIGN PROFESSIONAL INFORMATION:
Name: C,hU y Iti �rwiq-S
Mailing Address: PO Bw 977 J&krtt ort IVY 11 y 17
Phone#: 5)1c - 10Z- 3S1C/ Email: rrtaS 63(0aDI•CLv✓1
CONTRACTOR INFORMATION:
Name: 7-6-1�)
Mailing Address:
Phone#: Email:
DESCRIPTION'OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ,Wlteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $ �
Will the lot be re-graded? ❑Yes BPUo Will excess fill be removed from premises? ❑Yes -RNo
PROPERTY INFORMATION
Existing use of property: 'Rohl;( Intended use of property: A KCd use CKz1-0.1 I t-gwm
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 prcif'essional is responsible for all drainage and stcarrn water Issues as provIcledby
Chapter 236 of the Town Cade. Af°PIICATION lS ifEflE y MADE to the Building Department1or type issuance of a Building pasratalt pursuant to fife Buildingone
Ordinance of the Town of Southold,Suffolk,County,New`York and tither 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 appilcabla lay s,otMnances,bulldiog code,
housing code and regulations andto 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 B (print name): Gti^l Cam C f�
pp y(p ) ,� G) ram_ ,®Authorized Agent ❑Owner
Signature of Applicant: Date:
CONNIE D.BUNCH
STATE OF NEW YORK) Notary Public,State of New York
No.01 BU6185050
55: Qualified in Suffolk County
COUNTY OF ) Commission Expires April 14,2_W�
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 Avn ZO!�-.
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
residin at
ff g
6khereby authorize Megan Carrick to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
L131c) �
Owner's Signature Date
"
Print OWher's-Name
2-