HomeMy WebLinkAbout52220-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#: 52220 Date: 08/28/2025
Permission is hereby granted to:
Breezy Shores Comnty Inc
PO BOX 925
Mattituck, NY 11952
To:
Cottage#10- Install an HVAC mini-split AC only unit to an existing unheated cottage as applied for.
Premises Located at:
65490 Route 25, Greenport, NY 11944
SCTM#53.-5-12.6
Pursuant to application dated 07/22/2025 and approved by the Building Inspector.
To expire on 08/28/2027.
Contractors:
Required Inspections:
Fees:
HVAC $250.00
CO-RESIDENTIAL $100.00
Total $350.00
Building Inspector
TOWN OF SOiJ'THOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone(631) 765-1802 Fax(631) 765-9502 htt :l/Nv w.southoldtownn . ov^
Date Received
APPLICATION FOR BUILDING PERMIT
E C E � V E
For office Use Only
PERMIT NO. Buildinglnspector: 'Jin k.J�. L 2 2025
Applications and forms must be failed out in their entirety.Incomplete Building Department
applications will not be accepted. Where the Applicant is not the owner,an Town of Southold
Owner's Authorization form(P 2)shall be completed.
Date: _31,1 17 9.04Gr
OWNER(S)OF PROPERTY:
Name: SUM# tiOtD-
Project Address: rQ_,t2f\ " 1,9�2
Phone#: �1 6 "� ` Email:
Mailing Address:
CONTACT PERSON:
Name:
Mailing Address: Lh 0A L), 30
Phone#: 27. Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name: S�ar
Mailing Address: I JrD O 7naj 1 C G ` .
Phone#: (P31 — r7,3 Lf— & YAP
C Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure,❑Addition ❑Alte ation El Repair Demolition Estimated Cost of Project:
1lther '" AL UNLY
Will the lot be re-graded? ❑Yes ❑No Will excess fill be removed from premises? ❑Yes ❑No
I� 1
PROPERTY INFORMATION
Existing use of property: ac6a)kL44mIntended 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/.41 ector/design professbnd Is responsible for all drainage and stone water issues as provided by
Chapter M 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 Regulatl=6 for the construction of buildings,
additions,alterations or for removal or demolition as herein dash.The applicant alpa to comply with all applicable laws,onllner ms,building code,
housing code and regulations and to admit,tutimated Inspectors on premises and In bullding(s)for necessary Inspection.False state nranb made haebn we
punishable as Class A misdemeanor pursuant to Section=45 of the New York State Penal Inn.
Application Submitted By(print name): ❑Authorized Agent ❑Owner
Signature of Applicant: Date:
STATE OF NEW YORK)
SS:
COUNTY OF
being duly sworn,deposes and says that(s)he is the applicant
(Name of dividual signing contract4bove 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
�� a
day of � 2D
A ota Public
NAOMI MULLMAN
PROPERTY OWNER H !ZATI �(ary Public,State of New York
(Where the applicant is not the owner) Q Reg. No.02MU6061848
ualified in NewYork County
Commission Expires December 7,2025
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