HomeMy WebLinkAbout52364-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
S
r OUTHOLD 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#: 52364
Date: 10/16/2025
Permission is hereby granted to:
Southold Studios LLC
1230 Traveler St
Southold, NY 11971
To:
replace windows and doors to an existing dwelling as applied for.
Premises Located at:
1230 Traveler St, Southold, NY 11971
SCTM# 60.-2-1
Pursuant to application dated 09/04/2025 and approved by the Building Inspector.
To expire on 10/16/2027.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $250.00
CO-RESIDENTIAL $100.00
Total 350.00
Building Inspector
Y tlSl•4'G fM"
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 http�s:/'/www,southoldtownqyeov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only I E C E V E
PERMIT NO. Building Inspectcra
E P - 02
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an Building Department
Owner's Authorization form(Page 2)shall be completed. Town Of Soutbo,Jd
Date: Aq c-7_ 2-0, ZvZ S
OWNER(S)OF PROPERTY:
Name: Jo N rJ 1Q AY,9� SCTM# 1000- � Q —
Project Address: 23 I�PtV �
Phone#: (93 I♦ ,55 3 . 2A Zp Email:
Mailing Address: IZCI tZV[—('(r-�Cr %X
CONTACT PERSON:
n
Name: \TO H N
Mailing Address: zc� 60FFIN67 N
Phone#: ( _ 5 Email:
DESIGN PROFESSIONAL INFORMATION:
Name: j WAC �)2— l
Mailin Address:
Phone,#: l —SS Z��6 Email:
CONTRACTOR INFORMATION:
Name: b V V
Mailing Address: ZA EE A' N L (-,
Phone#: t _ ���� Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Stri ctiur ❑AdItion, ❑AlterationXRepair ❑Demolition Estimated Cost of Project:
❑Other
Will the lot be re-graded? ❑YesgNo Will excess fill be removed from premises? Dyes/X to
1
PROPERTY INFORMATION
Existing use of property: �� 5 Intended use of property:R(51D�
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes RNo 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
Ord Wanc�of the Tq n of outhbld,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings,
additions; flteratlol ( Ul reAval war'demolitlon 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,B'y(print name): o�(� 1/�>ahy� ❑Authorized Agent ❑Owner
Signature of Applicant: y Date:
STATE OF NEW YORK)
SS:
COUNTY OF
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 20
Notary Public
PROPERTY OWNER AUTHORIZATION A
(Where the applicant is not the owner) A
I, residing at Zf(
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