HomeMy WebLinkAbout52413-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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#: 52413 Date: 10/29/2025
Permission is hereby granted to:
Krakowsky P 2020 Trust
105 Seeley Rd
Wilton, CT 06897
To:
Install a generator accessory to an existing single-family dwelling as applied for.
Premises Located at:
1880 Isabella Beach Rd, Fishers Island, NY 06390
SCTM# 10.-6-1.7
Pursuant to application dated 10/24/2023 and approved by the Building inspector.
To expire on 10/29/2027.
Contractors:
Required Inspections:
Fees:
GENERATOR $125.00
CO-RESIDENTIAL $100.00
Total $225.00
Building Inspector
t d
�N f Franc? 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 httt)s://www.southoldtownny.gov
Date Received
APPLICATION FOR BUILDING PERMIT
'c For Office Onl
y
U
Y
PERMIT NO.
5aLt i 3 Building Inspector. 2
_
0 CT 2 7 2025
Applications and,forms must be filled out in their entirety.Incomplete
appikations wiil,not be accepted Where the Applkont Is not the owner,an
rr Buildinq „
Owner's Authorizatlon form' P 2 shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: LCCci Vd—3 SCTM#1000- f 0 te--t, 7
Project Address: e,6 6& 17,
Phone 4 Email:
Mailing Address:
CONTACT PERSON:
Name: ��.-`
Mailing Address: t3 t -tt LL-1 FT At 1 -NICJ
Phone#: ��Q�"��� ���'� Email: j iv L lrwje1 Ste n-cA L v
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address: $9 L/ Ce^fOk- 67r0T A-) � 2
Phone#: ��� Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address: C1 (,Q 335
Phone#: Email:—
33 , PT L; . - ALA w IIVI
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
10ther G L AJ f $ ,3.60 O
Will the lot be re-graded? ❑Yes wNo Will excess fill be removed from premises? ❑Yes EYNo
1
x R
PROPERTY INFORMATION
Existing use of property: intended 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/contrxtor/design professional Is responsible for all drainage and storm water Issues as provided by
Chapter 236 of the Town Code. APPUCATION 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 taws,Ordinances or Regulations.for the construction of bulldbW,
additions,alterations or tar 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.raise statements made herein are
punishable as a Class A misdemeanor pursuant to Section 210AS of the New York State Penal law.
Application Submitted By(print name): `" �''^��9 � .,Authorized Agent ❑Owner
Signature of Applicant: Date:
STATE OF NEW YORK)
SS.
COUNTY OF aS
� being duly sworn, deposes and says thatAe is the applicant
(Name of individual signing contract)above named,
,Vhe is the ArMITT
(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 �
2023"
tary Public
3
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
11 f, � )
i �A— I'\�(�1"1�� r iding at C)6 s iRj Wu
f �o � '
do hereby authorize V Q. to apply on
my eh the Tow of S uthoId Bu ding Department for approval as described herein.
Owner's5 nature Date
Q�LAIy�aj-4,,
Print Owner's Nam=
2