HomeMy WebLinkAbout52489-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#: 52489 Date: 11/21/2025
Permission is hereby granted to:
Stephan B Segouin
5673 High Flyer Rd S
Palm Beach Gardens, FL 33418
To:
Construct interior repairs to include partial sheetrock,insulation, plumbing and electric due to water
damage. No structural alterations.
Premises Located at:
380 The Strand, East Marion, NY 11939
SCTM#21.-5-4
Pursuant to application dated 11/18/2025 and approved by the Building Inspector.
To expire on 11/21/2027.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $250.00
CO-RESIDENTIAL $100.00
Total S350.00
Building Inspector
n� 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 1)s./1 ;�� It���.�� o : ° ,1' �.
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
J ,
PERMIT NO. 5D Building Inspector; 1
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date:11/2/25
OWNER(S)OF PROPERTY:
Name:Stephan Segouin ScrM# 1000-
Project Address:380 The Strand, East Marion
Phone#:917-912-3096 Email:
Mailing Address:5673 High Flyer Rd S, Palm Beach Gardens, FL 33418
CONTACT PERSON:
Name:Stephan Segouin
Mailing Address:5673 High Flyer Rd S, Palm Beach Gardens, FL 33418
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Jimail-
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration RRepair ❑Demolition Estimated Cost of Project:
❑OtherReplacing damaged drywall&floors from flood,adding a few sconces,covered by insurance claim $50,000
Will the lot be re-graded? ❑Yes MNo Will excess fill be removed from premises? ❑Yes *No
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PROPERTY INFORMATION
Existing use of property:Second home Intended use of property:Second home
Zone or use district in which premises is situated.. Are there any covenants and restrictions with respect to
this property? ❑Yes A No IF YES, PROVIDE A COPY.
,,^ responsible for all drainage and storm water issues as provided by
�9���1u���u h,.���1��, ,��� N ��"u�u�:����tl6 �rwFW�� The professionalisre p g
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.
Stephane Segouin
Application Submitted (print na e : ❑Authorized Agent ROwner
Signature of Applicant Date:
STATE OF NEW YORK)
SS:
CO U NTY 0 F 5U4r ' __ )
being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the Loc7 e g—
(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
yof / Y�_ Y . 20 Q)C5 �,4110
ry Public
I'40T-,STY P9 ii L Iwo, 9 TATE OF NEW YQR
(Where the applicant is not the owner) R1""Ib I �wl� tKco�Jl
COMM`38.'ON
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