HomeMy WebLinkAbout52522-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#: 52522 Date: 12/05/2025
Permission is hereby granted to:
Lubin JF Living Trt
24 Tower Ct
Syosset, NY 11791
To:
install generator as applied for per Trustees approval.
Premises Located at:
2765 Wells Rd, Peconic, NY 11958
SCTM#86.-2-2
Pursuant to application dated 11/03/2025 and approved by the Building Inspector.
To expire on 12/05/2027.
Contractors:
Required Inspections:
Fees:
GENERATOR $125.00
CO-RESIDENTIAL $100.00
Total S225.00
Building Inspector
rta t y 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 htt s:Hwvwar'w soLi h ldtownti . ov
Date Received
APPLICATION FOR BUILDING PERMIT
� rr
For Office Use Only
PERMIT NO, Building Inspector A
r
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:
OWNER(S)OF PROPERTY:
Name: -Z�l M V Q �N SCTM# 1000- _
Project Address: a ►f s �/E!�-S ('�l� �-
Phone#: Email:
Mailing Address: 5',44yA<
CONTACT PERSON:
Name: Aov"?,e;FC ,6. G�G�Yi�IG
Mailing Address: 23DD T�� � e
Phone#: S(�e Q��D�v�O Email: ,4PA -f- 30a @ Y.46WeCoA',-
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:'
Mailing Address; -�~3,po z-
Phone#: 5-16 Q8S'cytao Email: �3G� eip
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition [--]Alteration ❑Repair ❑Demolition Estimated Cost of Project:
[--]other ��� ' ✓ . $
Fi-l
the lot be re-graded? ❑Yes No Will excess fill be removed from premises? WYes ❑No
PROPERTY INFORMATION
Existing use of property: Intended use of property:
Zone or use district in which premises is situated: Are there any covena;Nci
�nd restrictions with respect to
this property? Dyes IF YES, PROVIDE A COPY.
PO'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
Ordinance of the Town of Southold,Suffolk,County,New York and other applicable laws,Ordinances or Regulations,for the construction of buildings,
housingadditions,alterations
and or for I
ors and to admit aolition uthon as inspectors abed.The applicant agrees to comply with all applicable laws,ordinances,building code,
p 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 By(print name): &.615 Ul AIW1006�� El Authorized Agent ❑Owner
Signature of Applicant: Date: I
941*�J�
STATE OF NEW Yoh)
SS:
COUNTY OF 5LA— &IK )
being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the
(Contract r,Agent, rporate Officer, etc.)
of said owner or owners, and is duly authorized to p rm 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
41�
day of w r- 20 o�Jr
Notary Publi
TRACEY I... DVVYM
PROPERTY OWNER AUTHORIZATION NOTARY PUBLIC,STATEOFNEW Y
oR
(Where the applicant is not the owner) NO.0Il}W6306900
1^1FIED IN SijFF LK COUNTY
COMW=S;ON E'XPI S JUNE 30,
1, 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
tl:ti I
Uq 4pr4, aN' ddd
j U
q
� rr
Building Department Application
AUTHORIZATION
(Where the Applicant is not the Owner)
I,.
y�ef�sV C-%.-( residing at
(Print property owner's name) (Mailing Address) /
do hereby authorize
(Agent)
to apply on my behalf to the
Southold Building Department,
(O is Signature) (Date)
(Print Owner's Name)
Glenn Goldsmith, President Z Town Hall Annex
., 54375 Route 25
A. Nicholas Krupski, Vice President P.O. Box 1179
Eric Sepenoski Southold, New York 11971
Liz Gillooly --lut Telephone (631) 765-1892
Elizabeth Peeples G B Fax(631) 765-6641
COUNTY,
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
October 16, 2025
James Lubin
24 Tower Court
Syosset, NY 11791
RE: 2765 WELLS ROAD, PECONIC
SCTM#: 1000-86-2-2
Dear Mr. Lubin:
The following action was taken by the Southold Town Board of Trustees at their Regular
Meeting held on Wednesday, October 15, 2025:
RESOLVED, that the Southold Town Board of Trustees APPROVE the Administrative
Amendment to Wetland Permit #10587 to install a 3'x5' generator and a 10'x12' shed.
Any other activity within 100' of the wetland boundary requires a permit from this office.
This is not a determination from any other agency.
If you have any questions, please call our office at (631) 765-1892.
Sincerely,
IL 4"
Glenn Goldsmith, President
Board of Trustees
BOARD OF I RZU3rTEES
TOWN OF SOUTH ILD N/Of= �
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