HomeMy WebLinkAbout52571-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#: 52571 Date: 12/23/2025
Permission is hereby granted to:
Peconic Landing @Southold
1500 Brecknock Rd
Greenport, NY 11944
To:
Unit#51-Cardinal Lane.Construct additions and alterations to an existing single-family dwelling as
applied for.
Premises Located at:
1205 Route 25,Greenport, NY 11944
SCTM#35.4-25
Pursuant to application dated 11/05/2025 and approved by the Building Inspector.
To expire on 12/23/2027.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Addition&Alteration $390.00
CO Single Family Dwelling-Addition /Alteration $100.00
Total S490.00
uWing Inspector
r; 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 :/1'www. outhldhw .tx o
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
� I 4
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PERMIT NO.� � Building Inspector:
Ins
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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: SCTM#1000- • ` ' 2 5
Project Address;
WA
Phone#: Ukw Email
Mailing Address:
CONTACT PERSON:
Name:
Mailing Address: Io U CmW w q`i
Phone#: Email: '^
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
ClAg i��'! C."U
Mailing Address: "" ` . kip
oil-
Phone#: 'a Email:
if
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ddition ❑Alteration ❑Repair ❑Demolition Es " ate tafreject:
❑Other �'Cost
[WLlllthe lot be re-graded? ❑Yes o Will excess fill be removed from premises? ❑Yes �01V0
1
PROPERTY INFORMATION
Existing use of property: k e s li d e t+a L 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 XPo 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
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.
Application Submitted By e(A- u T-Z k�K [BAuthorized Agent El Owner
Signature of Applicant: Date: 1,1A/
STATE OF NEW YORK)
SS:
COUNTY OF 5;.A-�kV, )
L being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contr ct)above named,
(S)he is the W YT ov-w�< o-(Tj'CeJ
(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
3 r `day of n ov , 20�� - �•
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
I, ? AZ KAC f A residing at L6010 3 29G-'W00,r- -P-D
do hereby authorize UAVF ,Tpokcrf -to apply on
my behalf to the Town f Southold Building Department for approval as described herein..
Owner's Signatur NOTARY PUBLIC STATE OF N Date
TAMMI S. GRATTA
F NEW YORK
SUFFOLK
LIC.#01GR6142111
Print Owner's Nam COMM. EXP. MARCH 13,20-.(-,
2