HomeMy WebLinkAbout52579-Z TOWN OF SOUTHOLD
" BUILDING DEPARTMENT
4C
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#: 52579 Date: 12/29/2025
Permission is hereby granted to:
Pellegrino NM Rev►o+c Trt
106 Parrot P1
Brooklyn, NY 11228
To:
Construct interior alterations to an existing condominium(Unit 5G1)as applied for.
Premises Located at:
2460 Shipyard Ln Unit SG1, East Marion, NY 11939
SCTM#38.2-2-8
Pursuant to application dated 11/06/202S and approved by the Building Inspector.
To expire on 12/29/2027.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $365.00
CO-RESIDENTIAL $100.00
Total $46S.00
Building Inspector
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Np � r, TO OF SOUTIHOLD--BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold,NY 11971-0959
m Telephone (631) 765-1802 Fax (631) 765-9502 fitt nM�
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Date Received
APPLICATION FOR BUILDING PERMIT
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For Office Use Only
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PERMIT NO.
ba5qq Building Inspector., II
Applications and forms must be filled out in their entirety. Incomplete
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applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form`(Page 2)shall he completed,.
Date:
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OWNER(S)of R P
Name SCTM# IV*0* av
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Project Address: O�):L
Phone#: Email
Mailing Address: WI_A
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CONTACT PERSON.
Name:
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Mailing Address:
Email
Phone#: C
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DESIGN PROFESSIONAL INFORMATION:
Name0 VI
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Mailing Address;
rtIIII 1 ,17
.......... ..........
Phone a*
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CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email,
DESCRIPTION of PROPOSED CONSTRUCTION
CI New Structure ❑Addition aeration ❑Repair ❑Demolition Estim td Cost of Pr t
[--]other
Will the lot be re-graded? ❑Yes U11�0 Will excess fill be removed from premises. ❑Yes ❑ o
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PROPERTY INFORMATION
---------------------........
Existing use of property: Intended use of property
pre f-nj n3_r��
Zone or use district in which premises is situated-, Are there any covenants and restrictions with respect to
. 1, -]Yes F�No IF YPS, PROVIDE A COPY.
0-1(,.-�00 ?,C/ �o this property? F
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M/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. APP ION IS HERESY ATE to the Building Department for the issuance of a8uIlding Permit pursuant to the Building Zone
Ordinance of"thei6wnoU Wo"i Stift1k,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 A applicable laws,ordinances,building code,
housing .ode 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 210AS of the Now York State Penal Law.
Application Submitted By(proin h me,;- ClAuthor'-led Age t wner,
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43 V
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Signature of Applicant: Date.
STATE OF NEW YORK)
SS.
VI
Oct,
COUNTY
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
DANIEL ROONEY
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PROPERTY OWNER AUTHORIZATION, Notary Public State of Ne York
NO.01 R0001 5526
(Where the applicant is not the owner) Qualified in Suffolk County
My Commission Expires Nov 3, 2027
6es d g at,
do hereby authorize o apply on
my beha to 1,e Town of Southold Building Department for approval as described herein.
blwrier i Signature Date
Print Owner's Name
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