HomeMy WebLinkAbout52602-Z TOWN of SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD, NY
c
BUILDING PERMIT
(THIS PERMIT MIDST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 52602 Date: 01/09/2026
Permission is hereby granted to:
Kimogenor Pt Co
Attn: Nancy A keno n
Carden City, NY 11530
To:
Cottage#8-Install in-kind window replacements to an existing dwelling as applied for. Property
requires a floodplain development permit.
Premises Located at:
50 Jackson St., New Suffolk, NY 11956
SCTM# 116.-6-24.1
Pursuant to application dated 11/17/2025 and approved by the Building Inspector.
To expire on 01/09/2029.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling-_Alteration $250.00
CO-RESIDENTIAL $100.00
Flood Permit $150.00
Total S500.00
Building Inspector
ry TOWN oC I1T COLD—BUILDING DEPART.�7E T
Town An
nex nnex 54.375 Main Road P. 0. Box 1179 Southoldnnv.gOv
-flww , NY 11971�-0959
Hall
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G Telephone (+631) 765-1802 Fax (631) 765-9502 ttH
—101111 pill
Date Received
Alm)"P"LICAT""'NU LLB k3
PER
MIT
For Office Use only
PERMIT NO Building Inspector',
P Em .w
milli own,
Applications and forms mint be filled out in their entirety. Incomplete
applications will not be accepted. where the Applicant is not the owner,an "
n p F
t' owner's Authorization farm(Page 2)shall be completed.
Date:11/7/2025
OWNER(S)OF PROPERTY:
S�CTM# 1000-
Name: Archer ... — ��14 �
Project Address: RdNew Suffolk NY 11958
� 855 Klmogenor Point
Phone#: 1� 524 8727 Email:warcherl58@aol.com
�
Mailing Address:23 Chester Ave Stewart Manor NY 11530
CONTACT PERSON:
Name:William Archer
Mailing Address:23 Chester Ave Stewart Manor NY 11530
Phone#: 6727Email:warcherl 58'aol.com
516 524
DESIGN PROFESSIONAL INFORMATION w
Name: '"
Mailing Address:
Phone#: Email
CONTRACTOR INFORMATION:
Name:Renewal by Andersen
Mailing Address:2029 New HwyFarmingdale NY 11735
Emai
l:
m
Phone#.0 31 843 1713 ext 2255 cvalente@rbalongisland.com
DESCRIPTION OF PROPOSED CONSTRUCTION
Addition ❑Alteration ❑Re air ❑Demolition Estimated Cost of Project:
❑New Structure ❑ p
�othe r Window Replacement 30,872
Will the lot be re-graded? ❑Yes RNo Will excess fill be removed from premises? L7 Yes Alo
1
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00
G,
PROPERTY INFORMATION
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.. ...............��,o,�
Existin use of ro err intended use of property,.,
g p p Y
nts and restrictions with respect re an
y covenants to
Zone or use district In which premises is situated: Are the Y this property? ❑Yes *No IF YES, PROVIDE A COPY.
99 Check Box After Readling'01 The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by
Chapter 236 of the Town Code. AP
PLICATION ICATIC>N IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zane
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
• Law.
punishable as a class A misdemeanor pursuant to Section z14.45 of the New York State Penal a
Application Submitted B tint name � � � ,-�, � C�7Authorized Agent owner
Date.S• nature of Applicant. t 11�
CONNIE D.BUNCH
Notary Public,St ate of New York
STATE O F NEW YO F�K}SS. No.01 BU G 185050
Qualified in Suffolk County
COUNTY OF Commission Expires April 14,2_0:&
being Y du1 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 statemen
ts 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
� a of �'�"`'�''�.- , 20 6�_ � ��V �'
F
Notary Public
PROPERTYOWNER AUTHORIZATION
(Where the applicant is not the owner)
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 M
Print owner's Name
2