HomeMy WebLinkAbout52626-Z TOWN of SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD, NY
CIO
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORD AUTHORIZED)
Permit#: 52626 Date: 01/23/2026
Permission is hereby granted to:
Pierre Drogo u l
536 E 13th St Apt 3F
New York, NY 10009
To:
finish the space above the garage of an existing single-family dwelling as applied for*
Premises Located at:
75 Clearview Ave, Southold, NY 11971
SCTM#70.-8-41
Pursuant to application dated 12/01/2025 and approved by the Building Inspector.
To expire on 01/23/2028.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $348.00
CO-RESIDENTIAL $100.00
� Total S448.00
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Building Inspector
TOWN OF SOUTHOLD BUILDING DEPARTMENT
]'own Hall Annex 54375 Main Road P. 0. Bo,,.K 1179 Southold, NY 11971-0959
I elephonc (631) 765-180? Fax (631) 76* -9502 \VNV\V,,ski,U tho d t,o�,v ni�1 V.�,2c)
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Date Received
APPLICATION FIOR BUILDING PERMIT
U
LL
For Office Use Only
PERMIT NO. Building Inspector','--,....... ..............
Applications and forms must be filled out in their entirety. Incomplete L 0l a
ap plications 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-
Project Address:
CZAe��44� 1 r- �
--------------
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E m a i 1: p/ ci c, C
Pho Cle #: 6-46 1
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Mailing Address: 76-- cZ_Z--h�4:P1ZV
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CONTACT PERSON:
Name: 5/4f Z
ZI
Mailing Address
Phone
DESIGN PROFESSIONAL INFORMATION:
Name: C t—,
Mailing Address _01y /61/;�?c,//
.- y /�V_
----- Email
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A
Phone coO
2:
#-
CONTRACTOR INFORMATION
FName,
Mailing Address'.
Email:
Phone
DESCRIPTION OF PROPOSED CONSTRUCTION
FNew structure 7Addition MAlte ration DRepair F�Demolition Estimated Cost of Project.
9
CIO<
�7 0ther $
M '
Will the lot be re-graded? files �Ao Will excess fill be removed from premises? ElYes o
L................
. ..........
..... .................
I I 1 01111111
.............
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PROPERTY INFORMATION
Existing use of property: Intended use of property:
Zone or use district in which premises is situated,: Are there any covenants and restrictions with respect to
this property? F_1Yes �No IF YES, PROVIDE A COPY.
Check Box Afte ir `irk The owner/contractor/design professional is responsible for all drainage and storm water Issues as provided by
�`tapter 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 anud 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.
ti
/)0/4 M/Authorized Agent nOwner
Application Submitted By(print name):
Signature of Applicant. Z Date, ;7
S7/-2-
STATE OF NEW YORK)
SS:
COUNTY OF
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 Drcem_xK- 120 a1*�
tar y Public
T(7ACEY`L., DWYM
PROPERTY OWNER AUTHORIZATION NC)TARW PUB L ,,STATE OF NEW Y08K
NO.01,DW,63,tVq00
(Where the applicant is not the owner) N"-IF ,' 11 1
J'I.'r F0, ;tJ'S 13 F FOLK COUNTY
EA0Pj7jt:.,,G,jUNE 3,01 40
residing at
t
r to apply on
ZL
__jLdo hereby authorize 'I
my behalf to the Town of Southold Building Department for approval as described herein.
V,,-11/28/2025
Owner's Signature Date
Pierre Drogoul
Print Owner's Name
2