HomeMy WebLinkAbout52691-Z 0��4��n�xyo 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#: 52691 Date: 02/26/2Q26
Permission is hereby granted to:
Mattituck Plaza LLC
PO BOX 77
Mattituck, NY 11952
To:
replace commercial AC unit as applied for(Walgreens).
Premises Located at:
10095 Route 25, Mattituck, NY 11952
SCTM# 142.4-26
Pursuant to application dated 12/30/2025 and approved by the Building Inspector.
To expire on 02/26/2028.
Contractors:
Required Inspections:
ELECTRICAL- ROUGH, PLUMBING, ELECTRICAL- FINAL, FINAL,
Fees:
HVAC $250.00
CO Commercial $100.00
Total $350.00
wilding Inspector
TOWN OF SOUTHOLD--BUILDING DEPARTMENT
�n Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
�i , ,�- ww. o the dt wn°
� Date Received
APPLICATION
FOR BUILDING PERMIT
For Office Use Only
PERMIT Na.
a Building Inspector:
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:09/11/2025
OWN ER(S)OF PROPERTY:
Names SCTM # 1000- .•-
ect Ad
dress: -
Pro, 1 aa95 Route 25 Mattltuck
Phone#: Email,
Mailing Address:
CONTACT PERSON:
Name:Brittany Ruben - Arris Inc
Mailing Address:5155 Bains Gap Road Anniston AL 36205
Phone#:25 brittany@arrisconstruction.com
Email: arrisconstruction.com
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DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address
Phone#: Email:
CONTRACTOR INFORMATION:
Name:Arris Inc
Mailing Address:5155 Bains Gap Road Anniston AL 36205
Phone#:2 6-237-1601 Email:brittan arrisconstruction.com
� brittany@arrisconstruction.com
OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project.:
Fw]Other RTU Replacement $30,000.00
i
Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ❑Yes Oi No
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N111111NN19N Jill IN 100010101M
WN
P"ROP'ERTY INFORMATION
Existing use of property.Wa teems Intended use of property:VVI 1greens
Zone or use district in which premises is situated: Are them any covenants and e str ctions with respect to
thisproperty? [:]Yes "'No �IF'YES PROVIDE A COPY.
❑ Check Box After Reding.. The owner/contractor/design professional is responsible for all drainage angst rm water,issues as provided by
Chapter 236 of the Town Code.APPLICATION 15 HEREBY C,l'IADE to the Building Department for the issuance of a Buil ;in Permit pursuant to the Building Zone
Ordinance of the Town of Southold,Suffolk,County,New York and ether applicable laws,ordinances or Regulations fo the c6osiruction of buildings,
additions,alterations or fvr removal or demolition as herein described.The,applicant agrees to comply with all appil�6bll laws,ordinances,building code,
housing code and regulations and to admit authorized inspectors an premises and in building(s)for necessary ins o, .False statements made herein are
punishable as a Class A misdemeanor pursuant to suction 210.45 of the New York State Penal Law. �
Briftany Ruberg
Application Submitted By(print name). horiz Agent ❑owner
f
Signature f Applicant: Date: 0 11/25
At&
STATE of*Wwqvl Riki,
JEAN IFER KACIE WILLIAMSON
C _d _
o NTY F f Notary Public
Alabama State at
Large
in u y$� rT-MeTos s and says t lat(S)he is the applicant
(Name of indivi signing contra , o e a e
(S)he is the Ck,6%/4-�, K),
(Contractor..Agent,Corporate officer,etc.
1
of said owner or owners,and is duly authorized to perform or have performed the said w r and to mare and fife this
application;that all statements contained in this application are true to the best of his/her g oiwle �e and belief;and
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that the work will be performed in the manner set forth in the application file therewith.
Sworn before me this
day of 20rV
_..
Notary, ublic
PROPERTY
. Y OWNER AUTHORIZATION
(Where the applicant is not the owner)
GYA"Aj_ t)q4eMW6r residing at
malf.I
do hereby authorize to apply on
my behalft own of Southold Building Department for approval as described herein.
Owner's signature te I
BAR ZE AN
r
Print owner's Name NOTARy PtIE C STATE F NEW YORK
.- '-- FWgistration o.01,MC6 U 187o
Qualified i aSuffndlk County
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