HomeMy WebLinkAbout52770-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#: 52770 Date: 03/19/2026
Permission is hereby granted to:
Peconic Landing @Southold
1500 Brecknock Rd
Greenport, NY 11944
To:
Fire alarm system upgrade for east portion of apartment building as applied for.
Premises Located at:
1205 Route 25, Greenport, NY 11944
SCTM#35.-1-25
Pursuant to application dated 03/11/2026 and approved by the Building Inspector.
To expire on 03/18/2028.
Contractors:
Required Inspectionsw... �. ..............................._
Fees:
_.. www_.........._ ......._ www_..._.........a .......... _w...........__. FIRE ALARM SYSTEM WW......WW_....$300.00
CO Commercial $100.00
Total $400.00
Building Inspector
TOWN OF SOUTHOLD—FIRE MARSHAL
y Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone 631 765-1802 Fax 631 765-9502 Jilt ://wt w. catltitotltowrttt 1qy
EDate Received
PROTECTION SYSTEM PERMIT
APPLICATION
For Office Use Only
PERMIT NO. mmm"J� Building ltascto �
Applications and forms must be filled out in their entirety.Incomplete
f( 1 202
applications will not be accepted.WORK IS NOT TO HE S'I`AWI''ED prior
to the approval of plans and issuance of a permit. m
Has a building permit been obtained for this project? ❑Yes ❑No
If yes, building permit#
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Date:
PROJECT INORMATION:
Project Address: SCTM# 1000-
City: Zip: 119114/
CONTACT PERSON INFORMATION:
Name:
Mailing Address:
Phone#: 6 3(_ a�6— ?'l q Email: �to�iy. i )c t
Preferred contact method(select one): hone ❑Email
CONTRACTOR INFORMATION:
Name:T o 6sa,i C614rzi I g U i Irk Contractor License#: a D D 0 3 �79
Mailing Address: S Ark r° }f j1793
Phone#: .,,. Email:,,�,evlip
a�n.
SCOPE OF WORK:
Occupancy Description: ❑Assembly kBusincss, ❑Education ❑Factory/Industrial ❑Institutional ❑Mercantile
,k�TResidcntial 0 Storage
........... .�.
Description of Work: go
' tPc3 yf rt`;
❑ New System Ed Existing System Modification
Sprinkler/Standpipe/Water Supply Fire Alarm/CO Detection Systems Other Fire Protection Systems
(Check all that apply) (Check all that apply) (Check all that apply)
❑ NFPA 13,13D or 13R System ❑Manual Automatic ❑ Smoke Control
❑Standpipe ❑ Fire Pump ❑Protected Premises (local) ❑Wet or Dry Chemical/Clean
❑Supervising station Agent
Number of sprinkler heads: Central Station ❑Kitchen hood/exhaust ❑ Other
Floor Area(sq. ft.):
1
hecl Box After Reading: I,the undersigned,understand that the issuance of a permit for the type which is herein applied for is based on
the agreement to conform to all regulations and requirements.I further understand that non-compliance of said requirements,by myself or any officer or
employee of the firm or individual listed as the applicant on this form,shall because for revocation of said permit.Upon revocation of said permit the
applicant or any employee of the applicant shall be prohibited to conduct such work for which this permit was issued.The reissuance of a permit shall be
based upon review of the circumstances leading to the revocation.Any false statement(s)made herein are punishable as a Class A misdemeanor pursuant
to Section 210.45 of the Penal Law
Application Submitted By(print name): u�s ,Authorized Agent ❑Owner
Company(if applicable):
��.............. ._.........
���" _..w..�.., ._.w.... w _....., _�.. .. .__w����w�w�._........................_�.__....._
Applicant Signature: Date: _ H
_.............. ....w.. .....................—ww.w _w__ ......... ........ ____�w......_.......... w...... �_��w_. ......w
FIRE PROTECTION SYSTEM PERMIT APPLICATION SUBMITAL INSTRUCTIONS
Submit application only after reviewing the requirements for the specific permit for which you are applying(click the applicable link
below).
FIRE ALARM/CARBON MONOXIDE DETECTION SYSTEM SliBMITrTAL GUIDELINES
FII2.E SPRINKL.EIL SI'STEM SUBrviTTTAL I"IADE;ILINES
0, FIXED F110.Sl.IPP1I,E IDELINES
FEES„
A$300 permit fee is required for a non-residential permit.A$100 Certificate of Occupancy fee is required if the project is not part of
an existing open building permit. All checks should be made payable to the Town of Southold.
Permits,once issued,shall at all times be kept on the premises designated thereon with a copy of approved drawings and all related
documentation required to obtain said permit.Installations subject to final testing,inspection and approval.Arrangements for
testing/inspection shall be made by contacting the Town of Southold Building Department(631)765-1802.
FOR OFFICE USE ONLY
Amount Paid: Check No.: FM:
Permit No.: Date: Exp.Date:.
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