HomeMy WebLinkAbout52766-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OFAPPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 52766 Date: 03/18/2026
Permission is hereby granted to:
Paul J Ta►reira
59 Plymouth Dr S
Glen Head, NY 11545
To:
Legalize as built mini splits and laundry alteration at existing single family dwelling.
Premises Located at:
4550 Westphalia Rd, Mattituck, NY 11952
SCTM# 111-11-21.1
Pursuant to application dated 02/09/2026 and approved by the Building Inspector.
To expire on 03/17/2028.
Contractors:
Required Inspections:
Fees:
As Built HVAC $500.00
CO Single Family Dwelling-Addition /Alteration $100.00
Total $600.00
Building Inspector
TOWN OF SOUTHOLD--BUILDING DEPARTMENT
" j Town Hall Annex 54375 Main Road P. 0 Box 1179 Southold,NY 11971-0959
5-1802 Fax (631) 765-9502Telephone (�31} 7�
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Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT No. .
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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
Owners Authorization form(Page 2)shall be completed.
Date:
OWN ER(S)OF P E
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N a m SCTM#1000-
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Project Address:
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Phone#: ��� w e P ( ram 1 0 i
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Mailing Address:
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CONTACT PERSON:
Name:
Mailing Address:
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION
Name.
Mailing Address:
Rhone' : Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email,
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DESCRIPTION OF PROPOSED CONSTRUCTION
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❑New Stru ❑Addition ❑Alteration I1I e air OlDemolition Estimated Cost dprojectt
Wl-<t h e
Will the lot be re-graded? ❑Yes o Will excess fill be removed from premises? ❑Yes ❑No
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