HomeMy WebLinkAbout52767-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#: 52767 Date: 03/18/2026
Permission is hereby granted to:
Stella Sakowicz
PO BOX 173
Peconic, NY 11958
To:
install replacement windows to an existing single-family dwelling as appied for.
Premises Located at:
725 Peconic Ln, Peconic, NY 11958
SCTM# 75.-5-3
Pursuant to application dated 02/11/2026 and approved by the Building Inspector.
To expire on 03/17/2028.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $250.00
CO-RESIDENTIAL $100.00
Total $350.00
Building Inspector
TON" OF SOUTHOLD--BUILDING DEPARTMENT
` Town Hall Annex 54375 Main load P. CJ. Box 1179 Southold NY 11971 a959
Telephone (631) 765-1802 Fax (631) 765-9502 https://www.southoldtownnv.ggv
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Date Received
APPLICATION FOR BUILDING PERMIT
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For office Use only
PERMIT No. Building Inspectors 0 '
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 shall be completed.
Dates
OWN ER(S)of PROPERTY:
Name: SCTM#1000-
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Project Address:
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Phone#: Email: 0�
Mailing Address:
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CONTACT PERSON: �
Name:
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Mailing Address: 0
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Phone Email: iwii
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DESIGN PROFESSIONAL INFORMATION,
Namesm.
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Mailing Address.
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Phone#: Email:
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CONTRACTOR INFORMATION:
Name:
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Mailing Address:
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Phone Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Str ct e DA d tion ❑Alteration PRei air I"De, intion Estimated Cost of Project:
00ther ,. 409
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Will the lot be re-graded? ❑Yes No will excess fill be removed from premises? ❑Yes o
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PROPERTY INFORMATION
Existing use of property: l In e dedTIe oArt :,rope
Zone or use 'strict in which premises is situated: Are there any covenants ind restrictions with respect to
this property? C]Yes No IF YES, PROVIDE A COPY*
Chec,k Box After Reading.',* The owner/corttractor/design,professional is responsible for all drainage and storm water iSsu0 s prouided by
.chapter,23 of the Town cods. PPL.I °N 1S H REB MADE to tine llding Department for the issuance of a� c llding Permit pu0s r� to o ulldlny;Zone
Ordinance of theTov'n of Souit%id, '°uf olk,°County,New York and other applicable Laws,Ordinances or Regulations,,for th+ 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 inspectionsw'Faise statements made herein are
punishable as a class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
Application Submitted By i. 7 a � .. GL authorized ent ne
Signature of Applicant: Date: if
CONNIE D.BUNCH
ary Public,State of New York
STATE OF NEW YORK) No.OI BU6185050
� M.
Oualifted In S ffoi'k County
COUNTY OF Ogmmission EXPIresAPril
being duly sworn, deposes and says that (s)he is the applicant
(Name of individual sign' g contract) ave named,
(S)he is the W
(Contractor,Age ,t,, 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 20 .
Notary Public
PROPERTY OWNER 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
Print owner's Name
2