HomeMy WebLinkAbout52798-Z TOWN of SOUTHOLD
BUILDING DEPARTMENT
2,
TH
NY
SOUOLD,
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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#: 52798 Date: 03/30/2026
Permission is hereby granted to:
M S L88 L LC
25180 CR 48
Peconic, NY 11958
To:
repair and alter an existing single-family dwelling as applied for.
Premises Located at:
8500 Alvahs Ln, Cutchogue, NY 11935
SC/M#95.-4-3r1
Pursuant to application dated 03/02/2026 and approved by the Building Inspector.
To expire on 03/29/2028.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $2.50.00
CO-RESIDENTIAL $100.00
Total 350.00
Building Inspector
TO" OF SOU"r HOLD--BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold,N 11971-0959
Y"
Telephone (631) 765-1802 Fax(631) 765-9502".,fit I t o to n .«oar.
Date Received
APPLICATION FOR BUILDING PERMIT 6
For Office Use only
PERMIT NO. Building Inspector
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Applications and forms must be filled out in their entirety.Incomplete
applications will not be,accepted. Where the Applilcant is not the owner,,an
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Ownees Authorization farm Pa shall be completed.
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Date: A,7
OWNERS OF PROV- It, q
Names SCTM#1000- "�. I
Project Address:
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-131510W
Phone .
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Mailing Address: 95WD Ck
CONTACT PERSONO
Name:
Mailing Address: J)v u
Phone#: E ail:
6 73a' 'zaw,&.1111,1159*�'t,
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DESIGN PROFESSIONAL INFORMATION*
Name:
Mailing Address:
Phone#0, Email:
CONTRACTOR INFORMATION*
Name: ry
o
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration JCRepair ❑Demolition Estimated Cost of Project:
Other A Joao, a AAC�,
, ...........
Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises? OYes JQNo
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PROPERTY INFORMATION
Existing use of property: intended use of property:
40,6&14 ..........
Zone or use district in which premises is situated: Are there any covenants and restriction with respedlo
this property? F71Yes E]No IF YES, PROVIDE A COPY.
Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water Issues as provided by
Chapter 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 Law,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 and 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.
Application Submitted By(print nano, []Authorized Agent owner
Signature 1
Signature of Applicant: Date: Z tz,
STATE OF NEWYORK)
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 ..................... .vl�-"
(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
da y
clic) 20 Z of r--c ........
Notary Public
JULIANNE CAROLINE FEDELE
Notary Public-State of New York
PROPERTY OWNER AUTHORIZATION Na,01FE0016050
Qualified in Suffolk County
(Where the applicant is not the owner) MY Commission Expires Nov 11, 2027
residing at
do hereby authorize I 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
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utchogue
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Suffolk County, New York
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Tax Map#1000-95-04-3.1
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Will the lot be re-graded? ❑Yes)d No Will excess fill be removed from premises? ❑Yes $QNo
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