HomeMy WebLinkAbout52855-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
0
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#: 52855 Date: 04/10/2026
Permission is hereby granted to:
Breezy Shores Comnty Inc
PO BOX 925
Mattituck, NY 11952
To:
install a woad stove to an existing single-family dwelling as applied for with flood permit. (#29)
Premises Located at:
65490 Route 25, Greenport, NY 11944
SCTM# 53.-5-12.6
Pursuant to application dated 03/27/2026 and approved by the Building Inspector,
To expire on 04/09/2028.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $250.00
Flood Permit $150.00
CO-RESIDENTIAL $100.00
Tota I $soo.00
Building Inspector
�� TOWN OFF SOUTHOLD--BUILDING DEPARTMENT
;ry Town Hall Anne 54375 Main Road P. 0. Box 11�`9� outhold, NY 11 971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 htt -i' vNv,,,vv.s,o"Li,t,ho,ldtow(n, ,a
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Date Received
APPLICATION FOR BUILDING PERMIT
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„ For Office Use Only
PERMIT NO. Building Inspector
Applications and forms must be filled out in their entirety. Incomplete L
applications will not be accepted. Where the Applicant is rot the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date
OWNER(S)OF PROPERTY:
Name: SCTM # 1000-
Project Address: I
Phone#: C1,rf 15 1 1 g I
Email:r)A K G A P-ef. C I.D L h C, MA ! L. COM
Mailing Address: e
CONTACT PERSON:
Name: A--F> 0 NIL
i
Mailing Address:
Phone# Email
D:,SIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone# Email:
CONTRACTOR INFORMATION:
Name: 1100 D
Mailing Address:
Phone# Email
DESCRIPTION of PROPOSED CONSTRUCTION
New,Structure ❑Addition ❑Alteration ❑Repair ❑lDemolition Estimated Cast of Project,
ter $
Will the lot be re-graded? ❑Yes IE NO Will excess fill be removed from premises? E]Yes ❑No