HomeMy WebLinkAbout52869-Z TOWN of SOUTHOLD
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BUILDING DEPARTMENT
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BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
ITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORD AUTHORIZED)
Permit#: 52869 Date: 04/15/2026
Permission is hereby granted to:
James McVeigh
31 8irchway
Tarrytown, NY 10591
To:
legalize "as built"window replacements to an existing single-family dwelling as applied for.
Premises Located at:
6350 New Suffolk Ave, Mattituck, NY 11952
SCTM# 115.43-25
Pursuant to application dated 04/02/2026 and approved by the Building Inspector.
To expire on 04/14/2028.
Contractors:
Required Inspections:
Fees:
As Built Alteration $500.00
CO-RESIDENTIAL $100.00
Total $600.00
Building Inspector
e� TOWN OF SOUTHOLD—BUILDING DEPARTMENT
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Town Hall Annex.54375 Main Road P. 0. Boy 1179 Southold,STY 1 1 97 1-0959
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Telephone (631) 765-1802 Fax (631) 765-9502 (�,Pa �. �� 'S 1O'1gt W V
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Date Received
A,PPLICAT,10..., N F1 OM 8.,v!qJ1VMLD1i INIG": RERPA,!
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For Office Use Only
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PERMIT NO. .._, BuildingInsp
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Applications and forms must be filled out in their entirety.incomplete
applications will not be accepted. Where the Applicant is not the owner,an
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Ownees Authorizatlon form(Page 2)shall be comp Meted.
Date:� — --
O ER(S)OF PROPERTY:
Name: SCTM#100 -
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Phone#: q -� Email: e 1 ..
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Mailing Address:
CONTACT PERSON:
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Mailing Address: tAa+4'1L0i VN
Phone CO V11
#:
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DESIGN PROFESSIONAL INFORMATION:
Name: no �,..
Mailing Address:
Phone#: Email.,
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CONTRACTOR INFORMATION:
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Name:
Mailing Address: P0
/A0,41" 119
Phone#: Email: CD
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Additio 11
AI te�ra�i � E�� e air Cl ll�Dem � � � Estimat ,d Cast of Project:
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Will the lot be re-graded? FlYes KNO Will excess fill be removed from premises? ❑Yes KNO
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PROPERTY INFORMATION
Existing use of property: Intended use of property:
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A;L,
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? E]Yes "No IF YES, PROVIDE A COPY.
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�I%" �e,c( Box 1"teladin The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by
Chapter 236 of the Town Code. APPUCATION IS HEREBY MADE to the Building Department forte Issuance of a Building Permit pursuant to the Building Zone
Ordinance of the Town of Southold,Suffolk County,New York and other applicable Laws,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 tpnn t. me f
'). AAuthiorized Agent ElOwner
Signature of Applicant: Date:
STATE OF NEW YORK)
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COUNTYOF S'v t±!0 1
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
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(S)he is the ............
(Contractor,Agent.,Corporate Officer,etL') J
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/ knowledge and belief; and
that the work will be performed in the manner set forth in the application file therewith.
Sworn before me this
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--day of 20_1,
�N o' r', P u
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TIFFANY J BEREZNY
Notary Public-Stateof New York
No.01 BE6264112
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PROPER,T , OWNER AUTHO , ION Qualifi mmission Ex ed in Suffolk county
[My Co 06117�1202.1j,
(Where the applicant is not the owner) ....... ..............
residing at
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do hereby authorize pp CUs-'�� 00) C'o to ap a pt n ply on
my behalf to the Town of Southold Building Department for approval as described herein.
03126/2026
Owner's Signature Date
Jim McVeigh
Print Owners Name
2