HomeMy WebLinkAbout52870-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Q SOUTHOLD., NY
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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#: 52870 Date: 04/15/2026
Permission is hereby granted to:
DP Weinman LLC
200 Mountain Rd
Irvington, NY 10533
To:
legalize an "as built"gas conversion of an existing single-family dwelling as applied for.
Premises Located at:
3075 Lighthouse Rd, Southold, NY 11971
SCTM# 50.-3-2
Pursuant to application dated 04/03/2026 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
w Building Inspector
' TOWN of SOUT:HOLD BUILDING DEPARTMENT
Ny Town.Hall Annex 54375 Main Road P. 0. Box 1179 Southold NY 11971-0959
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Telephone (631) 765-1802 Fax (631) 765-9502 .tt s . of o .to . o
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
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Applications and farms must be filled out in their entirety.incomplete PA!"
applications will not be accepted. Where the Applicant is not the owner,an . �
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name::.. SCTM# 1000- 0'�O. OV 0& 00- 002.XC
Project Address: ,,, �,, ', '�
�0? 12M1644
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Phone#: 3/..........................
( Email:
Mailing Address:
CONTACT PERSON:
Name,
Mailing Address: V0 Alq
Phone#:
Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
i
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email
DESCRIPTION OF PROPOSED CONSTRU ION
F�Newu Structure ❑Addition lteration ❑Repair ❑Demolition Estimated Cost of Project:
F Other
Will the lot be re-graded? E]Yes 260 Will excess fill be removed from premises? F7Yes o
PROPERTY INFORMATION
Existing use of property: intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
1� this property? FlYes F-INo IF YES, PROVIDE A COPY.
El Check Box After Readings* 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 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 210.4S of the New York State Penal Law.
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Application Submitted By(print name): b4t4 T0+iV1VV;1j00q 2�u/thorized Agent El Owner
Signature of Applicant Date: q13 4
...............
STATE OF NEW YORK)
COUNTY OF
being duly sworn, deposes and says that(s)he is the applicant
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(Name of individual signing contract)above named,
(S)he is the 14
(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
3 day of
Notary Public
ERIK JOSEPH MCKENNA
Nabuy PublIci StaW of Now York
No.02MS-62553,19 PROPERTY OWNER AUTHORIZATION
Oualffied in Suffolk County _ZS
Commission Expires Febwary (Where the applicant is not the owner)
4 20
residing at
ta., / ��
do hereby authorize qV 11) U Av 2�14 to apply on
my behalf to the Town of Southold Buil Ig Department for approval as described herein.
6w,ner S' s,ignature Date
Print Owners Name