HomeMy WebLinkAbout52876-Z TOWN OF SOUTHOLD
�107a
BUILDING DEPARTMENT
40
SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS ARID SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 52876 Date: 04/17/2026
Permission is hereby granted to:
Irene Magramm
245 E 63rd St Apt 1207
New York, NY 10065
To:
Install a generator accessory to an existing single-family dwelling as applied for.
Premises Located at:
4295 Pequash Ave, Cutchogue, NY 11935
5CTM# 137.-2-16
Pursuant to application dated 04/06/2026 and approved by the Building Inspector.
To expire on 04/16/2028.
Contractors:
Required Inspections:
Fees:
GENERATOR $125.00
CO Accessory $100.00
Total S22S.00
_J.D
Building Inspector
TO" OF SOUTHOLD--BUILDING DEPARTMENT
Town:Hall Annex 54375 Main.Road P. 0. Box 1179 Southold,NY 11971-0959
Telephone (631) 75�-1802 Fax (631) 759502 . h. I, b,o °
Date Received
APPLICATION FOR BUILDING PERMIT
.. r.. .
La
For Office Use Only ,,
PERMIT No. Building Isecs
A'P R 16 2026
....................................
Applications and farms must be filled out in their entirety. Incomplete
"I�l�
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-NO
Project Address: u
Phone#: Email:
Mailing Address: Jr-,e-Ao.
'0 /)
CONTACT PERSON:
Name: -
Mailing Address:
Phone#• //' Email.
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email,
CONTRACTOR INFORMATION:
Name:lf-_� ,C_oe,R C,MailingAddress,
............... �15 s
)P0
Phone#: 31 _ 73L(— Email:
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fle ev
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DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure FlAddition ❑Alteration ❑Repair ❑Demolition Estimated Cast of project:
�ther $
Will the lot be re-graded? ❑Yes B Will excess fill be removed from premises? ( ]Yes &10
t
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
this property? FlYes n No IF YES, PROVIDE A COPY.
El Ckieck 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 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(print name): 6" sj. , BA00"uthorized Agent ElOwner
Signature of Applicant: Date:
STATE OF NEW YORK)
Cc.
COUNTY OF N"I
..........."ga � s Levi. being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)above named,
(S)he is the (6'r\ +�
(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
day of "k'pc 20
Notary Public
LORE7TA IAMB
IRAUTHORIZATR
tn, Public,State of New York
PROPERT,YOWNE *� '�
#01 LA6179883
(Where the applicant is not the owner) Qualified in Suffolk County lz
Term Expires December 31,20
1 rtp CQ r0L M to residing at qa(q� au4e
K"(j �L6041��11 do hereby authorize to apply on
my behalf tot n of Southold Building Department foi-approval as described herein'.
IM
zoo—,
0 er's Signature Date
ra
Print Owner's N41e
2
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