HomeMy WebLinkAbout52989-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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#: 52989 Date: 05/18/2026
Permission is hereby granted to:
Sy Ghasserni
6785 Main Rd
East Marion, NY 11939
To:
Construct additions and alterations to an existing single-family dwelling as applied for.
Premises Located at:
6785 Route 25, East Marion, NY 11939
SCTM#31.4-1.1
Pursuant to application dated 03/24/2026 and approved by the Building Inspector.
To expire on 05/17/2028.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Addition&Alteration $843.00
CO Single Family Dwelling-Addition /Alteration $100.00
Total $943.00
Building Inspector
TOWN OF SOXJTHOLD--BUILDING DEPARTMENT
Town Mall Annex 54375 Main Road P. 0. Box 1179 Southold NY 11971-0959
Telephone(631) 765-1802 Fax(631) 765-9502 littDs�L/www.so,u,,tho,lldtow"ilny. of
Date Received
APPLICATION FOR BUILDING PERMIT
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For Office Use only
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Name: �► SUM#1000-
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Project Address:
Phone#: -516 1 .' Email: ,w .
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Mailing Address
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El New Structure ❑Addition VAlteration EIRepair El Demolition Estimated Cost of Project:
NJ Other
Will the lot be re-graded? ❑Yes 2No Will excess fill be removed from premises? nYesON#o
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Zone o e district in which remises is situated: Are there an covenants d restrictions with respect to � ,
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this property. ❑Yes �Zo IF 5, ;
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TOMHarr a ��a r n a� a na `unua�W SO �►n,Z"IO 4' +c��r+aw Yorks rw +crane %, ,„ o
Application Submitted Syf,, J qe ❑Authorized Agent M151Wner
Signature of iica; Date: J_ .—2 6
STATE OF NEW YORK)
SS:
_COUNTY 0E
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being duly sworn,deposes and says that(s)he is the applicant
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(Name Lf individual signing contract)above named,
(S)he is the
(Contractor,Agent,Corporal a 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
J.Lda y of
Notary Public
im4mrs'MMUM
PROPERTY OWNER,AUTHORIZATION WMM PU SUCo
(Where the applicant is not the owner)
r
iw,Mxuwy,,07�,2 Qt J-P,
I, residing at.
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Ownees Signature Date
Print Owner's Name
2
ST01KM[WA\1C1E1K
Albert J. Kru
k�. Jr.
MANAGE&IIIIE"",� M.
SUPERInSOR at
SOU THOLD Tower'HILL-P.o.Box 1179
53095 MainRoad-SOO"H+OL"D,NEW PORK 11971
Town of Southold
236 '" STO GEM�N 1 MFERRAL FORM
...........
( APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT
ONLY FOR PROPERTIES ONE ACRE IN AREA. OR LARGER. )
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APPLICANT: (PropertyOwner, Design Professional, Agentj Contractor, Other)
NAME: r
Date:
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Contact InforM11
(E-Mad s Teleouxx Numkr)
6, 31 1_3 530
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PropertyAddress, c c t o n of Construction Site:
S.C.T.M. .
1000
District
L,31
Section Block Lot
TO BE COMPLETED BY
SOUTHOLD TOWN ENGINEERING DEPARTMENT
� 0� ,
Area of Disturbance is less than 1 Acre. o . ,Permftl'53011K Ired
re
is,RMi d
1
Project does Not Discharge to''haters of the State. NoS.P.D. rmi
1 Acre Storm Runoff Discharges Directly
'lox. '�,
[3 - Area of Disturbance is Greater than
to Watersf the State of New Fork. THE AP ' ICA,' `TAB � �P� � �S� Per yit
o Issuance o�a `u i l ln� Permit.
DIRECTLY From N.Y.S. D.E.C. Prior t
e Storm-water Runoff Flows Through Southold
Area of Disturbance �s Greater than 1 Acre own -APPLICANT
�"
`s MS4 Systems to Waters of the State of New York. HE PP ICA T
Y
M OBTAIN
entTon, l.neer
a S. Per t through the Southold
E,rior n o a Buildln Permit.
Dater
Reviewed By:
FORM * SMCP-TOS December 2024
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