HomeMy WebLinkAbout53000-Z TOWN of SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD., NY
V
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#: 53000 Date: 05/20/2026
Permission is hereby granted to:
Julia A Conway
6 Water Way
Newburgh, NY 12550
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construct additions and alterations to an existing single-family dwelling as applied for.
Premises Located at:
300 .Sixth 5t, Laurel, NY 11948
SCTM# 126.-1-9
Pursuant to application dated 01/13/2026 and approved by the Building Inspector.
To expire on 05/19/2028.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Addition&Alteration $815.00
CO-RESIDENTIAL $1.00.00
Total 915.00
Building Inspector
TOWN OF SOUT'HOLD —BUILDING DEPARTMENT
�y Town Hall Annex 54375 Main Road P. CJ. Box 1179 Southold,NY 11971-0959
Telephone 631 765-1802 Fax 631 765-9502,11,
Date Received
kl-�PLICATION
.�..- For Office Use Only
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PERMIT NO. Building Inspector:
Applications and forms must be filled out in their entirety. Incomplete
pp .
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applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
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Date�
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OWNER(S)OF PROPERTY:
Name: fLL12 %�
SC TM#1000-
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J*�h M
�' Project Address:
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Phone#: Email:
Mailing Address:
CONTACT PERSON:
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Name: CCAC I No 6 `,
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Mailing Address: 'V*%
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Phone#: �.- Email: i
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DESIGN PROFESSIONAL INFORMATION:
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Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
La 0,� 6.V
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Mailing Address: �
3!P00- oodl, I(A_
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Phone#: '° .� �. Email '
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DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure Addition DAlteration ❑Repair ❑Demolition Estimated Cost of Project:
mother �, � 000
Will the lot be re-graded? E]Yes ❑No Will excess fill be removed from premises? ❑Yes O No
1
PROPERTY INFORMATION
Existing use of property: Intended use of property:
a
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes n No IF YES, PROVIDE A COPY.
0 Check Box After Readi'119,, 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 sta%ements made herein are
punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law,
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Application Submitted B (print name): - Y' 0 � 110 0 DAuthiorized,Agent 0 Owner
Signature of Applicant. F
STATE OF NEW YORK)
S�
COUNTY OF C�a I
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being duly sworn,depose
s and says that s h e Is the applicant
(Name of Individual signing ing contract) above named,
w
(S)he is the
(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 20_9�Z
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Public
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„I of New Yorkf,,10 M
k ' r f` 1" YIIu,N 'Yi
'� { WHIN OWNER bl�i.. r � � d�,. P[Y%N III NP -
X�tl � YPoNH%W1ri1Dri11111111111NA 1M�{�dWN(f��MiM� D�1NrA 171 MOimfi fN�W�NNMPNH MXXBYMMNM I 1 dM hd IHW Mb RON�WB,�u: y� , Y 3,f
(where the applicant is not the own .Z
Shivin Kwatra residing 300 6th ,Street, Laurel NY 11948
I, g at
do hereby authorize Carlos GuaZhambo to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
December 22, 2025
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Owner's Signature Date
S h ivi n Kwatra
Print Owner's Name
2