HomeMy WebLinkAbout53019-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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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#: 53019 Date: 05/26►/2026i
Permission is hereby granted to:
Constantine P Nikolis
24021 Maryland Rd
Douglaston, NY 11362
To:
Legalize an as-built air-conditioning unit as applied for.
Premises located at:
80 The Greenway, East Marion, NY 11939
SCTM#30.-2-47
Pursuant to application dated 05/19/2026► and approved by the Building Inspector.
To expire on 05/25/2028.
Contractors:
Required Inspections:
Fees:
As Built HVAC $500.00
CO-RESIDENTIAL $100.00
Total $600.00
Building Inspector
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T` '� T F OUTHOLi�—�CTILL�I DEPARTMENT
p Town Hall Anne. 54375 Main Road P. 0. Box 1179 Southold Y 11971-0959
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Telephone (631) 7 5-l 802 Fax (631) 765-9502 h Ns+ ���
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Date Received
APPLICATION FOR B PERMIT
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For office Use Only
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PERMIT No. 5 D e,
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Mailing Address:
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Name: C .0004
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Phone#: Email,
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❑New Structure EIAMition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
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Will the lot be re-graded? ❑YesQ6%No ill excess fill be rem,oved from pre isels? OYet XNO,
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PROPERTY INFORMATION
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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? ❑Yes No IF YES, PROVIDE A COPY.
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Application Submitted B (print name)., � DAuthorized Agent "iner
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Signature of Applicant,' ; � te"
CONN .,
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Notary Publ'ic,State of Now York
STATE OF NEW YO R K} Noe.011130185,0150
al lfied In Suffolk County
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Commission Expires AprII 14,2 c.
COUNTY OF }II
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
(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
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Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
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do hereby authorize to apply on
my behalf to the To nt of Southold Building Department for approval as described herein.
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Owner Signature Date
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Print Owner's Name
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