HomeMy WebLinkAbout53036-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
fat .� SOUTHOLD, NY
0
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#: 53036 Date: 06/01/2026
Permission is hereby granted to:
Thomas R Carley
350 Wampum Way
Southold, NY 11971
To:
replace a patio door to an existing single-family dwelling as applied for.
Premises Located at:
350 Wampum Way, Southold, NY 11971
5CTM#$7.-2-29
Pursuant to application dated 05/27/2026 and approved by the Building Inspector,
To expire on 05/31/2028.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $250.00
CO-RESIDENTIAL $100.00
Total $350.00
Building Inspector
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TOX� N �:._��. S��'�J�:�`ffO:�.D _BUILDING DEPA�.���"`I�.�x I�'�'
7� -1 'flail Afro., 54375 Main Road �P`. 0. Box 1179 Southold NY l �l 971--095
1;pficiie 6 1} 7(5- 0? ca (631) 75-957 Ott s/ , r.sout101
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Date Received
APPLICATION FOR BUILDING PERMIT
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For Office Use Only
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PERMIT NO, Building Inspector: ` "PC
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App'lications and forms,must be filled obt in their entirety. Incomplete
rn applicationsII nit be s + . Where thep
► li+art is na�t the owner,any
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Owner's Authorization form(Page 2 shall be completed., 64
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Date:
OWNER(S) OF PROPERTY.
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Name: Carley .SCTM # s000- -
Project Address:350 Wampum Way Southold NY 11971
Phone#:631-765-5471 Email: lGfusa@aol.com
Mailing address:350 Wampum Way Southold NY 11971
CONTACT PERSON
Name: Carley
Mailing Address:350 Wampum Way Southold NY 197
Phone#:631•-765-3471
Email:
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NFORMATION
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Name,,,
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Mailing Address:
Phone# Email:
CONTRACT R. A
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Name: Renewal By Andersen Ll
Mailing address: 2029 New Highway Farm NY 11735
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Phone#: 631-843-1713 x 2255 ..Email: ovalente rbelongi land com
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DESCRIPTION O S / i ...,✓i, is i ,.. .,
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❑New Structure ❑Addition WAlteration n Repair ❑Demolition Estimated Cost of Project,
n Other Replace 1 patio door $8590
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Will the lot be re-graded? ❑Yes *No Will excess fill be removed from premises? ❑Yes 00,No
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1JROPERTY INFORMATION
Existing use of property. intended use of property:
i
in which premises is situated ! Are there an covenants and restrictions with respect to
Zone or use district � Y
this property? nYes Fe�No 3F YES, PROVIDE A COPY.
R Check BoxAfter Reading,", The owner/contractor/design professional is responsible for all drainage:and storm water issues as provided by
Chapter 23G of the Town code. APPLIrATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zane
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.
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Application Submitted By(print name) ElAuthorized Agent ROwner
Signature of Applicant: Date:
UA_%_,j --
STATE OF NEW YO R K}
SS:
COUNTY OF Suffolk
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) alfove named,
(S)he is the
Ow n e 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
May
26
day of 20 ,
N ota i Public
u
fi . bvvjif Johnson
N� ' " JOB
y P'uhlic,State ofNewYork
PROPERTY OWNER Z Tit �.�w t 01J06349053
Qu ifified in Sufrolk:Count
(Where the applicant Is not the 014tTe
+ OMMission Expires
1, rending at
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signature Date
Print owners Name
2