HomeMy WebLinkAbout53123-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#: 53123 Date: 07/15/2026
Permission is hereby granted to:
Lois M Bennardo
3475 Oaklawn Ave
Southold, NY 11971
To:
construct alterations to an existing single-family dwelling as applied for.
Premises Located at:
3475 Oaklawn Ave, Southold, NY 11971
SCTIVI# 70.-6-1
Pursuant to application dated 06/05/2026 and approved by the Building Inspector.
To expire on 07/14/2028.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $322.00
CO-RESIDENTIAL $100.00
Total $422.00
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959
• � Telephone (631) 765-1802 Fax (631) 765-9502 httris,://www.southoldtownny.gov
Date Received
APPLICATION FOR BUILDING PERMIT
RE C E W E
For Office Use Only n
u I �.,
PERMIT NO. Building inspector.
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the owner,an F �a 'ror `�r �rrr�^r�t
Owner's Authorization form(Page 2)shall be completed.
Date: '
OWNER(S)OF PROPERTY:
Name: is a SCTM #1000- 70—��� � •-- ��
Project Address ,"� "' y� 3 (17. + rAolf11 7�
Phone#: (p�'I`Jfo��_(p�3 a— Email:/0lw5 n1l ,"
Mailing Address:3*71J S
CONTACT PERSON:
Name: Aft
r
Mailing Address:
Phone#: �� ~���o� Email:ki-shen
DESIGN PROFESSIONAL INFORMATION:
Name:
•
Mailing Address: ' , w1
Phone#:�Z31— 2-'7 fo EmailSs'6
CONTRACTOR INFORMATION: * 6e
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
ONewS uctlure ❑Addition Iter� ion ❑Repair ❑ e ion Estimated Cost of Project:
�Othe w $
Will the lot be re-graded? ❑YesWNo Will excess fill be removed from premises? ❑Yes o
1
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? ❑Yes ONO IF YES, PROVIDE A COPY.
❑ Check 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 jprint name)*Ic,,Sta�te
, 3e h El Authorized Agent wner
Signature of Applican y �
Date: `
Notary P of New York
STATE OF NEW YORK,) No,01'BU61 0 alb
SS: Qualified In Suffolk County
Commission Expires April 14,2
COUNTY OF )'
being duly sworn, deposes and says that (s)he is the applicant
(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 n
6�day of
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
residing 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 Owner's Name
2
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