HomeMy WebLinkAbout53164-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#: 53164 Date: 08/03/2026
Permission is hereby granted to:
6955 Route 25 Corp
405 South Dr
Mattituck, NY 11952
To:
Construct alterations to convert finished storage space to office space in an existing mixed use
commercial building as applied for per SCHD approval.
Premises Located at:
6955 Route 25, Laurel, NY 11948
SCTM# 122.-6-36
Pursuant to application dated 06/22/2026 and approved by the Building Inspector,
To expire on 08/02/2028.
Contractors:
Required Inspections:
.... ....... ......
DRAINAGE, FOOTING/REBAR, FOUNDATION 1ST, FOUNDATION 2ND, FRAMING/STRAPPING.. PLUMBING,
ELECTRICAL-ROUGH., FIRE RESISTANT PENETRATION , ELECTRICAL-FINAL, INSULATION,, FIRE SAFETY
INSPECTION, FIRE RESISTANT CONSTRUCTION, FINAL,
Fees:
Commercial-Alteration $819.00
CO Commercial-Addition/Alteration $100.00
Total $919.00
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 1 1 97 1-0959
Telephone (631) 765-1$02 Fax (631) 765-9502 iLttps:ll� Nr,s��z�t7uldto
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Date Received
APPLICATION FOR BUILDING PERMIT-
C E WE
For Office Use Only Dt E
PERMIT N0. 1�—r 4 Building Inspector: J/1-,
-imp, JUN 2 2 2026
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Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an Bul�d�n�--�����!g�
Owners Authorization form(Page 2)shall be completed. Of So,,_�Q�
Date:May 14, 2026
OWNER(5)OF PROPERTY:
Name:6955 Rt 25 Corp (S & D Williams) scTM # 1000- 122-6-36
Project Address:6955 Route 25 Main Rd. Mattituick NY 11952
Phone#:631-872-1457 Email,diw30@icloud.Com
Mailing Address:405 South Drive Mattituck NY 11952
CONTACT PERSON:
Name:Dawn Williams
Mailing Addre55:405 South Drive Mattituck NY 11952
Phone#:6318721457 Email:diw30@iCIOUd.COM
DESIGN PROFESSIONAL INFORMATION:
Name: Thomas R.A PLLCCharles M. ,
Mailing Address:206 Lincoln St. Riverhead NY 11901
Phone#:631-804-3796 Email:cdthomas63@aol.com
CONTRACTOR INFORMATION:
Name:Shawn and Dawn Williams
Mailing Address:405 South Drive Mattituck NY 11952
Phone#:631-872-1457 email:diw30@icloud-com
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
Other Conversion of finished storage to Once/b/m $�
Will the lot be re-graded? ❑Yes BNo Will excess fill be removed from premises? FlYes *No
1
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PROPERTY INFORMATION
Existing use of property: Mixed use intended use of property: Mixed use
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
Hamlet Business (HB) District this property? ❑Yes No 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",Ont,name): Dawn Widliarns DAuthorized Agent @@Owner
Signature of Applicant: Date: 5/14/2026
STATE OF NEW YORK)
SS:
COUNTY OF
C�DawnIIVilliams being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the Corporate officer
(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
A T5 aW A
day of 20 Z
.......... a AWL a I
Notary Public
I CHRISTOPHER B BONDARCHLIK
NO
PROPERTY OWNER AUTHORIZATION FTA RY P1 I RLIC STATF OF NFW YOR K
Registration No 0113(0�8944
(Where the applicant is not the owner)
Qualified in Suffoll(Cot A
-4
V\Commi�sion Expires
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
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