HomeMy WebLinkAbout53208-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#: 53208 Date: 08/17/2026
Permission is hereby granted to:
Milov&Napolitano SupCare Tr
9 Lefferts PI #1
Brooklyn, NY 11238
To:
legalize an "as built"generator as applied for.
Premises Located at:
905 Wildberry Ln, Southold, NY 11971
SCTM# 51.-3-12.13
Pursuant to application dated 08/04/2026 and approved by the Building Inspector.
To expire on 08/16/2028.
Contractors:
Required Inspections:
Fees:
CO-RESIDENTIAL $100.00
As Bu(I Generator $250.00
Total $350.00
B l ding Inspector
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APPLICATION FOR BUILDING PERMIT
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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 El 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 230.45 of the New York State Penal Law.
Application Submitted By(print name): (09003Z (044eav5et Authorized Agent ❑Owner
Signature of Applicant Date: c)Plr 3o zD26
STATE OF NEW YORK)
SS:
COUNTY OF 54CN61
2 �44g sAlt, being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the
(Contracto(,Agent, rporate Officer, etc.)
of said owner or owners, and is duly authorized top rn 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
2026
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6e C1)1U2t4 ,4
tary Public
TRAM IL.O EIS
NOTARY PUBLIC,.STATE OF N'kW YORK
PROPERTY OWNER AUTHORIZATION NO.01OW6306900
Where the applicant is not the owner OUALIFIEDIN SUFF"OLKCOUNTY
( p p ) COMW88ION 1FXPIREUUN 30„
I, 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