HomeMy WebLinkAbout53218-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#: 53218 Date: 08/24/2026
Permission is hereby granted to:
Henry A Sommer
385 Grissom Ln
Southold, NY 11971
To:
demolish an existing deck addition to single-family dwelling as applied for.
Premises Located at:
385 Grissom Ln, Southold, NY 11971
SCTM# 78.4-29
Pursuant to application dated 08/17/2026 and approved by the Building Inspector.
To expire on 08/23/2028.
Contractors:
Required Inspections:
Fees:
DEMOLITION $245.00
Total $245.00
4—W,lding Inspector� �
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold NY 11971-0959
Telephone(631) 765-1802 Fax (631) 765-9502 , ttps://"rww ,s t�ithol(;,Ito ,jiix . ov
APPLICATION
qp Date Received
ipBUILDING
For Office Use Only ((�
PERMIT No. Building Inspector:
,� ,G r,
(
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant Is not the owner,an " e
Owner's Authorization form(Page 2)shall be completed.
v�w�w
Date:
OINNER(S)OF PROPERTY:
Name: Henry Sommer SCTM#1000-7$-1-29
Project Address: 385 Grissom Lane, Southold, NY, 11971
Pnone#: 646-287-0439 Email: bernieij@aol.com
Mailing Address: 385 Grissom Lane, Southold, NY, 11971
CONTACT PERSON:
Name: Marissa Garcia
Mailing Address: 1 150 Lincoln Avenue Suite 4, Holbrook, NY, 11741
Phone#: 631-431-0498 Email: projectm anage r 9 sweeneys pool sm co m
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name: Kenneth Sweeney
Mailing Address: 1150 Lincoln Avenue Suite 4, Holbrook, NY, 11741
Pnone#: 631-431-0498 Email: kenneth@sweeneyspoolsvc.com
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair NfDemolition Estimated Cost of Project.-
[--]other ''JcLk O .. i $2,750.00,,
Will the lot be re-graded? 10yes ❑No Will excess fill be removed from premises? Yes ❑No
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PROPERTY INFORMATION
Existing use of property:Single Family Residence Intended use of property:Single Family Residence
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R-40 this property? ❑Yes VNo IF YES, PROVIDE A COPY.
het°k,Box After Reading: The owner/coritractor/design professional Is responsible for all drainage and storm water issues as provided by
Chapter 236 of the Town Code. APPUCATION 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 buildings)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(print name): Marissa Garcia B Authorized Agent ❑Owner
Signature of Applicant: Date:
STATE OF NEW YORK
SS:
COUNTY OF Suffolk
Marissa Garcia being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the Agent
(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
i
day of �4. �s f , 20 D4 r
Notary Public
DAVID J.SHEPARD
NotRjy 01SH6328441 Yodt
No,PROPERTY ER AUTHORIZATION oualified in Suffolk County
.Where the applicant is not the oXWXI�XE'Xr) mm my�missiunExlrirrssAuBust3,20
21
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
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