HomeMy WebLinkAbout53248-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#: 53248 Date: 09/03/2026
Permission is hereby granted to:
John Roslak
40 Oriole Dr
Southold, NY 11971
To:
install window replacements to an existing single-family dwelling as applied for.
Premises Located at:
40 Oriole Dr,Southold, NY 11971
SCTM# SS.-64S.1S
Pursuant to application dated 08/17/2026 and approved by the Building Inspector.
To expire on 09/02/2028.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $250.00
CO_RESIDENTIAL $100.00
kTotal $350.00
uilding 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 lstt : / v .southoldtownn ov
Date Received
APPLICATION
BUILDING' I
For Office Use Only j
c1!
PERMIT NO. a�c 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 ,
Owner's Authorization form(Page 2)shall be completed. �o
Date:08/10/2026
OWNER(S)OF PROPERTY:
Name John Roslak SUM#1000-055-00-06-00-015-015
Project Address:40 Oriole Drive, Southold, NY 11971
Phone#:(516)769-4955 1 Email:jroslak@yahoo.com
Mailing Address:40 Oriole Drive, Southold, NY 11971
CONTACT PERSON:
Name:Lindsay Loson
Mailing Address:2029 New Highway Fa7Email:
im dale, NY 11735
Phone#:315-335-8730 rli-40oriole—bpwd@permitflowteam.com
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:RENEWAL BY ANDERSEN OF LONG ISLAND
Mailing Address:2029 New Highway I Far min dale, NY 11735
Phone#:631-843-1713 1 Email:rli-40oriole_bpwd@permitflowteam.com
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure OAddition ®Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other Raplacemenl of 17 wlr�,�ke duMnq pad aperJIV anopwadan,MAWwwadd repleeemenl as needed,and Ankh work.No elnxAwsl changed Indlceled. $55,05
Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ❑Yes @No
Page 3 of 35
PROPERTY INFORMATION
Existing use of property:Residential Intended use of property:Residential
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
SOUTH OLD I
this property? Dyes IRNo IF YES,PROVIDE A COPY.
8 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(print name):Li ndsay Loson MAuthorized Agent ❑Owner
Signature of Applicant: Date: 08/10/2026
Viokey 8"Idd
STATE OFF "XQ&W) " ° NOTARY PUBLIC
SS: STATE OF NEVADA
Clark
° �` APpt.No.za-ass-oi
COUNTY OF ) ��ry � Mr° Expires Awouuxs,zov
Lindsay Loson 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
US!,
10th day of August 20 26 _ .*Aiw
, _...�. .
Notary Public
Notarized remotely using audio-video communication technology via Proof.
PROPEWrY OWNER AUTHORIZATION
(Where the applicant is not the owner)
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
Page I of 35