HomeMy WebLinkAbout53250-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#: 53250 Date: 09/08/2026
Permission is hereby granted to:
Paul J Derderian
235 Leeharn Ave
Bridgewater, NJ 08807
To:
construct additions and alterations to an existing single-family dwelling as applied for.
Premises Located at:
980 Madeline Ave, Fishers Island, NY 06390
SCTM# 6.4-10
Pursuant to application dated 08/18/2026 and approved by the Building Inspector.
To expire on 09/07/2028.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Addition &Alteration $423.00
CO-RESIDENTIAL $100.00
Total $523.00
ilding Inspector
`rr�r TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P, 0. Box 1179 Southold,NY 11971-0959
P Telephone (631) 765-1802 Fax(631) 765-9502 k�l��s:,6'av ��r,�,southol(Itot ynrx,;"'sLc��
Date Received
APPLICATION FOR BUILDING PERMIT C El
roar Office Use Only yy
A U G P p Fl 2026
PERMIT NO. Building Inspector.__
Ildi
rtment
Applications and forms must be filled out in their entirety.Incomplete Btt Tr WIl r Of Southold
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(page 2)shall be completed.
Date:2026-08-11
OWNER(S)OF PROPERTY:
Name:Paul Derderian SCTM#1000-1000-6.-7-10
Project Address:980 Madeline Ave Fishers Island NY 06390
Phone#:631 788 7818 Email:paulderderian@yahoo.com
Mailing Address:980 Madeline Ave #66 Fishers Island NY 06390
CONTACT PERSON:
Name:Paul Derderian
Mailing Address:980 Madeline Ave #66 Fishers Island NY 06390
Phone#:9083372194 Email:paulderderian@yahoo.com
DESIGN PROFESSIONAL INFORMATION:
Name:360 DESIGN PLUS, LLC
Mailing Address:4 Stonewood Drive, Old Lyme, CT 06371
Phone#:(617) 549 - 5457 Email:dnoe@360designplus.com
CONTRACTOR INFORMATION:
Name:Skyline Custom Carpentry, Inc
Mailing Address:PO Box 342 Fishers Island NY 06390
Phone#:631 943 7487 Email:skylinefi@live.com
DESCRIPTION OF PROPOSED CONSTRUCTION
[--]New Structure ❑Addition ❑Alteration ❑Repair ODemolition Estimated Cost of Project:
rebuild existing Deck with a screened in room $95,000.00
❑Other B ...m....�............ �.._
Will the lot be re-graded? ❑Yes 8 No Will excess fill be removed from premises? ❑Yes B No
1
PROPERTY INFORMATION
Existing use of property:Residental Intended use of property:Resldental
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R_80 this property? CJYes ®No IF YES, PROVIDE A COPY.
Check Box After Read in__ The owner/contractor/design rofessionalIsres sibleforalldrai drainage � µ ssues__w....
g; p responsible Wage and storm water issues as provided by
Chapter 236 of the Town Cede. 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 210.4S of the New York State Penal Lew.
Application Submitted
pp d By(print name): P �11DU rder aan ❑Authorized Agent Owner
Signature of Applicant: - �6
STATE OF NEW YORK)
SS:
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
day of 20�
Notary Public
(Where the applicant is not the owner)
I, residing at w,
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