HomeMy WebLinkAbout53265-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#: 53265 Date: 09/11/2026
Permission is hereby granted to:
Diane Klein
424 E 52nd St Apt 1C
New York, NY 10022
To:
install replacement patio door to an existing single-family dwelling as applied for.
Premises Located at:
1125 Seawood Dr, Southold, NY 11971
SCTM# 79.-7-62
Pursuant to application dated 08/21/2026 and approved by the Building Inspector.
To expire on 09/10/2028.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $250.00
CO-RESIDENTIAL $100.00
Total $350.00
Building Inspector�� ��
TOWN OF SOUTIiOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax(631) 765-9502 https://www.southoldtownny.gov_
Date Received
APPLICATION FOR BUILDING PERMIT D E C
For office Use Only
�a �°y J
4
PERMIT NO. 5.3)10� Building Inspector:
Building fMrffent
Applications and farms must be filled out in their entirety.Incomplete Town of S��uthojl,
applications will not be accepted. Where the Applicant Is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date:08/14/26
OWNER(S)OF PROPERTY:
Name:David & Diane Velasquez SCTM #1000-079.00-07.00-062.000
Project Address:1125 Se&-bod Dr. , Southold, NY 11971
Phone#:(917) 379-4330 Email:dkleinpt@aol.com
Mailing Address:1125 Sec-Pbod Dr. , Southold, NY 11971
CONTACT PERSON:
Name:Lindsay Loson
Mailing Address:2029 New Highway Farmingdale, NY 11735
Phone#:3153358730 Email:rli_1125seafooddr_bp@permitflowteam.com
DESIGN PROFES91ONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:RENEWAL BY ANDERSEN OF LONG ISLAND
Mailing Address:2029 New Highway Farmingdale, NY 11735
Phone#:631-843-1713 Email:rli_1125seafooddr_bp@permifflowteam,com
DESCRIPTION OF PROPOSED CONSTRUCTION
New Structure OAddition MAlteration ❑Re air ❑Demolition Estimated Cost of Project:
O p
❑Other $10,545.00
Will the lot be re-graded? 0Yes BNo Will excess fill be removed from premises? OYes BNo
Page i of 15
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
Southold this property? ❑Yes LONo 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 orfor 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):Lindsay Loson RAuthori2ed Agent ❑Owner
Signature of Applicant: ot.t.ILw"* oL.(}Q.UV'(, Date: 08/14/2026
STATE OF)Nkkl(A1MX) Virginia /qAS
SS:
COUNTY OF Newport News )
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 A ent
(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
14th day of August 20 26
r Notary Public
� r��a9ornu�n� s+��nr�
Nt Notarized remotely online using communication technology via Proof.
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PROPERTY OWNER AUTHORIZATION
an.x. Jury 31.2029
pp
Where the applicant is not the owner)
I, David Velazquez residing at 1125 Seawood Dr. Southold, NY 11971
do hereby authorize Lindsay Loson to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
r 9/4/2026
Owner's Signature Date
David Velazquez
Print Owner's Name
2