HomeMy WebLinkAbout52290-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
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#: 52290 Date: 09/24/2025
Permission is hereby granted to:
Graeb Fmly 2021 Irr Trt
625 Eugenes Rd
Cutchogue, NY 11935
To:
Convert existing shed into pool house as applied for.
Additional certification may be required.
Minimum 15'-0" setback to sideyard is required.
Premises Located at:
625 Eugenes Rd, Cutchogue, NY 11935
SCTM#97.-2-16.2
Pursuant to application dated 08/04/2025 and approved by the Building Inspector.
To expire on 09/24/2027.
Contractors:
Required Inspections:
Fees:
Accessory-Alteration $197.00
CO Accessory $100.00
Total 297.00
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
w, Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959
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Telephone (631) 765-1802 Fax (631) 765-9502 https:1/www.southoldtownny.go
Date Received
APPLICATION FOR BUILDING PERMIT
E C E U V E
For Office Use Only f]
P)JPERMIT NO._#5 Building Inspector: AUG — 25
Applications and forms must be filled out in their entirety: Incomplete Building D P rtment
applications will not be accepted ;Where the Applicant Is not the owner,an Town of ou�th ld
OwneesAuthoriiat�on;for nil
~(Pag `2)'shall be ompieted.
Date: •y'
OWNER(S)OF PROPERTY:
Name: SCTM #1000- �� — 2 �(o.2
U �
Project Address: (;Zs 1cN�S �L�p GVTACC,"C
Phone#: Email: C, 1NA1L-.0
Mailing Address:
CONTACT PERSON:
Name:
Mailing Address-
Ph one#: Email:.
DESIGN,PROFESSIONAL/,INFORMATION:
Name: pCXV:.JZICN OLSQTf r ��'
Mailing Address: Pb Fx GcJ7C4-10C1L)E-
Phone#: (,51. sv3, ose Email: Z 'N1C�Iv(�SQN. A" C2OrMAIL•
CONTRACTOR INFORMATION: .
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $
Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises? ❑Yes X0
1
PROPERTY INFORMATION
Existing use of property: tirJc-,L-1155- *�'*A Intended use of property:
Zone or use district in which premises is situated: Are there any covenants nd restrictions with respect to
✓ � this property? ❑Yes7No IF YES, PROVIDE A COPY.
„ Crntctwrdexign prfsiaril tonsfbNe for all drainage nsto .water tarldey
to REOTIMbb ? ltlra Zone
rdl it I dhrdtI +i� ina» it W,g fur the rKusnlfdiag ,
g
addti s alterations or for removal or demol+f+orYas herein descr+be�i the appricari!agrees to comply with all`appficable laws,ordinances,building code,
housm code and regulations and to admit authorized inspectors onhpremises and i6 b6iIdi6j(s)for necessary inspections false;tatemerfts made herein are
pumshabI I a class A;m+sde`"meangr pulsuant t,�ecti. 230AS of the dew York State Penal�law:
Application Submitted-gy(prints name): &G,'eNt`? 7F. t'tt"U-�{i authorized Agent []Owner
Signature of Applicant: �L Date:
CONNIE D. BUNCH
Notary Public,State of New York
STATE OF NEW YORK) No. 01 BU6185050
Qualified in Suffolk County
SS: Commission Expires April 14, 2 �
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
4 da,y of
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
I, /�!� residing at 5 � C�' .
do hereby authorize � ►� ` G�=J 5'U o to apply on
my behalf to the Town of Southo d Building Department for approval as described herein.
1
Owner's Signatur Date
Print Owner's Name
2
ffat BUILDING DEPARTMENT-Electrical Inspector
TOWN OF SOUTHOLD
Town Hall Annex- 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1802
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (Ail Information Required) Date: June 27, 2025
Company Name: Custom Lighting of Suffolk
Electrician's Name: Benjamin Doroski
License No.: 38893-ME Elec. email:Clos5170@gmaii.corn
Elec. Phone No: 631-298-4588 ElI request an email copy of Certificate of Compliance
Elec. Address.: PO Box 1698 Mattituck, NY 11952
JOB SITE INFORMATION (AII Information Required)
Name: John and Diane Graeb
Address: 625 Eugenes Road
Cross Street: Main Road
Phone No.. 631 603 6131
BIdg.Permit#: 5 a u email:dianengraeb@gmail.com
Tax Map District: 1000 Section: Block: 91 Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
SIn e-d --r-f F l e c+r I,C,
Square Foota e: 140 ft
Circle All That Apply:
Is job ready for inspection?: YES NO ❑Rough In Final
Do you need a Temp Certificate?: YES NO Issued On
Temp Information: (All information required)
1 Ph 3 Ph Size: A #Meters Old Meter#
Service Size❑
❑New Service[—]Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground wefiead
#Underground Laterals 1 H Frameo Pole Work done on Service? Y nN
Additional Information:
PAYMENT DUE WITH APPLICATION
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