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Home My WebLink About52318-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#: 52318 Date: 10/06/2025 Permission is hereby granted to: John P Rooney PO BOX 1622 Southold, NY 11971 To: construct alterations to an existing single-family dwelling as applied for with sanitary certification, Premises Located at: 425 Maple Ln, Southold, NY 11971 SCTM# 64.4-25 Pursuant to application dated 08/14/2025 and approved by the Building Inspector. To expire on 10/06/2027. Contractors: Required Inspections: Fees: Single Family Dwelling- Addition &Alteration $393.00 CO-RESIDENTIAL $100.00 Total $493.00 Building 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 littj s:// ww southold'townrn . go�� Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only C PERMIT NO, Building Inspector; AUG1' 4 2025IUJ Applications and forms must be filled out in their entirety.Incomplete applications will not be accepted. Where the Applicant is not the owner,an Building Department Owner's Authorization form(Page 2)shall be completed. Town I Southold Date. OWNER(S)OF PROPERTY: Name:" t 100- 2-5 Project Address: "" l lei 7)- Phone#: 41j _ Email C\ G Mailing Address: )D ( -2 ox 16, Z c 7 b�— CONTACT PERSON: Name: Mailing Address: Phone#: Email: DESIGN PROFESSIONAL INFORMATION: Name: akkI.,, K C,8 1. E c. Mailing Address: 93s 73 Email: Phone# 5 o "E)' CONTRkCTOR INFORMATION: Name. . Mailing Address: Phone#: Email: DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition QAlteration ❑Repair ❑Demolition Estimated Cost of Project: 90ther . u � 1PAIS, Will the lot be re-graded? ❑Yes �&No Will excess fill be removed from premises? ❑Yes)qNo 1 PROPERTY INFORMATION Existing use of pro pertyV,,5, ENTI Intended use of property: s �t_ Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes;7No IF YES, PROVIDE A COPY. ----------- 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): I"l /� Authorized Agent C Owner Cam.✓�cr-- Signature of Applicant: date: � STATE OF NEW YORK) S : COUNTY OF being duly sworn, deposes and says that (s)he is the applicant A149&= � M�&, (Name of individual signing contract)above named, (S)he is the (Contracto ,Agent,' o porate Officer,et(!,) 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 1`f dayof u 20 ' S _ otary Public T"RACEY L. WY FIY PUS ,STATE OF:NEW YORIC PROPERTY OWNED' AUTHORIZATION NOS fllOW 63069 d (Where the applicant is not the owner) OLIALIPIEU IN UFFMIK COUNTTy #ASSION EXPIRES JUNE30, i4ufl� UJ-,qA1, �Nv residing at ;, zimp do hereby authorize , c 11 l tb Qpiy on my behalf to the Town opSut'hold Building Department for approval as described herein. wner's i a re W¢; Date � CrP y L ps "tiod A) �, Print Owner's Name 2 n -, RCHITECT MARK SCHWARTZ &ASSOCIATES 28A0 3 \lain R(;ad• PO B,)x 93).3)•C:urrhm',lic. NYI1935 631.73+.4185 1 September 30,2025 Southold Town Building Department 54375 Main Road Southold,New York 11971 Re: Phillips Property 425 Maple Lane Southold, NY To whom it may concern, I have reviewed the septic system Certification by John Crandell dated 06/20/25 (attached). Based on this information,to the best of my knowledge,this completed system has been installed as per code requirements for a 4 Bedroom Residence. Please contact this office with any questions you may have. Sincerely, } . PIC Mark Schwartz .uA "+ �omswia P..Yak tew CERTMCA` ON OF SEWAGE DISPOSAL SYSTEM BY INSTALLER A ffi—maauylswaa�Wt of kawlr* `kff mwsa#wR2 it ww M ,�� ara� ma's.rAr&�wwsia w . Health DeImuzzal RCkFC=e N®bmr SHIP 25-0N55 Suffolk Ta Map!:Dist 1000 ,ems) 064 Rks,)01 Lo s) 025 w " Project Name or AddFcm 425 mms L� t Y I i 971 AI-L l now+ D0P-0T'H l Dtrsed5 46i-�25 SF.tI7CTAJYl LA OIPls 7ZFA739°JNl'DNll Volme opnons): A;m 4i y s Make and Model: Material: C'A=U6 [I ] c _. " Rated Daily TreatoteW CApwRy(8pflons)= Shxpc: r,ReCaDVAN. J4 C:ylhadaical Material [I Cmiem []FtbmjUss lactic Top_ [I SWpTndfic Stak[]De wy U77ONLFil®YGPOOLS " Nmba Name ofTsmkA�r " of Pools QE&W TR" DlamerQ and Effecaw Depth Voh®e(pttow)k .. Top: []slab [l Tic slab []Dome mweriat: [)cAnamtrg, (]>- 1msdc " Name of Pmcast Maau� Top: []SW[]T S>*[]u®e s � SM * coral'mtbetrDbungmmUm p ss� l �c=d M�(i lc)* Top: [I Slab []Traffic Slab Wome []IJJA Total Dear Feet of Leaching Strtwcdue(s): '" Name of Precast Mangy - COFMANDLWS histalled covers comply with muent standards(secondary safety device installed if cover wdght less that 601bs) g Ycs []NIA —p-m t 6e��y�� tine hem imta0od by ar a iw�e widN tt+e ' o d,11 ee>ar danara swo any and all b—t«m wIld md ale opmMimd in MoNdowe..ih mm6eames ummmooda- 1r2D2= a " tw 13111 �p yN==A�;pt NW Drain lilt Inc lbu 631�"l 12 ftwlewood Drive Itocky Poett NY 11778 c. Commuer Aff9m Liquid wasm tiw umnber ana endotsenmdKs): '"rm.D9DM0N71'AW +McoAfpu j1mow);!7jrsdmrAAtrAiErtAcofmr m�" to man »I��do trim��at scb o&=aft�e Dq wrta � saa�lt and odorsAmudm nee am y**Ak 1 atsn 0"'dry dart*6 OWTS mspNaom or ftea t � � awe" Instdws Si 4 Installer's Name: hCra TM DOCUMMT guar aarrsna oatcWur.SMAToass FROM T=ttysMUM M; Min $�'rp 1D,4 aw-oo"'sr' ales �aSD 60-llw `'v z all, Mr � 9 - �- �� - �•, �.. 4 .,,. ..` e ' d y � A' SEWtit AND D" � .. "E*RANDDRAIN N&NANCP.COM �. e.. 11J IL O r � r ty, Suffolk County Department of H alth Services 0111e0of'Wastewaterll ua eut 360 Vaphank Avenue,Suite 2C J. *pba*New York1198o tir d (631)852-5700 OR HeoltbWWM@Suffoikgoontyny.gov CERTIFICATION OF SEWAGE DISPOSAL SYSTEM ABANDONMENT Health Department Reference Number: SHIP 2540455 r Suffolk Tax Map#:Dist: 1000 a6a 0 ' Project Name or Address: 425 Maple Lane Southold.New York 11971 � v- Subdivision Name&Lot# W Applicant Name:WROTW PMtwPs I HEREBY CERTIFY THAT; L The first septic tanMearhtng pool,from the foundation,was located and uncovered.,,AND 2. If liquid sewage was noted therein,was pumped dry by a licensed swage hauler„AND 3. Tank(pool was inspected fair outlet line to an overflow pool,AND p 4. Overflow pool(s)was/were located,uncovered and items#2 and#3 were repeated until all parts of • , sanitary system were located,AND 5. All parts of sanitary system were removed or filled with clean backfill and any corbelled block domes 4 ° collapsed. A. I also certifythat the sanitary system abandoned is t tary y consisted of- First tank/ 1 feet diameter feet deep( �^ P°O �_ )precast 4block ( )other First overflow pool��feet diameter 6 feet deep( )precastlock ( )other Next overflow pool feet diameter feet deep( )precast'( )block ( )other Next overflow pool feet diameter feet deep( )precast ( )block ( )other Company which pumped out sanitary system if different from certifying company: Name of Company *.' Address: a Consumer Affairs License Number. M� ; .. t' �' aia�a.� �,a 2azo2s Print N Datracw St �AND DRAIN MAINTENANCE INC pyne,631-04s-1599 Address:12 wH mly�• I1tlNOOD DRIVE ROCKY PONT NY 11778 Consumer Affairs License Number. 6t4440-Lw L This certification shall n be used in lieu of inspections required by personnel of the Department and may be duplicated on company letterhead,provided it contains the above information. o 4, 4 ►HOTOCOPWS OR DOCUMENTS WILL NOT BE ACCEPTED e a WWM-090 (Rev.02112) { MAIN RO'AO ,ems 7 drive b eef- r ,. /f C T `��' �� 1 ,4 (ApeMAP � o� �� a �• .. Vjpiek Iry - &.1oN A. $ .-ALVPvA' - So tu--lA-jR.R.IMSTOM- AT' Sou 7-HO/.0, /V. }! ar -Ro d le f e. V4 n I? .4i Area 4. Z97 acres �' Land .Su 4"