HomeMy WebLinkAbout52367-Z eu �e 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#: 52367 Date: 10/16/2025
Permission is hereby granted to:
Manis T Revoc Trt
47 Vanderlyn Dr
Manhasset, NY 11030
To:
Construct additions and alterations to an existing single-family dwelling to include a rear covered
porch, sunroom with HVAC and outdoor shower as applied for.
Premises Located at:
850 Robinson Ln, Peconic, NY 11958
SCTM# 98.-4-33
Pursuant to application dated 09/05/2025 and approved by the Building Inspector.
To expire on 10/16/2027.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Addition&Alteration $440.00
CO Single Family Dwelling-Addition /Alteration $100.00
Total $540.00
Building Inspector
7'F
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 htt S.//WW IvV of t:[,1oldt',)Wili . loy,
Date Received
APPLICATION FOR BUILDING PERMIT
E C � 19 E
For Office Use Only
PERMIT NO.� EP — 2025 Building Inspector..
Applications and forms must be filled out in their entirety.Incomplete w i incg Depwtment
applications will not be accepted. Where the Applicant is not the owner,an 'fokvn of Southold
Owner's Authorization form(Page 2)shall be completed.
Date: ! — aS —Z'r
OWNER(S)OF PROPERTY:
Name:Thomas & Asimina Manis SCTM#1000-98.-4-33
Project Address:850 Robinson Lane, Peconic, NY 11958
Phone#:516-365-7792 1Email:
Mailing Address:47 Vanderlyn Drive, Manhasset, NY, 11030
CONTACT PERSON:
Name:Thomas & Asimina Manis
Mailing Address:47 Vanderlyn Drive,Manhasset, NY 11030
Phone M 516-365-7792 Email:
DESIGN PROFESSIONAL INFORMATION:
Name:Kehl Design Assoc. LLC.
Mailing Address:265 Jasmine Lane, Southold, NY 11971
Phone#:631-433-9084 Email:ssbn654@optonline.net
CONTRACTOR INFORMATION:
Name:NA at this time
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ®Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other 75K
Will the lot be re-graded? []Yes igNo Will excess fill be removed from premises? ❑Yes WNo
1
PROPERTY INFORMATION
Existing use of property:Residential Single Family Intended use of property:Residential Single Family
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R_40 this property? ❑Yes ®No IF YES, PROVIDE A COPY.
N 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 rt me):Brett D. Kehl l RAuthorized Agent El Owner
Signature of Applicant: Date: OR—®S Z02,'C—
STATE OF NEW YORK)
SS:
COUNTY OF Suffolk )
Brett D. Kehl 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
— day of 20
a rj Public
TP AOXY L. DWYER
IIPRQPERTY OWNSRm�n
U l 11U�IIZA rION NOTARY PUBLIC,STATE OF NEW`FOR
(Where the applicant is not the owner) NO.01DWs306s00
nU,:$LIFIED IN SUFFOLK COUNTY
COMIMSSION EXPIRES JUNE 30,
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
2
:Bxetlditig,])tpartifie,nt AOgligati2n
AUTHORIZATION
(Where the Applicant is not the Owner)
1 Yv� residing at
(Print property owner's haine) (Mailing A nt e
,' .
do hereby authorize
(Agent)
to apply on my behalf to the
Southold Building Department.
(Owner's Signature) t
(Print Owner's Name)
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