HomeMy WebLinkAbout52546-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#: 52546 Date: 12/12/2025
Permission is hereby granted to:
Gregory Olsen
PO BOX 158
Laurel, NY 11948
To:
construct alterations to an existing single-family dwelling as applied for.
Premises Located at:
6645 Great Peconic Bay Blvd, Laurel, NY 11948
SCTM# 126.-10-20
Pursuant to application dated 10/14/2025 and approved by the Building Inspector.
To expire on 12/12/2027.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $283.00
CO-RESIDENTIAL $100.00
Total $383.00
iris Inspector
P, TOWN OF SOUTHOLD—BUILDING DEPARTMENT
�p5
�� Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
r Telephone (631) 765-1802 Fax(631) 765-9502 htt a1�" w. cat1'oldtown . Yy
o
Date Received
PERMITAPPLICATION FOR BUILDING
V �
(�For Office Use Only
PERMIT NO. Building Inspector:
Applications and forms must be filled out in their entirety. IncompleteTM" ' y
applications will not be accepted. Where the Applicant is not the owner,an q 'oo
Owner's Authorization form(Page 2)shall be completed.
Date: 11th October,2025
OWNER(S)OF PROPERTY:
Name: Mr. & Mrs. J. Jeffrey SCTM#1000- 126.00 - 10.00 - 020.000
Project Address: 6645 Peconic Bay Boulevard, Laurel, N.Y. 11948
Phone#: 516.728.7306 Email: johnrjeffrey9@gmaii.com
Mailing Address:
CONTACT PERSON:
Name: Nigel Robert Williamson
Mailing Address: P.O. Box 1758, Southold, N.Y. 11971
Phone#: 631.834.9740 Email: nigel_architect@hotmail.com
DESIGN PROFESSIONAL INFORMATION:
Name: Nigel Robert Williamson R.A.
Mailing Address: P.O. Box 1758, Southold, N.Y. 11971
Phone#: 631.834.9740 Email: nigel_architect@hotmail.com
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION Di-KoL IS i l Ex Its riN Cr
❑New Structure ❑Addition iRAlteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other
Will the lot be re-graded? ❑Yes BNo Will excess fill be removed from premises?
22. 21 Scz. Fr, 1►� Exl s ►65 C, ADD F-r^1 BaTN 2ooM
GLOSET 71. 865 Se+a r. 1A1 sxm E
i
f
PROPERTY INFORMATION
Existing use of property: Single Family Dwelling Intended use of property: Single Family Dwelling
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R40 this property? ❑Yes*NO IF YES, PROVIDE A COPY.
Al Check Box After Reeding: 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(pri t name): BAuthorized Agent El Owner
Signature of A li o C
STATE OF NEW YORK)
SS:
COUNTY OF -,-jU_:Ef C9` ' )
Nigel Robert Williamson
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the Agent
(Contracto A ent orporate 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_ ��7��� ' � .. .... ZB
Notary Public
T^ACEY L. DWYER
PROPERTY OWNER111 ) wP M, I NOTARY PUBLIC,STATE OF NEW YORK
... ...� ...... NQ.01 DW6306900
(Where the applicant is not the owner) OU2.1-:FIED IN SIJFFt-,)LK COUNTY
COM11ASSiON EXPI'4I S DUNE 30,2 ,I!p
I y residing at ���-� 4~ 4 x4w. "WA,
"
John R. Jeffre
Nigel Robert Williamson
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
/,o 1;,x 4x
ner's S#1161r" Date
Print Owner's Name
2
OL AK
=. .,
K
MAP-"O
SU EYE
FLUP,-ENCE C, ...',i
• x
i
O
A�.L AY� B-U
ix
W m6
n
L
FA Lm
orf STORE
s „
.PR-MO
10
w PCH.
32 QI'4o�
3owimm
61
�hwC �- APPROX. l TO 6PA'+r AVE.
P CON!r BAY 5O�:i_,S A P-D
c_ To 11w �
. . .
Yl *50-N
AN
C. -
f G e ter w.
;.