Loading...
HomeMy WebLinkAbout52549-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#: 52549 Date: 12/12/2025 Permission is hereby granted to: Dana Didriksen 31 Howard St Sag Harbor, NY 11963 To: construct alterations to an existing single-family dwelling as applied for. Premises Located at: 6180 Clay Point Rd, Fishers Island, NY 06390 SCTM# 2.4-6 Pursuant to application dated 10/15/2025 and approved by the Building Inspector, To expire on 12/12/2027. Contractors: Required Inspections: Fees: Single Family Dwelling- Alteration $250.00 CO-RESIDENTIAL $100.00 Total $350.00 Building Inspector—� TOWN OF SOUTHOLD—BUILDING DEPARTMENT s Town Hal Annex 54375 Main Road P. O. Box 1 179 Southold, NY 11971-0959 % Telephone (631) 765-1802 Fax (631) 765-9502 hit s://WW1yV.Sou�th rl ittawr1l . t ' Date Received APPLICATION FOR BUILDING PERMIT 'E Or Office Use Only PERMIT N0. � � Building Inspector w Applications and forms must be filled out in their entirety. Incompletek applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date: 10/3/2025 OWNER(S)OF PROPERTY: Name: Rachel Williams & DanaDi ric son SCTM# 1000-002.00-01.00-006.000 Project Address: 6180 Clay Point Rd,. Phone#: Email: Mailing Address: CONTACT PERSON: Name: Mailing Address: Phone#: Email. DESIGN PROFESSIONAL INFORMAT'I Name: Mailing Address:. Phone#: Email: CONTRACTOR INFORMATION: Name: William A. Bartlett President HP Broom Housewright Mailing Address: P.O. Box 7 , 162 Ferry Rd, Phone#: 360-390-2 16 Email: julie@hpbroom.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition CXAlteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $ 265,000.00 Will the lot be re-graded? ❑Yes IYX No Will excess fill be removed from premises? ❑Yes ®No 1 PROPERTY INFORMATION Existing use of property: residential Intended use of property: no change Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to 1 . Simplex this property? ❑Yes Y No IF YES, PROVIDE A COPY. © Check Box AfterReading: 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): illiarn A. Bartlett X❑Authorized Agent ❑Owner Signature of Applicant: 4Date: Gc�'�r+Zt+i-i cry t' STATE OF ILK) SS: COUNTY OF L41EW ) W i►I i cxky-% A . rbc t►e-+-i- 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 ►"^ day of ZO �'� t►I!iliiliii Notary Public ADO ,.., C,r or10TARy� ' PROPERTYT I TI (Where the applicant is not the owner) . PIJBL •.' t4 30,'v ( 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