HomeMy WebLinkAbout52554-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#: 52554 Date: 12/16/2025
Permission is hereby granted to:
JD Property Solutions LLC
90 Willow Ave
Islip, NY 11751
To:
legalize "as built"alterations(including HVAC system)to an existing single-family dwelling as applied
for. Additional certifications may be required.
Premises Located at:
675 Dicks Point Rd, Cutchogue, NY 11935
SCTM# 110.-2-14
Pursuant to application dated 10/22/2025 and approved by the Building Inspector.
To expire on 12/16/2027.
Contractors:
Required Inspections:
Fees:
As Built Addition/Alteration $500.00
CO-RESIDENTIAL $100.00
Tota I S600.00
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 h -ANy.southoldtow�n . o
Date Received
APPLICATIONBUILDING
For Office Use Only
PERMIT NO. =� Building Inspetor: _
Applications and forms must be filled out in their entirety.Incomplete _ 4; &t
applications will not be accepted. Where the Applicant is not the owner,an =o___n o -s -oi-J
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: SCTM#1000-
Project Address: I S
Phone#: Email`
-
Mailing Address: 10
. 9 [ Owyl
CONTACT PERSON:
Name:DaUnQ Mh
Mailing Address-A
��tlYV � � 'v
Phone#: '� 3F el 0 EmailDM&Mnl I q 4��,qm-id
DESIGN PROFESSIONAL INFORMATION:
Name: U iq,)MhUCI N= - IffiN -t)j6161V) C
Mailing Address: 01A fie
Phone#: U'J — a d �1- ? b� Email: aim com
CONTRACTOR INFORMATION:
Name: wy fV V/\�)
Mailing Address:
Phone#: U J Z Lot Q
Email:_
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition Alte ion Re air ❑Demolition Est] to of Project:
Other �. p 1
Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises? ❑Yes ❑No
PROPERTY INFORMATION
Existing use of property: Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes El No 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): bush ld"Authorized Agent ❑Owner
Signature of Applicant: Date: l0 I Z2(Zoz,
STATE OF NEW YORK)
COUNTY 01= K
TALU112 D%h being duly sworn,deposes and says that(s)he is the applicant
(Name of i dividual signing contract)above named,
(S)he is the t
_ &
(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
Lday of %1 U l/VV ,202
Notary Public
PROPERTY OtAFNER AUTHORIZATION
q ^per
(Where the applicant is not the owner) ff h
I,
_:UrA MVIM- cesid* at
Qr do hereby authorize =yu Mr I to apply on
my Abeto the ToWn of Southold Building Department for approval as described herein.
JF
ZZ20ZT
ctu
I is " nare Date
Y
Prin Owners Name
Building Degartment Application
AUTHORIZATION
(Where the Applicant is not the Owner)
1, �0?-,h residing at q,o W l U J ' I V'- . N I P
(Print property owner's e) gAddress)
do hereby authorize POLUM gh
(Agent)
to apply on my behalf to the
Southold Building Department.
�L� W
( 4 ner's ' ture) (D te)
(PrintOwner's e)
c
�19
CERMICANIONS HEREON SIGNIFY THAT THIS PLAT OF PROPERTY IS A TRUE AND CORRECT REPRESENTATION OF A RECENT SURVEY MADE UNDER MY DIRECTION IN ACCORDANCE WITH THE EXISTING CODE OF PRACTICE
_ LAND SURVEYORS BY THE NEW YORK STATE ASSOCIATION OF PROFESSIONAL LAND SURVEYORS.SAID CERTIFICATIONS SHALL RUN ONLY TO THE PERSON WHOM THE SURVEY WAS PREPARED AND ON THEIR
BEIIALF TO THE TITLE COMPANY,GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON.THIS CERTIFICATION IS ONLY FOR THE LANDS DESCRIBED HEREON, ITS NOT A CERTIFICATION OF TITLE. ZONING,
R FREEDOM FROM ENCUMBRANCES. CERTIFICATIONS ARE NOT NOT TRANSFERABLE TO ADDITIONAL OR SUBSEQUENT OWNERS.
CS 24019'50" E 100.00,
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THE OFFSETS OR DIMENSIONS SHOWN FROM THE IMPROVEMENTS TO THE PROPERTY LINES ARE FOR A SPECIFIC PURPOSE AND USE,AND THEREFORE ARE NOT INTENDED TO BE USED AS A GUIDE IN THE ERECTION
OF Fes.WAUIS,POOLS,PATIM UUILDINGS,MOTIONS TO BUILDINGS OR ANY OTHER IMPROVEMENTS.SUBSURFACE AND ENNORNMEMAL CONDITIONS NOT SHOWN. PROPERTY CORNER MARKERS WERE NOT SET
AS A PART OF THE SURVEY.EASEMENTS,AND OR RIGHTS-OF-WAY OF RECORD. IF ANY: NOT SHOWN.
PJM LAND SURVEYING, PLLC UNAUTHORIZED ALTERATION OR
132 CLYDE STREET/SUITE 16 ADDITION TO THIS SURVEY IS A
WEST SAYVILLE NY 11796 VIOLATION OF SECTION 7209 OF
PHONE 631-563-0400 NEW YORK STATE EDUCATION LAW.
FAX 631-563-5808
PJMSURVEYING ral A L.CON1
LOT:--- REVISIONS
MAP OF:DESCRIBED PROPERTY
FILED: ---- NO ---- COUNTY:SUFFOLI
SITUATE:CUTCHOGUE,TOWN OF SOUTHOLD COPIES OF THIS SURVEY MAP NOT
CERTIFIED TO: TITLE NO.: BEARING THE LAND SURVEYOR'S
EMBOSSED SEAL AND SIGNATURE
SHALL NOT BE CONSIDERED A TRUE
ARID VALID COPY
PROJECT Nth_2025-227
DATE- 10/09/2 25 _
DRAWN: CM CHECKED BY:PM SCALE: 1"=20' DISTRICT: 1000 SECTION: 110 BLOCK: 02 LOTS : 14