HomeMy WebLinkAbout52577-Z TOWN of SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLDNY
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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#: 52577 Date: 12/29/2025
Permission is hereby granted to:
Gail Chmela
23 Tern Ct
Bay Shore, NY 11706
To:
Construct additions and alterations to an existing single-family dwelling as applied for per SCHD
approval.
Premises Located at:
605 Cedar Dr, Southold, NY 11971
SCTM#78.-7-40
Pursuant to application dated 11/06/2025 and approved by the Building Inspector.
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To expire on 12/29/2027.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Addition&Alteration $1,033.50
CO Single Family Dwelling-Addition /Alteration $100.00
Total $1,131SO
Building Inspector
TOWN'' l' OF SOUTHOLD-BUILDING DEPARTMENT
aJ Town Hall Annex 54375 Mama Road P. 0. Box 1179 Southold,NY 11971-0959
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Telephone (631) 765-1802 Fax (631) 765-9502 11�it Li�L./ °��� o� ����� �; � �� o
Date Received
APPLI�'�CATION FOR BUILDING
For office Use Only
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PERMIT NO. 5 Building Inspector
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Applications and forms must be fired out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
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date:
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OWNER(S)OF PROPERTY:
Name: SCTM#1000- r7 -H 0
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Project Address: (Do$-
Phone#: % (0 G Email: Ali 1 C- '1 . 1 4 -�
Mailing Address. (,o5- dXk*k 0 It a Iq
CONTACT PERSON:
Name: f4eqw mlcl<-,�,,
Mailing Address: 'T)D Box B -7 -7 k�amf*a+ )\,*'Y 11C/91
Phone#: '- - � 7 Email:
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DESIGN PROFESSIONAL INFORMATION:
Name: ha"ll'o Thcynct
Mailing Address: -7 ame�pty--t- q V
Phone#. (c r -7 ---34';`/9 E r11 a I. +DWIC6, ao ccrY)
CONTRACTOR INFORMATION:
Name: l
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New structure ddition GaATteration CI Repair ❑Demolition Estimated Cost of Project:
❑Other
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Will the lot be re-graded? QYevlo Will excess fill be removed from premises? ❑Yes o
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PROPERTY INFORMATION
Existing use ofproperty' Intended use of property: .Sc it F'cumk
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Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes IgNo IF YES, PROVIDE A COPY.
011111liecilic Sox After g: The owntr/contractor/design professional Is responsible for all drainage and storm water Issue as provided bry
Chapter 236 of the Town Code. APPLICATION I5 HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to dw Building Zane
Ordinance of the Town of,Southoki,Suftik,County,New York and other applicable Laws,ordinances or Regulations,for the construction of buildings,
l addictions,alterations or for removal or demolition as herein described.The applicant agnw to comply with all applicable laws,ordinances,bul'ldinig 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 I.aw.
Application Submitted B r,�,
App" y sprint it Au#h+�ri*ed Agent Downer
Signature of
8 Applicant: Date: 1 1-60-c�►5
i
STATE OF NEW YO RK)
SS:
COUNTY OF, Y La l .........................................
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being duly sworn, deposes and rags that;s;he is the app!icant
(Name of individual signing contract)above named,
(S)he is the
(Contractor(Contractorif Agent, r orate Officer,etc.)
ofsaid owner or owners,and is duly authorized to e o 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 Yfm
2D
tary Public
TPACEY L. DWYM
NOTARY PUBLIC,STATE OF NEW YORK
P�ROPERI,Y �Hj ti
IY 1110.01 DW63090
the licant is not the owner 0!Ji%*ED IN$I R ' TY
(Where pp } �� � E UON
C MMOS ICON EXPPAUS JUi E$ 0 2.. ,(0
I residing at
i ��
do hereby authorize to apply on
pP Y
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my behalf to eiTo n of Sout ld I ding art t for approval as described herein.
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owner's Signature Cate
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SHED 0.4'S. PLANTER 3.5 W.
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a -SYSTEMS, INCLUDING HEAT
ARE TO BE ELECTRIC. NO
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PROPOSES OR EXISTING*
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STREET— MAIN
BAYVIEW ROAD
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