HomeMy WebLinkAbout52585-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#: 52585 Date: 12/30/2025
Permission is hereby granted to:
Gail Chmela
23 Tern Ct
Bay shore, NY 11706
To:
Construct a garage with covered porch accessory 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.
To expire on 12/30/2027.
Contractors:
Required Inspections:
Fees:
Accessory-New Structure $723.00
CO Accessory Structure $100.00
Total S823.00
7RL"jo I'110clo''113610
Building Inspector
a -BUILDING DEPARTMENT
NT
1'
TOWN OF �t�UTHC)LD
N Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold,NY 11971-0959
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z Telephone 631 765 1802 Fax 631 765 9502
Date Received
APPLICATION FOR BUILDING PERMIT
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For Office Use Only wA 64
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to �
PERMIT N0. �� Building Inspector.
Applications and forms must be filled out in their entirety.Incomplete u
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page z)shall be completed.
Date: ...............—
l
OWNER(S)OF PROPERTY:
Names SCTM#1000-aa, rA.0)OL
Project Address: (OC)S Cedav- 'Delij Q...,.
Phone#: 67(e. q2 - Llel C Email: i C✓hmeI(xC)0,01
Mailing Address: �- Ueafa_r- W\)-c „ 0,k ter-�C:)1C:1 joy
CONTACT PERSON:
Name: C Co-AMC .
C�--
Mailing Address: ` �, - ell 11c1q,1
i
Phone#: p .— �7 Email:
r`Vo
.......................
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address: J
Phone#: C- .-.. --- Emai I:
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CONTRACTOR INFORMATION:
Name: 1-B-b
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
A�IewStructure ❑Addition FlAlteration ❑Repair ❑Demolition Estimated Cost of Project:
Other $-~ �
WiII the lot be re-graded? ❑Yes (Nlo Will excess fill be removed from premises? nYes ANo
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Existing use of � 1� �i r� intended use of property:
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ic?ne or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? E]Yes U944� IF YES, PROVIDE A COPY.
e C� ili '�'�°�1 li The owner/c ntractor/'deslBn professional Is responsible for all drainage and storm water issues as provided by
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pursuant to the Building tone
Building Department for the issuance of a Building Permit g
23�of the T IIII AP l�AT1t�N IS HEREBY MADE to the 8ui B P
Chapter Cod*. Pt. � p
ordinance of the"foam of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings,
additions,alterations or for removal or derv~as herein described.The applicant,agrees to com*with all app ikabie lams,ordinances,bOding code,
housing code and regulations and to admit authorized lnsp "ors on premises and In building(%)for necessary inspections.False statemenb made herein are
punishable as a Class A misdemeanor pursuant to Section 210AS of the New York State Penal Law.
1 rcat�on Submitted� authorized agent Dt�w ner
App Y(print name):
Signature ofApplicant: Heq a n Date: {p 2
STATE OF NEW YORK)
r� S
COUNTY OF �
0
being duly sworn, deposes a..d Says Ma ,s,he is the apr..can.
(Name of individual signing contract)above named,
(S)he r s the
cnt°aCI� ��rtt,� rporate 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 2
16PY Public
PROPERTY OWNERTHFly PUBLIC,,0 SSA
(where the applicant is not the owner) No.O W6
LK COU,Nr y,
O i SI N EXPi° �S JUNE
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1I /-Cil _ iI
residing at
s�Llr�I L
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do hereby authorize im,Lk to apply on
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my behalf to e To of Sout ld' ''ding a t for approval as described herein.
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Owner's Signature Dane
Print Owner's Name
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)er 181 24"0 COMPONENTS THIS ACCESS ONLY PROPOSED
90 20'"0 HDPE SECURE HEAVY COVER BY OLYLOC E P T I C SYS
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20" SAFTY SCREEN BY POLYLOC ( .)^
Fatal Volume 1069 HOUSE (NOT TO SCALE)
ELEV. 5Df� .12 x 12 POLYLOK D--BOX
CANS FINISHED GRADE W/ PDB--12 RISER AND
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ELEV. 47.5 RQTO--FLOW 3050--4 LEVEI Rate 1320/--
CL N "" T
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