HomeMy WebLinkAbout52596-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#: 52596 Date: 01/06/2026
Permission is hereby granted to:
Robert Thomson
43 Willis Ave
Floral Park, NY 11001
To
Construct a garage with attached pergola accessory to a single-family dwelling as applied for.
Premises Located at:
675 Pine Tree Rd, Cutchogue, IVY 11935
SCTM# 104.4-6
Pursuant to application dated 11/13/2025 and approved by the Building Inspector.
To expire on 01/06/2028.
Contractors:
Required Inspections:
Fees:
Accessory-New Structure $403.50
CO Accessory Structure $100.00
Total 503.00
Building Inspector
� � + 1� I C LT'TI3(IL3 --BUILDING DEPARTMIENT
Town Hall.Annex. 543 75 Main Road P. 0. Box 1179 Southold,NY 11971-095 9
���� Telephone I(631) 7 5-1 02 Fax (631) 765-9502 h.tt S:flW � .���out o� .t��w � � ��
I
Date deceived
APPLICATION FORBUILDING PERMIT
For Office Use Only
C
PERMIT NO. Building Inspecto..............
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a.
Applications and forms must be filled out in their entirety. Incomplete
applications will not he accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Cate:
OWNER(S)OF PROPERLY:
CTM# 1000-
............ 60—
Project Address
Phone#: Email:e;�
Mailing Address,
CONTACT PERSON
Name:LocJ�, JLle,_
Mailing Address:
r
Phone#: Email:
Ly._'Wra"4/4 ono'
DESIGN PROFESSIONAL INFORMATION:
Na
dw�
Mailing Address:
Phone#: Email, 11'16"- 1 4'�O- ON
CONTRACTOR INFORMATION*
Narne
P
r
MailingAddress3'�fE2?
ws C
..........
�
...........
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
m
'New Structure ❑ d�tion CAA r Ad i lteration �Rep air ElDemolition - Estimated Cost of Project:
, ,
C Other ........ �Ao :'(-G',5 T1 $ L6_1 Jr
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..........
..........L
*.
Will the lot be re-graded? F2�es No Will excess fill be removed from premises? C]Yes o
l
PROPERTY INFORMATION
Existin use of roe w I intended use of properly:
p p
in which remises is situated- Are there any covenants and restrictions with respect to
Zone or use district p
this property? F�Yes No IF YES, PROVIDE A COPY.
K
, to` d ng�oThe owner/contractor/design professional responsible for all drainage and storm water issues as provided by
pter 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 Craws,Ordinances or Regulations,for the construction of buildings,
additions,alterations or for removal or demorition 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 Cim A misdemeanor pursuant to;section 210.4S of the New York Staft Penal Law.
Application Submitted Y � mm Authorized riz+ed Agent ❑owner
pp
Signature of scant [date:
STATE OF NEW YORK)
S•
COUNTY OFSU
bung duly sworn s that(s)he is the applicant
�� deposes and says
(Name of individual signing contract) above named,
(S)he is the
(Contractor,Agent,Corporate Officer,etc.)
owner or owners and is duly authorized to perform or have performed the said work and to make and file this
of said own Y
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 mariner set forth in the application file therewith.
Sworn before me this
bbe
u n N
ay of
Notbry Public
�..
LINDSAY NADRAMIA
Notary Public-State of New York
PROPERTY OWN AUTHORIZATION
NO.01 NA001889b
Qualified in Suffolk County (Where the applicant is not the owner)
My Commission Expires Dec 19,2027
5 w
L
F/ lo3 �c� !
0/1 residing at
coo hereby authorize
0leve IV e �� to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
13-2
Owner's Signature Date
■
Pant Ownees Name
2