HomeMy WebLinkAbout52604-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 SPECIFI.CATI'ONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 52604 Date: 01/12/2026
Permission is hereby granted to:
Mitchell Keschner
4 Fairbanks Blvd
Woodbury, NY 11797
To:
Construct a pickleball court accessory to a single-family dwelling as applied for.The proposed court
must maintain minimum side and rear setbacks of 15 feet.
Premises Located at:
1010 Bight Rd, Orient, NY 11957
SCTM# 14.-2-20
Pursuant to application dated 11/17/2025 and approved by the Building Inspector.
To expire on 01/12/2028.
Contractors:
Required Inspections:
Fees:
Sports Court-Tennis/ Pickleball $125.00
CO-RESIDENTIAL $100.00
Total S225.00
Building Inspector
TOWN OF SOUTHOLD— BUILDING DEPARTMENT
Telephone Town 1l Annex 631) 7651 802 375 Fax (63 )in Road 7 650-9502 111'�9 Southold, NY 11971 0959
,utheldt�� vran� __.
Date Received
APPLICATION FOR BUILDING PERMIT
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PERMIT NO, Building Inspectors; 7
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Applications and forms must be filled 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.
Date: 013 "Ir
OWNER(S)OF PROPERTY:
Name; t- ` 'G�/ SCTM # 1000- I
Project Address:
Phone#: g l Email;
Mailing Address; 4itvh 1
CONTACT PERSON: "
Name:
Mailing Address:
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name: kv1 rX 1�Z1,✓ {` ACY-YA � ce,-f5 L l /'�I i l�ti �i� �c � ��•�� C "'
Mailing Address:
Phone#: 5-/ L S 1, Jy7 3 Email: vj�M c
DESCRIPTION OF PROPOSED CONSTRUCTION
ew Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other
Will the lot be re-graded? ❑Yes Ur No Will excess fill be removed from premises? ❑Yes D%o
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PROPERTY INFORMATION
Existinguse of property: Intended use of property: P,
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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 ❑No IF YES, PROVIDE A COPY.
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.
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Application Submitted By (print name): M -AC he I I K e�5C%"i N-C/- ❑Authorized Agent NOwner
Signature of Applicant: Date: ill )
STATE OF NEW YORK)
SS:
COUNTY OFMiM )
being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the 'N.4v
(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
d'ay Of_ .. °. 20
N 01-13Y ROJAS
Notary Public-State of New York
No.01 R06310324
�( f ,, � ) �r 1 ' (w�)1 �� t( '�� �T�' iN( y Qualified in Nassau County 2(p
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mm --•--�- - Commission Expires 08/25/20_
(Where the applicant is not the owner)
Olt 6kbv/—---------
residing at 1 V r
do hereby authorize . apply on
my behalf to the Town of Sou' hold Building Department for approval as described herein.
Owner's Signature
Date
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Print Owner's Name
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