HomeMy WebLinkAbout52692-Z TOWN of SOUTHOLD
J0 BUILDING DEPARTMENT
SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT CAN THE PREMISES
WITH ONE SET OFAPPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION of THE WORK AUTHORIZED)
Permit#: 52692 Date: 02/27/202C
Permission is hereby granted to:
Bernadette M Arnold
267 Hempstead Ave
Rockville Centre, NY 11S70
To
Construct additions and alterations to an existing-single family dwelling as applied for.
Premises located at:
660 Topsail Ln, Southold, IVY 11971
SCTM#79.-7-16
Pursuant to application dated 12/ 1/2025 and approved by the wilding Inspector.
To expire on 02/27/2028.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Addition&Alteration $1,859.50
CO Single Family Dwelling-Addition/Alteration $100.00
Total 1959.50
Building Inspector
TOWN OF SOUTHOLD BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax(631) 765-95a2L .fl ry sou1 o ���
,
Date Received
APPLICATION FOR BUILDING PERMIT
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w,
For Office Use Only
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PERMIT NO. Building Ile �., . ...
Applications and forms must be filled out in their entirety. incomplete
applications will not be accepted. Where the Applicant Is not the Darner,an
Ownees Authorization form(Page 2)shall be completed.
Date:December 31, 2025
OWNER(S) PROPERTY*
Name:Bernadette and Michael Arnold SCTM# 1000-79-7-16
Project Address:660 Top Sail Lane, Southold, NY
Phone#:516-313-2581 01111 TEmail:arnoldlaw optimuim.net
arnoldlaw@optimuim.net
Address:660 Top Sail Lane, Southold, NY
CONTACT PERSON:
Name:Michael Hand
.....................
Mailing Address:P01256, Mattituck, NY ..........
Phone#: _ Email:michael@mchdesignservices-com
63� 905 1947
DESIGN PROFESSIONAL INFORMATION:
Name:
Jarnes Deerkoski, P.E.
Mailing Address:260 Deer Drive, Mattituck, NY .....................
Phone#:03 1-774-7355 Email:
CONTRACTOR INFORMATION:
Name.
Mailing Address,.:
Phone#: Email:
u.
DESCRIPTION OF PROPOSED EI CONSTRUCTION
re Addition Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑New Structu p
$250,000
❑Other
g
'111!`ill the lot be re-graded? ❑Yes 54 No Will excess fill be removed from premises? RYes *No
1
OWN
PROPERTY INFORMATION
Existing use of Property:sing le family dwelling Intended use of property:single I family dwelling
..............
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
r40 this property? OYes No IF YES, PROVIDE A COPY.
'13 Check Box After Reading'e' 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,,ordinancess,building code,,
housing code and regulations and to admit authorized inspectors on premises and In building(s)fornecessary Inspections.False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 210AS of the New York State Penal Law.
-------------
...............
Anrlet`te Sch uma ,,ter
Application Submitted By(print name):► @Authorized Agent ElOwner
er
�
Date,: 12/31/2025
Signature of Applicant:
CONNIE D.BUNCH
Notary Public,State of New York
STATE OF NEW YORK) No.OIBU6185050
Qualified in Suffolk County
SS:
,e,�7 Commission Expires April 14,2
'I J,
COUNTY OFFt��
iJ being duly sworn, deposes and says that (s)he is the applicant
1 v
L 12 l'W a
(Name of individual signing-contract) above named,
(S)he is the e�
(Contractor,Agent, Corporate Officer, etc.)
of said owner or owners, and is duly authorized to per-form 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
da y o
f 20
Notary Public
PROPERTY OWNERAUTHORIZATION
(Where the applicant is not the owner)
residing at
-do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
owner's Signature Date
Print Owner's Name
2
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