HomeMy WebLinkAbout52693-Z TOWN of SOUTHOLD
BUILDING DEPARTMENT
NO
SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT CAN THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 52693 Date: 02/27/2026
Permission is hereby granted to:
Joy A Kaelin
PO BOX 313
Southold, IVY 11971
To:
Construct alterations and legalize as-built(partially)finished basement at an existing single-family
dwelling as applied for.
Additional certifications may be required.
Premises Located at:
155 Shepard Dr, ,Southold, IVY 11971
SCTM#78,-1-16
Pursuant to application dated 12/19/2025 and approved by the Building Inspector.
To expire on 02/27/2028.
Contractors:
Required Inspections:
Fees:
As Built Alteration $1,100.00
Single Family Dwelling- Alteration $346.00
CO single Family Dwelling-Addition /Alteration $100.00
Total S1,546.00
Building Inspector
TOWN OF SOUTHOLD BUILDING DEPARTMENT
ab
Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold,NY 11971-0959
-1802 Fax (631) 765-9502 1 ttp,,,.,��Nv vw.,ou�tbojdownii .-,gqv
Telephone (631) 765
Date Received
APPLICATION FOR BUILDING PERMIT
a.
For Office Use Only
PERMIT NO. .54�2 Building Inspector.:'_
Nil
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the owner,an
I Owner's Authorization form(Page 2)shall be completed.
Date:12/15/2025
OWNER(S)OF PROPERTY: ...................
, Name:MATTHEW VIEDERMAN &LUCY GILMOUR SCTM#1000-78.1-16
Project Address:1 JJ S
HEPARD DRIVE
Phone#: 17 Oo3-9493 Email:matt@viedermanarchitect-com
9
Mailing Address:41 UNION SQUARE WEST SUITE 70►5, NEW YOR , NY 10003
CONTACT PERSON:
Name:MATTH EW I EDERMAN ARCH ITECT
Mailing Address:41 UNION SQUARE WEST SUITE 705, NEW YORK, NY 10003
Phone#: -
Email:matt@vi ederm an architect com
917 6039493
DESIGN PROFESSIONAL INFORMATION:
Name:---e;.:�m�
ATTHEW VIEDERMAN ARCHITECT
Mailing Address:41 UNION SQUARE WEST SUITE 705, NEW YORK, NY 10003
Phone#:917 603-9493 Email:matt@viedermanarchitect.com
CONTRACTOR INFORMATION:
ff Name"TO BE DETERMINED
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
O New Structure 1771Addition 'Alteration FIRepair 013emolition Estimated Cost of Project:
Elother $112,000
.. .................
Will the lot be re-graded? F-71Yes, RNo Will excess fill be removed from premises? FlYes 10R No
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PROPERWIT INFORMATION
Intended use of property:single family home
Uisting use of property:single family home
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
Roo this property? EJYes, WNo IF YES, PROVIDE A COPY.
storm s as provi ed by
R Che�ck Box After Reading The owner/contra ctor/design professional is responsible for all drainage and orm water Issues d
Chapter 236 of the Town Code. AP PUCATION 15 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 teen?or demolition as herein described.The applicant agrees to comply with ail applicable laws,ordinances,building code,
housing code and regulations and to admit authorized inspectors an premises and in building(s)for necessary inspections.False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 210.4S of the New York State Penal Law.
�%��`�= � El/Authorized Agent ?Owner
Application Submitted By(print name): `tW
Signature of Applicant: Date:
STATE OF NEW YORK)
SS:
CO U NTY OF cvo- ?2±3.)
f 1` G' �d ,--rex�f
F-- being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the 71-7-f-t eFw
(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
app lication; 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 20 CIN
Notary Public
L
0:1 C1+
dw
NOTARY PUBLIC own
NO.01 CL0031206 PROPERmIr"y OWNER AUT HORI Z Awrlm,N
My Comm,,Expires ......
Nov 20,2028 (Where the applicant is not the owner)
OF
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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