HomeMy WebLinkAbout52700-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD, NY
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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#: 52700 Date: 03/02/2026
Permission is hereby granted to:
Roger Chudzik
625 Corey Creek Ln
Southold, NY 11971
To:
construct an accessory storage building/garage as applied for.
Premises Located at:
625 Corey Creek Ln,Southold, NY 11971
SCTM# 78.-4-25
Pursuant to application dated 10/23/2025 and approved by the Building Inspector.
To expire on 03/01/2028.
Contractors:
Required Inspections:
Fees:
Accessory-New Structure $449.00
CO Accessory $100.00
Total S549.00
ding Inspector
'TOV'VN OF' C)UTH(�LD- BUILDING DEPARTMENT
C9 Tows.Hall Annex 54375 Main Road P. o. Box 1179 Southold,NY 11971-0959
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Date Received
BUILDING PERMITAPPLICAT �NFOR ..
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For office Use only
U L 3 2 2 5
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PERMIT No. Building Inspector—
Applications d,
and forms must be filled out in their entirety. Incomplete _ : f
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page" )shall be completed.
Date,
OWNER(S)OF PROPERTY:
Name: --� CTM# 1000- $ �` �f' 2
Project Ad d ress
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mm Eail:
Phone
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Mailing Address.
CONTACT PERSON:
Name:
Mailing,Address. � 000
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Phone#: ;� Email, 1,
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DESIGN PROFESSIONAL INFORMATION:
Names
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Mailing Address. Ith4his 1n"0
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Ph.................one _ 0 Email��
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CONTRACT R INFORMATION:
T"ION:
Name- ma
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Mailing Address ,, `� w�� ,
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Phone#: - E 4 c� .
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DESCRIPTION OF PROPOSED CONSTRUCTION
kNew Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
16
CJ other ���1 c � f\
Will the lot be re-graded? 14Yes ❑No Will excess fill be removed from premises? [-yes, 5AO
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PROPERTY INFORMATION
. .. ...... ...... . ..........
Existing use of property: Intended use of property:
02�144 14 zv
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Zone or use district in which premises is situated Are there any covenants and restrictions with respect to
this property? E]Ye Sl-.-.A o IF YES, PROVIDE A COPY.
O'Check Box After Reading: 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 wlth all applicable lam,ordinances,building code,
housing code and regulations and to admit authorized Inspectors on premises and In buflding(s)for necessary inspectiom False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
44
Application Submitted By(print name): Authorized Agent ElOwner
Signature of Applicant: Date:
STATE OF NEW YORK) CONNIE D.BUNCH
SS: Notary Public,State of New York
No.01BU6185050
COUNTY OF Qualified in Suffolk County
Commission Expires April 14,20a5s"-
ajt�j being duly sworn, deposes and says that she is the applicant
(Name of ihi'vidual signing contract)above named,
(S)he is the A 41
.............T
(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
day of 0C+b-jQ" 20 C�_
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
residing at
to apply on
do hereby authorize im4k, o 1,q
my be h t To", of thold Building Department for approval as described herein.
Ito
11
owner is Signature Date
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Print Owner's Name
2
FS.C.T.M. NO. DISTRICT. 1000 SEC'nON:78 BLOCK:4 LQT(S):25
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THE WATER SUPPLY, 1+4+ELLS,DRME.LS AND CESSPOOL LOT 22
LOCA71ONS SH0WV ARE FROM F7ELQ a85ERVA 77f.N S
AND OR DATA 08 TAINED FROM 0THERS LOT COVERAGE
MAX.ALLOWABLE 4673 B.F.or 20%
, .3-3 SOXT._ UEVATTAY DARN DWELLCNG WIDECK: 3096 S.F.
UVAUWGRM ALTERA TIOV 00?A00f TM 70 7RS SURVEY IS A WOLA ITON W SWRON 7M Or PC NEW YORK 5TA TF EDttCA TtCW LA W OF 7WS SURWY
MAP Nor wAmNG 7HE LANo s 's amossm SEAL:MALL Nor ae commu M W A VAUD MVE COP Y WARAN=r MV MWCW SMALL.MIN SWIMMING POOL: 927 S.F.
CWLY 7V THE PMSaV FM WW TW SURVEY IS PREPARM AND CK IRS aNALF W THE VUE COWANY,00Vl7WVfrAL AGENCY AND LENEWC NS7►TV?70M1t
LMM HEREW,AND TO T7E AWGAUS OF INEWYAWG/NS7TE/170►,GUAR ARE NOT 7R SHED: N/A(96 S.F.)TO BE REMOVED
TW OFFSM CR aWM9aVS SNOW HOMM FMW NE MOFEYTY t S TO 7W S7ftCWfiW AW FUR A F?C PURPOSE AND USE VOa7W RCY ARE PROP.B LD G: 648 S.F.
T W7000 7V MMU410VT WE rY UNES OR TO ft#DE Mr D?EC7XW OF FEN=ADDnWAL S7RUCTWW3 OR AAO WhER FXffWVM0VTS CASEVENTS
AQ/w 4-MWAX Mgn#nM MWOM 40 tts-IAVW� AKE Awr aA&umrm amms p s_ y rvcvff av rrw ommms AT rw aw or pAwy
TOTAL 4671 S F 2�I
SURVEYOR LOT 21 CER"nFIED TO: C
MAP OF:COREY CREEK ESTATES 0,
flt):AUG. 15, 1967 -
SiTUAM AT:BAYVIEW
M SQUTH{LC} s a_ XMNEM M 11QXM K XAND_9URMCING. -
SUFFOLK COUNTY.NEW YORK c� C j a AM_
_ Frofeeelolul Land Surveying and Design REVISED 01-20-26
F.O.Box 153 Aquebogue,New York 11931
RtE#224-38 SCAM-1"= Q' QAm-MAR. 29, 2024 M.N.USG NO 050682 Pxs{631} -L5W fez(431)205-LM8 UPDATE &ADD PROPOSED BLDG & LOT COVERAGE 1 -15-25