HomeMy WebLinkAbout52783-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD, NY
0
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SETOF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 52783 Date: 03/25/2026
Permission is hereby granted to:
Robert A McCaughey
2860 Pine Tree Rd
Cutchogue, NY 11935
To:
install HVAC system to an existing single-family dwelling as applied for.
Premises Located at:
2860 Pine Tree Rd, Cutchogue, NY 11935
SCTM# 104.-2-17
Pursuant to application dated 02/19/2026 and approved by the Building Inspector.
7o expire on 03/24/202$.
Contractors:
Required Inspectians:
ELECTRICAL- ROUGH, PLUMBING , ELECTRICAL-FINAL, FINAL,
Fees:
HVAC $250.00
CO-RESIDENTIAL $100.00
Total 350.00
Building Inspector
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TOWN OFC) TI-I[ LI —BUILDING DEPARTMMNT
Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold,NY 11971-0959
° Telephone(631) 7+65-1 02 Fax (631) 765-9502 Win&www,,s thold.�
Date Received
APPLICATION FOR BUILDING PERMIT
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For Office Use Only
PERMIT No. N
Building Inspector, r � � o
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..............................................
Applications and forms mast be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an w1, �;
Ownees Authorization form(Page" shall be completed.
I
Date February 6, 2026
OWNER(S)OF-PROPERTY:
Name:Kara Czerniecki SCTM#l000-104-2-17
Project Address:20 Pine Tree Road, Cutchogue, New York, 11935
0000 Who 1�
Phone#:(51 ) 320-1902 Email:kara.czlernliecki@gmlail.com
Mailing Address:2860 Pine Tree Road, Cutchogue, New York, 11935
CONTACT PERSON:
Name:Kara Czerniecki
how W11"
Mailing Address:2860 Pine Tree Road, Cutchogue, New York, 11935
WNW
Phone#: 51 20-190 2Email:kara.czerniecki@gmail-com
DESIGN PROFESSIONAL INFORMATION
Name:N/A
Mailing Address
Phone#: Email:
CONTRACTOR INFORMATION:
Name:Kolb Mechanical Corp.
Mailing Address:11500 Sound Ave, PCB Box 106, Mattituck, NY 11952
Phone#: 631 298-5527 Emaii:ethant@kolbmechanical.com
DESCRIPTION OF PROPOSED CONSTRUCTION
New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Projecto,
510therinstallation of new heating/cooling systems $35,000
Will the lot be re-graded? OYes 5R No Will excess fill be removed from premises? ❑Yes ®No
1
PROPERTY INFORMATION
•residential Intended use of ro ert ;residential
Existing use of property. p p Y
-----------
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R-40 residential this property? C]Yes rm-R No IF YES, PROVIDE A COPY.
desk n rof+ inal i ,r o : lhN�e;r ally and tow� ter,Ismit'va, 1 ��t
® Ch ec Box After,Read ii ng. Theeowner/contractor/ g , ,
,
° � 1, rIttp the 0 A n, ZoneChapter 236 thel To n CoAPFLIC TIC IS NE EBY MADE to th 8uildi ,��p �
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or r. �h � irwn� ( , uia�n n n
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Kara Czerniecki
Application Submitted By(print name): ElAuthorized Agent ROwner
Ilk
Signature of Applicant. Date. .. ..csoj
Jose Sabastro
STATE OF NEW YO R K) Notary Public,State of New York
SS. Registration No.01 SA0020644
COUNTY OF Qualified in Bronx County
Commission moires Feburary 1,2028
�i' 12► �t � being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the L,44& Z&k�t, A
(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 , 2.0C�
�� Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
i► 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
S.C,T-M. NO_ DISTRICT, 1000 SECTION:104 BLOCK:2 LOT(S):17
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LOT 41
DIRT DRIVEWAY 187-5511
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P/O LOTS 42&43
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THE WATER SUPPLY. WALLS,DRYKELLS AND CESSPOOL
P/O LOT 43 LOCA77ONS SHOON ARE FROM FIELD OBSERVA77ONS
AND OR DATA OBTAINED FROM 07HERS
APE DA UM.,
EA-_ �40 Fieet or 0,,30 AC ELEVA 77ON T
RES
'SV\.ok UNAUT7,'OR120 ALTERA77ON OR ADDITION TO THIS SURVEY 15 A 140LA77ON OF SEC77ON 7209 OF THE NEW YORK STATE J57?UCA77ON LAW COPIES OF THIS SURVEY
MAP NOT SEARING THE LAND sURVEYOR'$EmBOSSED SEAL SMALL NOT BE CONSIDERED To BE A VALID 7RUF COPY GUARANTEES INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR W4OA4 THE SVRVfY IS PREPARED AND DN HIS BEHALF To THE 77TLE COUPANY GOVERMVENTAL AGENCY AND LENDING IMST?TU7701V
�D elt LISTED HEREON.AND TO THE A-SVONEES OF THE LENDING IN577TU710N.GUARANTEES ARE NOT TRANSFERABLE
THE L4= TS OR DWENSIONS SHOW HEREON M040 THE PROPERTY LINES 70 THE STRUCTURES ARE FOR A SPEC1f7C PURPOSE AND USE THEREFORE THEY ARE
NOT INTEWLED 70 MONUMENT THE PROPERTY LINES OR TO GUIDE THE EREC77ON OF FENCES,ADD1770MAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS
AND OR SUBSURFACE STRUCfVRES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY
URVE OF�P/O LOT 42 fta
CERTIFIED TIFIED TO:JOSEPH SALVATORE;KARA CZERNIECKI;
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MAP OF:NASSAU FARMS 7- A J -CAN CH SAW N=_
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FiLED:MAR. 28, 1935 No. 1179 T" SU ,-E
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SlTUAlEO AT.CLITCHOGUE
Tom On SOUTHOLD ki
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SUFFOLK COUNTY, NEW YORK EENNETE M VOYCEWX LAND SURVEYING,PLLC
Profeagional Land Surveying and Deerign
P.O.Box 153 Aquebogue.Now York 11931
RLE 0225-167 SCALE.-1"=20' DATE:SEPT, 19, 2025 s Lw- wa 353-m PHONE(831)2 -16W M(031)200-15M