HomeMy WebLinkAbout52837-Z TOWN OE SOUTHOLD
10 BUILDING DEPARTMENT
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#: 52837 Date: 04/06/2026
Permission is hereby granted to:
Roger Chudzik
625 Corey Creek Ln
Southold, NY 11971
To.
construct a screened-in porch on an existing deck addition of a single-family dwelling as applied for.
Premises Located at:
625 Corey Creek Ln, Southold, NY 11971
SCTM# 78.-4-25
Pursuant to application dated 03/13/2026 and approved by the Building inspector.
To expire on 04/05/2028.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Addition &Alteration $470.00
CO-RESIDENTIAL $100.00
Total 5 70.00
i
Building Inspector
TOWN OF SOUTHOLD BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold,NY 11971-0959
Telephone (631) 765 1 02 Fax �(631) 765 95C1P �.
.....................-------
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. Building Inspector: �
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( 'age 2)shall be completed.
Date
OWNER(S)OF0ROPERTY"#
Name. Roger Chudzik & Ellen Darion
SC
TM#1o °
Project ddrss re t old
Phone# Erna i - r�ehodzl, C peat t
407 5,5
Mailing Address: �
CONTACT PERSON:
N a rn e'� Roger Chudzik
Mailing Address. 2 'or Creek Lane, Southold 11971
Phone 157,
Emaik rchudzi 'comcast.,net,
DESIGN PROFESSIONAL INFORMATION:
Name, e
Mailing Address. PO Box 444, Orient
One 4 E aill` del 'kl Stud r ° ct .Co.
CONTRACTOR INFORMATION:
Name: got selected yet
Galin Address
Phone, Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
------------
FlAlteration ❑ air F Demolition Estimated Cost of project
❑New 11 Structure ®A ddition Re p
❑other $ not estimated yet
Will the lot be re-graded C�Yes
No Will excess fill be removed from premises? ❑Yes RNo
?
te
f
PROPERTY INFORMATION
Existing use of property: Single family residence Intended use of property: same as existing
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R40 this property? 7Yes No IF YES, PROVIDE A COPY.
19 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 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.
R oger;
Application Submitted By(print name): ClAuthorized Agent Rowner
.................................
Signature of Applicant: Date:
CONNIE D.BUNCH
Notary Public,State of New York
STATE OF NEW YORK) No.OIBU6185050
SS: Qualif led In Suffolk m County
COUNTY OF Comls�slon Expires April 141'_0_08
being duly sworn,deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the
(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
0C�
1 2
day of jj a:(o
Notary Public
PROPERTY (.)WNER AUTHORI;aim XFION
(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
1
S.C.T.M. N0. DISTRICT: 1000 SECTION:78 BLOCK: 4 LOT(S):25
} 0.91W STK.
236.02
LOT 20 11•�
con
will
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m 4'VINYL FENCE
47 GAS 17.1'
£. 0 LAND N/F OF
DRAIN p to be remove m STEVEN
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S 85004
THE WATER SUPPLY, WELLS,DRYWELLS AND CESSPOOL LOT 22
LOCATIONS SHOWN ARE FROM FIELD OBSERVA77ONS LOT COVERAGE -
AND OR DATA OBTAINED FROM DINERS
MAX.ALLOWABLE 4673 S.F.or 20°la
AREA:23,365.33 SQ.FT. or 0.54 ACRES EIEVA7701V DATUM: DWELLING W/DECK: 3096 S.F.
UNAUTHORIZED ALTERATION OR ADDI7701V TO THIS SURVEY IS A WOLA77ON OF SECTION 7209 OF THE NEW PORK STATE EDUCATION LAW. COPIES OF THIS SURVEY
MAP NOT BEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VAUD TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN SWIMMING POOL: 927 S.F.
ONLY 70 THE PERSON FOR WHOM 7HE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERNMENTAL AGENCY AND LENDING INS777UTTON SHED: N/A(96 S.F.)TO B E REMOVED
LISTED HEREON,AND TO THE ASSIGNEES OF 7HE LENDING INS777U77ON,GUARANTEES ARE NOT TRANSFERABLE
THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO 774E STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE 7HEREFORE THEY ARE PROP.BLDG: 648 S.F.
NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE 774E EREC7701V OF FENCES,ADDITIONAL STRUCTURES OR AND 07HER IMPROVEMENTS. EASEMENTS
ANDIOR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON 774E PREMISES AT 7HE 77ME OF SURVEY
TOTAL 4671 S.F.or 20%
SURVEY OR LOT 21 f F N CERTIFIED T0: ROGER CHUDZIK;
MAP OF.COREY CREEK ESTATES
FILED:AUG. 15, 1967
SITUATED AT:BAYVIEW
TOWN OR SOUTHOLD a
SUFFOLK COUNTY, NEW YORK ., KE)\TNETH j0 G, PLLC
Professional Land Surveying and Design REVISED 01-20-26
P.O.Boa 153 Aquebogue,New York 11931
ROE#224-38 SCALE: N.Y.S LISC.Na 050882
1'$=20' DATE:MAR. 29, 2024 PHONE(e31)298-1688 FAX(Ml)298-1588 UPDATE & ADD PROPOSED BLDG & LOT COVERAGE 12-15-25