HomeMy WebLinkAbout53031-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
�. SOUTHOLD, NY
�fi�bNt't.M`
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#: 53031 Date: 05/28/2026
Permission is hereby granted to:
Gail C Toma
PO BOX 842
Southampton, NY 119690842
To:
legalize "as built"alterations to an existing single-family dwelling as applied for. Additional
certification maybe required.
Premises Located at:
5845 Bridge Ln, Cutchogue, NY 11935
SCTM#84:1-6.13
Pursuant to application dated 05/22/2026 and approved by the Building Inspector.
To expire on 05/27/2028.
Contractors:
Required Inspections:
Fees:
As Built Alteration $500.00
CO-RESIDENTIAL $100.00
Total 600.00
�� Building Inspector
� TOWN OF OUTHOL1IT�►--BUILDING DEPARTMENT
's9 Town Hall Annex 54375 Main Road P. 0. Box 1179r Southold, NY 11971- 59
Telephone (631) 765 1802 Fax (631) 765 9�5a b 5. . ox
Date Received
PPL C:ATI I FOR BUILDINGPERMITAP s ,w
L6
Lt 5
For Office Use Only
�vlPERMIT NO Budding Inspecto
r ,� Inspector_
_..
Applications and forms must be filled out in their entirety. Incomplete 3 � 7���e� % ��� �� � ����
applications will not be accepted. Where the Applicant is not the owner,an
Mm
h+orization form(Page shall be completed. �
Caner" Au# � � �
Date:
OWNER(S)OF PROPERTY
Name: 6A>o Toyt4 V+- SCTM # 1000-
13
Project Address5-
Phone#: 4 � -
Email
r r l
.�-
AL
Mailing Address: t P-61
✓�"� ,
CONTACT PERSON:
Name::
Mailing Address: � 4-,6
Phone#: Email
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email
CONTRACTOR,INFORMATION:
Name:
Mailing Address: ..............
Phone#: --c;2 0 15
DESCRIPTION RIPTION OF PROPOSED CONSTRUCTION
re AdditionSQAlteration ❑Repair Demolition Estimated Cost of Project.
� ]New 5tructu
❑Ot her ?. ,!
___
Will the lot be re-graded? �Yes KNo Will excess fill bye removed from premises? ❑Yes No
,
E
. .........
MM NOW MW "WA111111,
PROPERTY INFORMATION
Existing use of propertyo, Intended use of property:
0.05 L de a
Zone or use district in which premises is situated, Are there any covenants and restrictions with respect to
this property? E]YesXNo IF YES, PROVIDE A COPY.
0 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'I'S'HEREBY MADE to the Building Department for the issuance of 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.
nt
Application Submitted By(prjint, e): ElAuthorized Age Xbwner
Signature of Applicant: Date:
STATE OF NEW YORK)
SS:
COUNTY OF �`A
being duly sworn, deposes and says that(s)he is the applicant
........ ...........
(Name of individual signing cor—vtr�'Ict)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
"day of
Not#S*A?NWWEWAN, Y.*
Rotate Public-State of New
No,01106370215
Qual,fied�in,Suffolk County
Commission EXpires 20130
PROPERTY OWNER AUTHORIZAT
(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
S C TV NO DISTRICT: 1000 S "TION:84 BLOCK: I LOT(S).6.IJ
X, J, LOT 12
3 6 10, 8 6
N43020'20"E
MON
V014 1
OU-P
4 01 i
r
C) FW
SHED
MON
LL
09
z
f
LO 1' 13
27
e-�
MON
7
MON
S43*20'F200"W
LOT 14 THE WATER SuppLy, WELLS, DRYPXLLS AND CtSSPOOL
LOCATIONS SHOWN ARE FROM FIELD 09SERVAPONS
A NO OR DA TA 06 TA INED FROM 0 THERS.
92
ELEVARON DAILIM.,SQ.rT or 1.27 ACRES
1JNAVrH0,PJ,?VD AIJERATION OR ADDIRON TO THIS SURVEY IS A %e7OL/i7j0N Or SF-CTION 7.209 OF THE tiEW YORK STATC EDUCATION LAW. COPIrs Or TH15,rIURVLy
MAP NO VEARING PIE LAND SURVEYORS EMBOSSED SEAL SHA).., Nor eE CONSIDERED tO BE A VALID FRUE COPY GUA RAN TUS INDICATED HERCON HALL RUN
0,,V4,y To rhl:rrpSO.N,FOR sib OAf THE SURVEY IS PREPARED AJV0 ON PI 15EPIALF TO rHf'TITLE COMPANY,GOVERWEWAL AGENCY'AND LENDING INSWUPON
LISTED tJEREE61%1,ANU TO THr A6S,6jNECS Or THE LENDING INSTIPJTICN,CUAPAWICES ARE NOr TRANSFCRABLE
T4C OF,'5VS OR VJMCNSWA/S'.5YOW HEREON �THE PROF-1-RrY LINES 1`0 T?fE STPUCTURES ARE FOR A SPECIFIC PURPOSE AND"!�E THERCFORC THEY ARE
Nib T JNrrj;JOLft) j"O jqC?Nj&4J*NT T14jr JOROPERTY Lm--OR TO 1-,UiDE THE ERE'ViON Or FMCCS,ADDITIONAL SrquCTURES OR AND 07NCR 01PROWMCNN CASX,-'A4CNr5
5ij,;x Y v
4 NDIOR SUPSURrA CC SrRUCIL)RES RECORDED nR UNRECORDED AR Nor GUARAWEED UNLESS PHYSIC&L Y EWDENT i�w E PREMISES A r Y� rgit,
St RVrY OF
VAP OF SYLORE7 ESTATES
Q�?v N f7i jj
-3 LE
76 No.6 390 NLEO:%JUNE 8,
cu,rCHOGUE VA-1)
si rUAICr)AT.
TOiN of SOUTH OLD KENNETH M WOY,:HUK ja U G, PLLC
SUrFOLK COUNTY, NEW YORK
406 Professional Land Surveying and Design i
00%& P.O. Box 163 AqueVague, New York 11031
BILE 1 3-70 'SCALF- 1 30'DAIF, MAY 1 1, 20 1 j--1 PHONE(03I)E98-080 FAX(631):296-1688 UPDATE SURVEY 06-14-21
NY.S, L ISC N. 050882 1 oye Uk
malnWnIng the records of Robert J,Rena"Ay&Kenneth St.V h
E�