HomeMy WebLinkAbout53068-Z TOWN of SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD, NY
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#: 53068 Date: 06/15/2026
Permission is hereby granted to:
Christopher L Sullivan
314W94thSt
New►York, NY 10025
To.�
Construct alterations to an existing single-family dwelling to partially finish the basement as applied
for.
Premises Located at:
24380 Route 25,Cutchogue, NY 11935
SCTM# 109.-3-2.41
Pursuant to application dated 04/30/2026 and approved by the Building Inspector.
To expire on 06/14/2028.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $806.00
CO Single Family Dwelling-Addition/Alteration $100.00
Total S906.00
Building Inspector
K.
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TOWN OF SOUT:HOLD--BUILDING DEPARTMENT
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Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765 9502h�ttps-'H
www,.southol d1ownny.am
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Date Received
APPLICATION FOR BUILDING PERMIT
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For Office Use Only r
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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(Page 2)shall be completed.
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Date: 021;7
OWNER(S)OF PROPERTY:
Name: �Aoer= 1CWekS
CT #1000-log
Project Address:
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Phone#: Email: ,
Mailing Address-, 4, C5, OCR .
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CONTACT PERSON:
Name
Mailing Address:
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Phone#: �� " - - ,- ,�.— Email:
DESIGN PROFESSIONAL INFORMATION:
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CONTRACTOR INFORMATION:
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Name:
Mailing Address: 7
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Phone# ..... Email
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition NAlteration ❑Re air ❑Demolition Estiat� Cost of Project:
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Will the lot be re-graded? ❑Yes o Will excess fill be removed from premises? C]Yes ❑No
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PROPERTY INFORMATION
Intended use of property-, F A�Pf'IZ 1PA0,00 -jw
Ex J sti ng use of p ro p e rty C
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? DYes No IF YES, PROVIDE A COPY.
70 Check Box After Readingle* 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 building1s)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.
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Application Submitted By(prin, ame KAutMrized Ag nt Downer 11 A,,g,
Signature of Applicant:
D,ate,,
STATE OF NEW YORK)
COUNTYOF. 51 Al -llt�)
�v Lvael4fox)l being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the 144�,�Wr
(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
Ad;ay of 20
464�� i2
Notary Public
'IAWN;NICHOLSON
NOTARY PU SLIC STATE OFIN EWYOR
WIN. SUFFOLK COUNTY
PROPERT Y OWNEK A Ul'HA OR"IZAT iO-N LIG,#01,N1,00149, 62
(Wherethe applicant is not the owner) COMM.,EXP-OCT.26t 21,02
I HDI L.-- residinja at
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hereby authorize F;5 to apply on
my bee,,,,,',,'to t e Town of Southold Building Department for approval as described herein,
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0 ner, au Jgnature Date
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Print Owner's Name
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