HomeMy WebLinkAbout51695-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
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#: 51695 Date: 02/28/2025
Permission is hereby granted to:
Town of Southold
Attn: DPW
Southold, NY 11971
To:
demolish and reconstruct a storage building as applied for. All utilities shall be disconnected from
building prior to demolition.
Premises Located at:
165 Peconic Ln, Peconic, NY 11958
SCTM#75.-5-14.2
Pursuant to application dated 10/07/2024 and approved by the Building Inspector.
To expire on 02/28/2027.
Contractors:
Required Inspections:
Fees:
Total so
Y,
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 htt ://www,southoldtc)wiiii .,,o
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Date Received
APPLICATION IL DI
For Office Use Only LJ
g ... .
PERMIT NO„ 5l Building Inspect�ar.
A .l..a . �"�l�'„.,�
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.
Date:October 4, 2024
OWNER(S)OF PROPERTY:
Name:Town of Southold Highway Department SCTM # 1000-075.00-05.00-014.001
Project Address:275 Peconic Lane, Peconic, NY 11958
Phone#: 6604_ _ Email:
631 727
Mailing Address:53095 Main Road P.O.Box 1179, Southold, NY 11971
CONTACT PERSON:
Name:
Michael Collins, PE
Mailing Address:53095 Main Road P.O. Box 1179, Southold, NY 11971
Phone#:631-765-1560 Email:michael.collins@town.southold.ny.us
DESIGN PROFESSIONAL INFORMATION:
Name: L.K. McLean Associates Engineering & Surveying, D.P.C.
Mailing Address:437 South Country Road, Brookhaven, NY 11719
Phone#:631-286-8668 Email:cdwyer@lkma.com
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
RNew Structure ❑Addition ❑Alteration ❑Repair RDemolition Estimated Cost of Project:
❑Other $ 1,700,00.00
Will the lot be re-graded? i Yes ❑No Will excess fill be removed from premises? ❑Yes *No
1
PROPERTY INFORMATION
Existing use of property:Storage Intended use of property:Storage
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R_80 this property? Eyes ENO IF YES, PROVIDE A COPY.
N 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.
Application Submitted By(print name):Christopher F. Dwyer RAuthorized Agent Downer
Signature of Applicant: , Date: October 4, 2024
STATE OF NEW YORK)
SS:
COUNTY OF SUFFOLK
Christopher F. Dwyer (LKMA D.P.C.) being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the Agent
(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 is
e
day 20 Z-6
Notary PUbIN'
CHRI TINE WI AND
NOTARY PUBLIC,state at New York
1116 10359,Suffolk.Court �
PROPERTY Ill UT ) ) ission Explre August 17ZD2-5
(Where the applicant is not the owner)
I, Oka 0 s-idIng at 3309-
$ ti
Christopher F. Dwyer of LKMA D.P.C.
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signature Date
Albert J. Krupski, Jr.
Print Owner's Name
2
Albert J. Kru ski Jr. Su
p PTO RIMMA NE]R,
SUPERVISOR IM[AUNAW]EIM[]ENT
SOUTHOLD TOWN HALL-P.O.Box 1179
53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of Southold
CHAPTER 236 - STORM WATER MANAGEMENT REFERRAL FORM
( APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT
ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER. )
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
APPLICANT: (Property Owner, Design Professional, Agent, Contractor, Other)
NAME: Chris D er Date:
(Print) 01/22/2025
hpslnnt)
Contact Information: cd er@l.kma.com
(E-Mail&Telephone Numbed
631-286-8668
Property Address / Location of Construction Site:
275 Peconic Lane S.C.T.M. #: 1000
District
Peconic, NY 11958
I
075.00 05.00 014.002
Section Block Lot
TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT
- - - - - - - - - - - - - - - - - - - - - -
F _ — _ — - - _. _ _ — _. � i�.D.E. .Permit is Required
I
X Area of Disturbance is less that 1 Acre. No S.
- Project does Not Discharge to Waters of the State. No S.P.D.E.S. Permit is Required I
- Area of Disturbance is Greater than I Acre&Storm-water Runoff Discharges Directly
to Waters of the State of New York. THE APPLICANT MUST OBTAIN a S.P.D.E.S. Permit
DIRECTLY From N.Y.S. D.E.C. Prior to issuance of a Building Permit.
❑ - Area of Disturbance is Greater than I Acre&Storm-water Runoff Flows Through Southold
Towns MS4 Systems to Waters of the State of New York. THE APPLICANT MUST OBTAIN
a S.P.D.E.S. Permit throe h the Southold Town Engineering Department
Prior to Issuance of a Building Permit.
e
Reviewed B r: � � —� Date: � ' 1�S"
FORM # SMCP-TOS December 2024 � f cclv -4 ""7