HomeMy WebLinkAbout52021-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#: 52021 Date: 06/18/2025
Permission is hereby granted to:
Gail C Toma
PO BOX 842
Southampton, NY 119690842
To:
Legalize an "as built" rear deck addition to an existing single-family dwelling as applied for.Additional
certification may be required.
Premises Located at:
5845 Bridge Ln, Cutchogue, NY 11935
SCTM#84.4-6.13
Pursuant to application dated 05/19/2025 and approved by the Building Inspector.
To expire on 06/18/2027.
Contractors:
Required Inspections:
Fees:
As Built Deck $659.00
CO Single Family Dwelling-Addition /Alteration $100.00
Total $759.00
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) 765-95021itt ,s://www.soutliol �tor » . �s
Date fiecek d
APPLICATION FOR BUILDING PERMIT
� k
r, For Office Use Only
PERMIT NO. `-� Building Inspector„ 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:May 9, 2025
OWNER(S)OF PROPERTY:
Name:Daniel Rodgers / Gail Toma SCTM# s000-q-73�(- q g4 q
Project Address:5845 Bridge Lane, Cutchogue, New York 11935
Phone#:631-627-0089 Email:drodgersatty@gmaii.com
Mailing Address:PO Box 74 Remsenburg, New York 11960
CONTACT PERSON:
Name:Daniel Rodgers, Esq.
Mailing Address:same as above
Phone#:same as above Email:same as above
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:Mr. Will RepairsThe Expert, Corp.
Mailing address:850 Ostrander Avenue, Riverhead, New York 11901
Phone#:631-2fl6-874-0 -Email:Mr.Willrepai-rs@hotmail.com
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
Eil Other"As-built"application-outdoor deck 10,000
Will the lot be re-graded? ❑Yes ANo Will excess fill be removed from premises? ❑Yes ®No
1
PROPERTY INFORMATION
Existing use of property:Residential Intended use of property: Residential
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes i@No IF YES, PROVIDE A COPY.
❑ 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 15 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 an premises and in bullding(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 nam :Daniel Rodgers ❑Authorized Agent 1ROwner
Signature of Applicant: Date: May 9, 2025
STATE OF NEW YORK)
SS:
COUNTY OF Suffolk
V being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)Wove named,
(S)he is the o
(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
I day of ��� , 20 "
Notary Public
M:a egban Mackie
PROPERTY OWNER AUTHORIZATION " t'o.01 'Sta6193'�34
N�,(ilM �141 Ywk
,�4
(Where the applicant is not the owner) Qualified in Suffolk+Counip"
My aissio Expires Scpt=b 22,21
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 DI3INIC1 1000 SECTION:84 BLOCK: I I OT(`o):G Li
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T1tL'OIFSEI OR DIMENSIONS SHOW HEREON FROM THE PROFLRIY LINE:;TO DIE SfRUCTURF-ARE FO/'A:J4 C1FlC PURPOSE ANU USE IHFREFORE THEY ARE
NOT INTENDED 10 MONIIMI.NI IHF PROPt RlY LIA'I.'i OR TO GUIDE IHC LRECRON OF FENCES.AOOIRONAI SIRI/CRIRtY OR AND 0711FR IMPROVEMENTS'. FASEMFNIS'
AND/OR.5110_;uRrArE SITtUf'RIRE,:NI CORUED OR UNRT.COIIDCD ARF NOT .IJARANTFFD(INLET, P)f VCALLY E.1411CN1 ON RIC P'RLMISFS AT 7HE TIME OF SURVEY
SURVEY OF LOT 13 f CE.'FTIFIED TO, DANIEL G
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SCALE: 1/4"' = 1'-0" '� tA 5/29/2025
SHEET NUMBER
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