HomeMy WebLinkAbout52123-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#: 52123 Date: 07/23/2025
Permission is hereby granted to:
William Jude Burns
PO BOX 521
Cutchogue, NY 11935
To:
Construct alterations to existing single family dwelling as applied for.
Premises Located at:
690 Old Saddle Ln, Cutchogue, NY 11935
SCTM#95.-4-18.8
Pursuant to application dated 05/07/2025 and approved by the Building Inspector.
To expire on 07/23/2027.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $615.00
CO Single Family Dwelling-Addition /Alteration $100.00
Total V1 .00
Building Inspector
TOWN OF SOUTHOLD-BUILDING DEPARTMENT
' Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
ry
Telephone (631) 765-1802 Fax (631) 765-9502 lit l s://www.sotitholdtowtinypo�
Date Received
APPLICATION FOR BUILDING PERMIT Ah�
44"o
If /
For Office Use Only n_
PERMIT NO. Building Inspector„ `"""
Applications and forms must be filled out in their entirety. Incomplete " 10 4,
applications will not be accepted. Where) the Applicant is not the owner,an r
Owners Authorization form(Page 2 shall be completed.
Date:05.01.25
OWNER(S)OF PROPERTY:
Name:Garrett Lake SCTM# 1000-95-4-18.8
Project Address:690 Old Saddle Ln - Cutchogue, NY 11935
Phone#:631.774.3610 FE-mTl-jonlakepropertyggmail.com
Mailing Address:690 Old Saddle Ln - Cutchogue, NY 11935
CONTACT PERSON:
Name:Zackery E. Nicholson, RA
Mailing Address: 1250 Evergreen Drive - Cutchogue, NY 11935
Phone#:631.513.6589 Email:ZENicholson.ArchQa gmail.com
DESIGN PROFESSIONAL INFORMATION:
Name:Zackery E. Nicholson, RA
Mailing Address: 1250 Evergreen Drive - Cutchogue, NY 11935
Phone#:631.513.6589 Email-ZENicholson.Archggmail.com
CONTRACTOR INFORMATION:
Name:TBD
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure [--]Addition MAlteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $
Will the lot be re-graded? Dyes MNo Will excess fill be removed from premises? ❑Yes @No
i
PROPERTY INFORMATION
Existing use of property:Single Family Dwelling Intended use of property:Single Family Dwelling
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
AC this property? ❑Yes 'ig 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 Z36 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 pass A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
Application Submitted By(print name):Zackery E. Nicholson, RA RAuthorized Agent ❑Owner
Signature of Applicant: Date: 05.01.25
STATE OF NEW YORK)
S•
COUNTY OF
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the
(Contracto Agent, orporate Officer,etc.)
of said owner or owners, and is duly authorized to p I- 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 .20
No blic
CTPACA, EY L. DWYM
NOTARY PUBLIC,STATE OF NEW YORK
PROPERTYOWNER........ .,...... _._._._._ ...... _ �Otj�LIFIEDINSUFFOLKCOUNTY
(Where the applicant is not the owner) COM 110.98ION EXPi1jcS JUNE 30,221p
I� Garrett Lake residing at 690 Old Saddle Ln - Cutchogue, NY 11935
do hereby authorize Zackery E. Nicholson, RA to apply on
m behalf to the Town of Southold Building Department for approval as described herein.
05.01 .25
Owner's Signature Date
Garrett Lake
Print Owner's Name
2