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Home My WebLink About52124-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#: 52124 Date: 07/24/2025 Permission is hereby granted to: Thomas Deierlein 19 Westbury Rd Garden City, NY 11530 To: Legalize an"as built"finished basementto a single-family dwelling as applied for.Additional certification may be required. Premises Located at: 770 Chablis Path, Southold, NY 11971 SCTM#51.-3-3.10 Pursuant to application dated 06/13/2025 and approved by the Building Inspector. To expire on 07/24/2027. Contractors: Required Inspections: Fees: As Built Addition/Alteration $1,189.00 CO Single Family Dwelling-Addition /Alteration $100.00 Total $1,289.00 Building Inspector I 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 � s. wa ,,�� j �1i : 1 � � Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only oZ I N()N 1 3 2025 �00 PERMIT NO. Building Inspector': Building De rartment Applications and forms must be filled out in their entirety.Incomplete town of Southold applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date:5.28.25 OWNER(S)OF PROPERTY: Name:Tom & Mary Beth Deierlein SCTM#1000-51.-3-3.10 Project Address:770 Chablis Path Southold Phone#:1-917-287-591 Email:tomdeierlein@gmail.com Mailing Address: 19 Westbury Road, Garden City NY 11530 CONTACT PERSON: Name:Joan Chambers Mailing Address:PO BOX 49 Southold NY 11971 Phone#:631-294-4241 Email:joanchambers10@gmail.com DESIGN PROFESSIONAL INFORMATION: Name:Lou Schwartz Mailing Address:? Ridgewood St, Bay Shore, NY 11706 Phone#031) 410-6838 Email:tiderunnereng@gmail.com CONTRACTOR INFORMATION: Name:as-built Mailing Address: Phone#: Email: DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project. ❑Other finished basement Will the lot be re-graded? ❑Yes RNo Will excess fill be removed from premises? ❑Yes WNo 1 PROPERTY INFORMATION Existing use of property:Single family residence Intended use of property:same Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to AC I this property? E]Yes W No IF YES, PROVIDE A COPY. ig 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. APPUCATION 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):Joan Chambers i'Authorized Agent ❑Owner Signature of Applicant: , CONNIE D.BUNCH Date: Notary Public,State of New York STATE OF NEW YORK) No.01 BU6 Suffolk lk 50 Co c, Qualified in Suffo County O� b SS: Commission Expires April 14,2 COUNTY OF ) Joan Chambers 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 me this day of ,20 r .2 — Notary Public PIIQPEi ryER AU I,II1I II' ZA`I°°IIII (Where the applicant is not the owner) , Thomas J Deierlein residing at 770 Chablis Path do hereby authorize Joan Chambers to apply on my hehalf to the Town of Southold Building Department for approval as described herein. 6/10/2025 owners JIg nature Date Thomas J Deierlein Print Owner's Name 2 r "itw p;eq;I�«+--,-: +e,;—,-jN,,.p �wtrt"'1^ ^�"L` ,.: ® �or4.bX,/6/-J SING LE FAMILY DWELUNG ON an familar' iitt the St andards for -116 'i ' " Ap val and Construction of Subsurface S ge Disposal SYstem for Single Family Re deRces' C ft A.C mot%p.iL,C,N and W311 abide by the conditions 000-oiW ff forth therein and on the permit to ustruct". Z a , 4 h gym« ly 0 LaIVO L r o A:ut new �0 rDITT gQ,r,s/.t/6 fvk ate. j?7/ l