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Home My WebLink About53237-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#: 53237 Date: 08/28/2026 Permission is hereby granted to: John Dolan 17 Whitehall Blvd Garden City, NY 11530 To: Construct additions and alterations to an existing single-family dwelling to include HVAC system and outdoor shower as applied for per SCHD approval. Premises Located at: 620 Oak Dr,Southold, NY 11971 SCTM#80:2-12 Pursuant to application dated 08/04/2026 and approved by the Building Inspector. To expire on 08/27/2028. Contractors: Required Inspections: Fees: Single Family Dwelling- Addition&Alteration $1,319.00 CO Single Family Dwelling-Addition /Alteration $100.00 Total $1,419.00 J& Building Inspector v 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 littl2s, o Date Received APPLICATION For Office Use Only PERMIT NO- -53� 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 I �� Q Owner's Aerthorization form(Page 2)shall be completed. Date: 7/31/26 �_� E3tf14 OWNERS) OF PROPERTY: Name:DIANE AND JOHN DOLAN SCTM#1000-80-2-12 Project Address:620 OAK AVE SOUTHOLD 11971 NEW YORK, NY Phone#:516-220-1815 Email:JOHN_DOLAN@GLIC.COM Mailing Address:620 OAK AVE, SOUTHOLD 11971 NEW YORK, NY CONTACT PERSON: Name:KATHERINE SAMUELS Mailing Addre,s:25235 MAIN ROAD CUTCHOGUE NY 11935 Phone#:631-734-6405 Email:KATE Ca)SAMUELSANDSTEELMAN.COM DESIGN PROFESSIONAL INFORMATION: Name:SAME AS ABOVE Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name:TBD Mailing Address: Phone#: Email: DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ®Addition RAlteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $650,000 Will the lot be re-graded? OYes *No Will excess fill be removed from premises? ❑Yes *No ------------- Docusign Envelope ID:8578B39B-6E6A-89EC-8280-14D2898FB412 PROPERTY INFORMATION Existing use of properly:RESIDENTIAL intended use of property:RESIDENTIAL Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to R-40 1 this property? E]Yes IiiiiiNo IF YES, PROVIDE A COPY. 0 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 Miss A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted By(print name)* katherine jean samuels gAuthorized Agent D Owner Signature of Applicant: Date: 07/31/2026 Pennsylvania STATE OF b1FcWxWW) SS: COUNTY OF Beaver Katherine Jean Samuels 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. M.0—E V&W fla"Rd& a—C.." �-p— Sworn before me this My C�NuFfb 4w 1298553 31st day of July 20 26 Notarized remotely online using communication technology via Proof. Notary Public PROPERTY OWNER AUTHORIZATION (Where the applicant is not the owner) John Dolan 620 Oak Drive, Southold, NY 1, residing at do hereby authorize Kate Samuels to apply on my behalf F4wayof Southold Building Department for approval as described herein. 7/28/2026 Owner's Signature Date John Dolan Print Owner's Name I I'll, 2 SITE DATA 400 C*t—dor A—,Ri—f Pad,N,York 1140E 144 A Lel.6sLa2aT^2sosM9a"9lrolaring AREA=19,800 Sq,FT. ,com 5VBDIVI$IQN- ,1 OFFICE OF THE SUFFOLK COUNTY ON JJULY 011931 AS FILE NO.8 CLERK fa g} ''em s 1 t(ti444/T h�FOtt h7 ht� 'DATUM =N&VD 198E U - V�4l�eNl►i+�sAYy`f4t'r— Honw'd YL Yolmg,Lmd S.rtvayor _Tha.C.P.V R,m-af—I _ u DEPTH TO GROUNDWATER{SON AREA OF SANT.SYSTEM) =21 FT �` �O'i9€a> aF T• a -i S r=a@ A.mi. &r,6 'NUMBER OF BEDROOMS(DESIGN EQUIVALENT) =4 1'' MINIMUM REQUIRED LA OWTS CAPACITY =440 GAL j - HEALTH DEPARTMENT USE PROVIDED LA OWT5 CAPACITY =SDD GAL 7 s gg t LEACHING SYSTEM REQUIRED =304 SFSWA S LEACHING SYSTEM PROVIDED =3W SFSWA J eA?e,f NOTES FOR ° �t•rrr cq ABANDONMENT OF SANITARY STRUCTURES . \ ABANDONMENT IN-PLACE � §R - SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES EXISTING—SYSTEMS SHALL BE ABANDONED BY REMOVING ALL RESIDUAL ; 4 SEWAGE WASTES BY A LICENSED WASTE HAULER,REMOVD46 THE TOP OF THE t JV - " pp-t �� PERMIT FOR APPROVAL OF CONSTRUCTION FORA STRUCURE(S),BACK}nLING WITH SUITABLE SAND AND GRAVEL MATERIAL, 'T a / C4F + _ i`� Y a p[N � ; 'D4y A '�'� SINGLE FAMILY RES€PENCE ONLY ING AND PROPERLY COMPACT '! € f 40 ABANDONMENT BY REMOVAL (( 6R 5EWAGN65Y5EF15Y SO REAOANDONED REMOVP46 E ENTIRE RESIDUAL SEWAGE WASTE58YALICEN5ED HAULER.REMOVING THE ENTIRE DATE Tf9U STRUCTURE(5),BACKFILLIN6 WITH SUITABLE SAND AND GRAVEL MATERIAL. / f ` C 3 / `� a�.IIa '.+ � Fr APPFzoy I AND PROPERLY COMPACTING. - / is_ A bdF'e FOR MAXIMUM OF 4 BEDROOMS ABANDONMENT OF SEWER PIPING ' I EXPIRES THREE YEARS FR€)hi LATE OF APPROVALTIE ASSOCIATEDSHALL BE CUT AND CAPPED AS A MEANS OF Rom''�.� ow, ABANDONMENT.THE DEPAkTMENT SHOULD BE CONTACTED FOR FURTHER ABANDONMENT REQUIREMENTS,IF FUTURE CONSTRUCTION 15 CONTEMPLATED IN THE AREA OF THE ABANDONED SEPTIC SYSTEM Z ¢ p r j;` pg WR -CATFON BA, (11 t.-3TIN6 SEWAGE DISPOSAL SYSTEMS,EITHER IN-PLACE,OR BY REMOVAL,MUST BE CERTIFIED BY EITHER A LICENSED DE516N PROFESSIONAL OR LICENSED CONTRACTOR AS INDICATED BY THE - AfSy b t1'` s' AF DEPARTMENT ON THE PERMIT TO CONSTRUCT.FOR PROJECTS SERVED BY Tk MUNICIPAL SEWER DISTRICTS,THE APPROPRIATE MUNICIPAL AGENCY WITH j (( e p JURISDICTION SHOULD ALSO BE CONTACTED. faa ! COrdt SURVEYOR'S CERTIFICATION p '{ -4y 'WEHERESYCERTIFYTODIANE DOLAN THAT THIS SURVEY WAS I: 4q,32 'gy p - PREPARED R4 ACCORDANCE WITH THE CODE OF PRACTICE FOR LAND SURVEYS A TEST HOLE 04 # ADOPTED BY THE NEWYORK STATE AS5baA- ON OF rROFE= AL LAND �. -; j% _ �,r. `--. ""Wd f SURVEYORS, t f f HOWARD W.YOUNG,N..S LS,N6`115993 { DANIf1 A_WEAVER,N.YS LS.N.1. SURVEY FOR moYN , � 0 DIANE DOLAN 27 NOTES L D "MAP OF REYDON SHORES"1,THE OWES SHALL BE MODEL CEN-5 MANUFACTURED BY FUJTC EAN USA. 2.THE DESIGN ENGINEER,FUTICIEANUSA REPRESENTATIVE,AND SCDHS at Southold,Town of Southold €.. 1 REPRESENTATIVES SHALL OBSERVE THE INSTALLATION OF THE OWFS {11 AND LEACHING SYSTEM.APPROVAL FROM ALL TERM PRIOR TO BACFtAl Suffolk County,New York T 3,THE SYSTEM START UP WILL BE COMPLETED UNDER THE DIRECT SUPERVISION OF A FUTICIEAN USA REPRESENTATIVE. B)�LQ= PERMIT 5URVC F( 4.AN EXECUTED OPERATION AND MAINTENANCE CONTRACTBEtWEEN 1' LEGEND THE MAINTENANCE PROVIDER AND PROPERTY OWNER MUST BE R ` SUBMITTED TO THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES C..tyT Mep affi<e 100D sn-.a� 80 — 02 LOT 12 B s�GEE _ (5CbH5)PRIOR TO APPROVAL OF THE IJA OWTS RE6LSTRATION BY THE 5CDHS IN ACCORDANCE WITH ARTICLE 19 OF THE SUFFOLK COtrtdiY FIELD SURVEY BBC -BELGIAN 9LOCKCURS T: Q SANITARY CODE. MAP PREPARED COMPLETED OCT.21,2025 CE -CELLAR ENTRANCE .� - €¢ S.FINISHED FLOOR ELEVATION(5)SHALL.BE VERIFIED BY THE CH =CHIMNEY ARCHITECT. Record DfRevisions CMF =CONCRETE MONUMENT FOUND } &T1EREARENO KNOWN EXISTING DRVWaL5 AND NOPROPOSED CM5 =CONCRETE MONUMENT SET DRYWELL5 FOR THE SUBJECT PARCEL REVISION DATE COP �E PAc N: T.UNDERGROUND UTILITIES SHOWN HEREON ARE BASED ON - IPFOH =IRON PIPE FOUND }" I ABOVEGROUND EVIDENCE AND AVAILABLE RECORDS,CONTRACTOR SHALL OL =OVERHEAD YWIRESINE I FIELD VERIFY ALL UNDERGROUND REQUIRED PRIOR TI ANY OL =ON PROPERTY LINE 'j. I CONSTRUCTION AND MAINTAIN REQUIRED INSTALLED UP STR AM OF HE ---- OS OUTDOOR SHOWER Q B.A GARBAGE GRINDER SHALL NOT BE INSTALLED UPSTREAM OF THE f> PRF =P05T 6 RAIL FENCE �-+,� - . -CON 1-49.CONTRACTOR CHALLONTRACTOR ACTOR S INVERT 7IFY E iN PRIOR R INS =WOOD FENCE CONSTRUCTIONN-CONTRACTOR SHALL NOTIFY ENGINEER OF RECORD OF INS =W WOOD KE TAKE SET }+I ,I Q ANY DISPCREPANA'E5, INS WOOD STAKE SET 0 15 30 60 90 WY =WATER VALVE \ �3UF� 10.MAINTAIN A MINIMUM COVER OF 59'OVER THE T#OF THE PROPOSED f,3 =LIGHT POLE Y � WATER SUPPLY LINE MAINTAIN A MINIMUM SEPARATION OF IO FT SCOIe:V= 30' =FIRE HYDRANT ++� / BETWEEN THE WATER LINE AND NEARBY SEWER/STORM COMPONENTS. • =END OF DIRECTION/DISTANCE \/ J08 NO.20250153 OWG.2025 0153yp 1 OF 2