HomeMy WebLinkAbout53245-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#: 53245 Date: 09/02/2026
Permission is hereby granted to:
John Brush
360 Leslie Rd
Cutchogue, NY 11935
To:
construct alterations to an existing single-family dwelling as applied for.
Premises Located at:
75 Carrington Rd, Cutchogue, NY 11935
SCTM# 111.-11-28
Pursuant to application dated.08/17/2026 and approved by the Building Inspector.
To expire on 09/01/2028.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $352.00
CO-RESIDENTIAL $100.00
Total $452.00
4
�� �Iding Inspector� �
are
�r t� TOWN OF SOUTHOLD—BUILDING DEPARTMENT
p Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone(631) 765-1802 Fax (631) 765-9502 littr)s://www.sotitlioldtowiiiiv.9�O—V
Date Received
APPLICATION 7 " <
For Office Use Only
PERMIT NO. '" � 5 Building Inspector: C
i
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Own Applicant not the owner,an
Owner's Authorization form(Page )hall be completed.
Date:
OWNER(S)OF PROPERTY:
Name:JOHN & CHRISTINE BRUSH SCTM#1000-111.-11-28
Project Address: 1330 WUNNEWETA RD, CUTCHOGUE, NY 11935
Phone#:631-655-3457 Email:
Mailing Address: 1330 WUNNEWETA RD., CUTCHOGUE, NY 11935
CONTACT PERSON:
Name: BRETT KEHL
Mailing Address:265 JASMINE LANE, SOUTHOLD, NY 11971
Phone#:631-433-9084 Email:SSBN654@OPTONLINE.NET
DESIGN PROFESSIONAL INFORMATION:
Name: KEHL DESIGN ASSOC. LLC. (BRETT KEHL)
Mailing Address:265 JASMINE LANE, SOUTHOLD, NY 11971
Phone#:631-433-9084 Email:SSBN654@OPTONLINE.NET
CONTRACTOR INFORMATION:
Name: NA AT THIS TIME
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ®Alteration ❑Repair ❑Demolition Estimated cost of Project:
❑Other 25K
Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ❑Yes ®No
1
PROPERTY INFORMATION
Existing use of property: R-40 SINGLE FAMILY Intended use of property: R-40 SINGLE FAMILY
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
RESIDENTIAL R-40 this property? ❑Yes El 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. 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 taws,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 lams,ordinances,building code,
housing code and regulations and to admit authorized Inspectors on premises and in buildings)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): BRETT D. KEH L WAuthorized Agent ❑Owner
Signature of Applicant: Date:
CONNIE D.BUNCH
Notary Public,State of New York
STATE OF NEW YORK) No.01 BU6185050
Qualified In Suffolk County
SS: Commission Expires Apr11 14, 2 C.K
COUNTY OF SUFFOLK )
BRETT D. KEHL 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
�� n
day of f'r 20Q� /-- a
0 � �,t tl 1
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
I, 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
Town Hall Annexe Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O. Box 1179 fia
Southold, NY 11971-0959 ti
10
BUILDING DEPARTMENT
NOTICE OF UTILIZATION OF TRUSS TYPE CONSTRUCTION PRE-ENGINEERED
WOOD CONSTRUCTION TIOI AND/OR TIMBER CONSTRUCTION
Date:
Owner:
Location of Property: I YS O W U N I -
Please take notice that the (check applicable line):
New commercial or residential structure
Addition to existing commercial or residential structure
Rehabilitation to an existing commercial or residential structure
to be constructed or performed at the subject property reference above will utilize
(check applicable line):
Truss type construction (TT)
X Pre-engineered wood construction (PW)
Timber construction (TC)
in the following location(s) (check applicable line):
Floor framing, including girders and beams (F)
Roof framing (R)
Floor and roof framing (FR)
Signature: _
Name (person submitting this form): 1Ct -t
Capacity(check applicable line):
Owner
Owner representative
TrussReg15.docx Effective 1/1/2015
Building De artment A lication
AUTHORIZATION
(Where the Applicant is not the Owner)
I, @ r x t► a qs� residing at q 0IJ NF vJ6:—t A i
(Print property owner's name) (Mailing Address)
` do hereby authorise 6 W--W t �
(Agent)
to apply on my behalf to the
Southold Building Depatment.
try _rLg U
(Owner's Si (Date)
(Print Owner's Name)
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