HomeMy WebLinkAbout46627-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 #: 46627 Date: 7/28/2021
Permission is hereby granted to:
Dilollo, Patrick
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5 Washin ton Ave
pay lle, NY_W 1...1..70.9a.w_...
To: legalize "as built" HVAC system as applied for.
At premises located at:
870 Inlet Ln., Greenport
SCTM # 473889
Sec/Block/Lot# 43.-2-8.1
Pursuant to application dated 7/19/2021 and approved by the Building Inspector..
To expire on 1/27/2023.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $400.00
CO-ALTERATION TO DWELLING $50.00
Total: $450.00
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Bui g Inspector
� s TOWN OF SOUTHOLD—BUILDING DEPARTMENT
„ Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
v Telephone (631) 765-1802 Fax(631) 765-9502 https://www.southoldto)yppy,gqv
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
��L2 �b '1 9 2021
PERMIT NO. Building InPtar,_
Applications and forms must be filled out in their entirety.Incomplete P 517.1' P� DEPT".
�.�-
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date:07/09/2021
OWNER(S)OF PROPERTY:
Name:Patrick DiLollo scTM#1003-43-2-8.1
Project Address:870 Inlet Ln Greenport NY 11944
Phone#:516-993-8322 Email:pjdilollo@gmail.com
Mailing Address:27 The Plaza Suite H Locust Valley NY 11560
CONTACT PERSON:
Name:SAME AS ABOVE
Mailing Address:
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name:SAME AS ABOVE
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:Empire Electric & Maintenance LLC
Mailing Address:27 The Plaza Suite H Locust Valley NY 11560
Phone#:516-993-8322 FEMTII:pdilollo@empireelectric.co
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
DOther HVAC as built $5000
Will the lot be re-graded? ❑Yes R No Will excess fill be removed from premises? ❑Yes RANo
1 __J
PROPERTY INFORMATION
Existing use of property:Resdlental 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 this property? ❑Yes *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 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):Patrick— Lof Io ❑Authorized Agent @Owner
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Signature of Applicant: "' ��°""" �� Date: 7/�
LISA GIOIA
STATE OF NEW YORK) " " - NOTARY PUBLIC-STATE OF NEW YORK
SS: No.01616126405
COUNTY OF Ovelified in Nassau County
u� + sla�io E�splf�o - 2 o
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Via.`c4c Q 0 being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the
(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 thereWlfA GIOIA
WbTAPY PUBLIC-STATE OF NEW YORK
Sworn before me this No.01 G161 26405
QU®Ilfied in Nassau County
day of c A 20 ` i IV Commission Expires 05.02.2W aGra'
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
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