HomeMy WebLinkAbout47201-Z .:jA
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
ti TOWN CLERK'S OFFICE
10
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 #: 47201 Date: 12/8/2021
Permission is hereby granted to:
HSA Hldgs II LLC
108 Remington Rd
Manhasset, NY 11030
To. install generator as applied for.
At premises located at:
4985 Great Peconic Bay Blvd., Laurel
SCTM # 473889
Sec/Block/Lot# 128.-1-16
Pursuant to application dated 11/18/2021 and approved by the Building Inspector.
To expire on 6/9/2023.
Fees:
ACCESSORY $100.00
ELECTRIC $85.00
CERTIFICATE OF OCCUPANCY $50.00
Total: $235.00
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`buil n pector
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 llitpti://www.southo ,£ ,.
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only j
1 -Iln�
PERMIT NO. Building Inspector � � I � � t
3
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an BUIM i�� Y s.
Owner's Authorization form(Page 2)shall be completed. TOWN 0r Sou`HOLD
Date:November 8, 2021
OWNER(S)OF PROPS
Name:Joseph Peters t — ��, —L /
SCTM# 1000- a
Project Address:4985 Peconic Bay Blvd. Laurel NY
Phone#:631-298-8113 Email:jhpehp@gmail.com
Mailing Address:4985 Peconic Bay Blvd. Laurel NY 11948
o CTPERSONS
Name:Sean O'Neill
MailingAddress:PO Box 64 Jamesport NY11947
Phone#:631-722-3595 Email:oneilloutdoorpower@hotmail.com
DESIGNPROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:Universal Electrical Services LLC
Mailing Address:151 First Avenue Massapequa Park NY 11762
Phone#:516-242-9204 1 Email:gebhard73@gmail.com
DIESCRAPTION OF PROPOSED CONSTRUCTION -
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Othergenerator $12,000
Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises? ❑Yes ! No
1
PROPERTY INFORMATION
Existing use of property:Residential Intended use of property:Residential
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
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 New York State Penal Law.
Application Submitted By(print name):Sean eill
Xuthorized Agent ❑Owner
Signature of Applicant: Date: -1 -21
STATE OF NEW YORK)
SS:
COUNTY OF 5 ��
)
Jean ONeill 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 I 1 day of L6e m , 20 2—1
Notary Public
TMM iL l FIR
NOYMYPU13=STAM OF N YCFl!<
PROPERTY OWNER AUTHORIZATION N(I 010W830%W
(Where the applicant is not the owner) MOAM 04 WFFOLX COUNTY
2L�-),
I, residing at
Joseph Peters 4985 Peconic Bay Blvd.
Laurel NY Sean eill
do hereby authorize to apply on
my behalfAo the Tow"f Southold Building Department for approval as described herein.
11
-B-LoL
Owner's ignature Date
Joseph Peters
Print Owner's Name
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