HomeMy WebLinkAbout47249-Z TOWN OF SOUTHOLD
z 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 #: 47249 Date: 12/21/2021
Permission is hereby granted to:
Scannapieco, Gerald
660 Chablis Path
Southold, NY 11971
To: install generator as applied for.
At premises located at:
660 Chablis Path, Southold
SCTM #473889
Sec/Block/Lot# 51.-3-3.11
Pursuant to application dated 12/1/2021 and approved by the Building Inspector.
To expire on 6/22/2023.
Fees:
ACCESSORY $100.00
ELECTRIC $85.00
CERTIFICATE OF OCCUPANCY $50.00
Total: $235.00
Lfli
gilding Inspector
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 _ E =: �� � .� go
Date Received
A PI - _ 1 N FOR
For Office Use Only #`
PERMIT NO. = Building Inspector
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
Owner's Authorization form(Page 2)shall be completed.
Date: 121
OWNER(S)OF PROPERTY:
Name: "'o I SCTM#1000- ._ 3
Project Address:
r
Phone#: Email:
Mailing Address:
CONTACT PERSON:
Name:
Mailing Address:
Phone#: G�I — 41r-7._ Z3Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
=wStructure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
IR
her $ �G 'i�Glr�
Will the lot be re-graded? E1Yes.§j4<o Will excess fill be removed from premises? ❑Yes.�Wo
1
PROPERTY INFORMATION
Existing use of property: Intended use of property: :7::d
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes ONO IF YES, PROVIDE A COPY.
c Box Afterg 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): jZ l'tborize AgentElOwner
Signature of Applicant: Date:
STATE OF NEW YORK)
COUNTY OF
i being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing co tract)above named,
(S)he is the
= (Contractor-;"Agent,Corporate Officer, etc.)
of said owner or owners, and is duly aiti 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 202-1 it
vi't-
Notary Public
TRACEY L. DWYER
NOTARY PUBLIC,STATE OF NEW YORK
_Q
A NO. DWO306900
DRODE _
(Where the applicant is not the owner) QUALIFIED IN SUFFOLK COUNTY
COMMISSION EXPIRES JUNE 30,
4 residing at
��. do hereby authorize ' to apply I on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signature Date
Print Owner's Name
2
UI ING DEPARTMENT-Electrical Inspector
�c
TOWN OF SOUTHOLD
Tows Hall Annex- 54375 Main Road - PO Box 1179
_ Southold, New York 11971-0959
s Telephone (631) 765-1802 - FAX (631) 765-9502
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APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date:
Company Name: _.
Electrician's Name: -
License No.: 71,F—d�'�' Elec. email:
Elec. Phone No: request an email copy of Certt i to of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Required)
Name:
Address: t
Cross Street: p
Phone No.:
BIdg.Permit#: � � LA email:
Tax Map District: 1000 Section: Block: Lot: ::3
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
S uare Footage.-
Circle
ootage:Circle All That Apply:
Is job ready for inspection?: YES NO Rough In Final
Do you need a Temp Certificate?: El YES UAO Issued On
Temp Information: (All information required)
Service Size1 Ph 3 Ph Size: A #Meters Old Meter#
❑New Service[]Fire ReconnectO Flood ReconnectOService ReconnectOunderground Doverhead
# underground Laterals R 1 = H Frame Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION
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