HomeMy WebLinkAbout47545-Z TOWN OF SOUTHOLD
Y BUILDING DEPARTMENT
4 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 #: 47545 Date: 3/14/2022
Permission is hereby granted to:
Kersh, Adam
wwww____wwwwww______...____,,,,,�..............._... �... _wwwwwww__.......................�.............._____........._.�. �_ww__...... ................
318 Warren St A5
......
o ............. _..
Bro klyn NY 11021
To: Remove existing hot tub and install new on grade hot tub at existing single family
dwelling as applied for.
At premises located at:
530...Middleton....Rd.,....Greenpo. .......w.............._ _-
SCTM # 473889
Sec/Block/Lot# 40.-5-4
Pursuant to application dated 2/11/2022 and approved by the Building Inspector.
To expire on 9/13/2023.
Fees:
SWIMMING POOLS -ABOVE-GROUND WITH REQUIRED FENCING $250.00
CO- SWIMMING POOL $50.00
................................................
Total: $300.00
Building Inspector
JFI TOWN OF SOUTHOLD—BUILDING DEPARTMENT
179 Southold 11971-0959
Town Hall ex 54375 Main Road O. Box 1 � NY
�
Telephone 631 765-1802 Fax 631 765-9502
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
1 �
PERMIT NO. t
. ...� ��.. Building Inspector:
A a
pplications and forms must be filled out in their entirety. Incomplete w
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date: �_/ 10 / Z o 1 1--
OWNER(S)OF PROPERTY:
Name: 4-bk SCTM#1000-
�.�, � � 1 � p � �
Project Address: p M /lc f �� h
Phone#:
Email,.
Mailing Address: S q �
F
ACT PERSON:
: z-4 9/ong Address: 3 7-0
14 4- ►
Phone#:
, 4(.-- q k' Email: el c
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email
CONTRACTOR INFORMATION:
Name: C I p
C9rL
Mailing Address; C
Phone#:
�7 l— 7- l Email:
e C/",
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repa�ir []Demolemol'ition Estimated Cost of Project:
❑Other A 1,4-P -r- fiv b
Will the lot be re-graded? ❑Yes Mo Will excess fill be removed from premises? ❑Yes C�No
1
PROPERTY INFORMATION
Existing use of property: d�t it I Intended use of property: S
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R 1/.,,J 0 this property? ❑Yes biNo IF YES, PROVIDE A COPY.
1:1 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): EF-4'i (� l o NAuthorized Agent ❑Owner
Signature of Applicant: (-/kit ts, 6 �q """ " Date: a
CONIE D.BUNCH
STATE OF NEW YORK) Notary Public,State of New York
SS: No.01BU6185050
COUNTY OF Qualified in Suffolk Counter
Commission Expires April 14,
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the a I-r&c. fi o V
(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
day of r rl.A.o ' 20
..
Notary Public
PROPERTY OWNER
ATION
(Where the applicant is the
..
1, A DA v- A f 14 residing at
hereby authorize <<Lf o _ Q l ' ° ` �"— to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
� 2_lro l 20 2 -L
Owner's Signature Date
Print Owner's Name
2
� tf BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
at
Southold, New York 11971-0959
Telephone (631) 765-1802 - FAX (631) 765-9502
err� �pLJ l pG � + r�ny 9. w an d o sc Litho 1 o ��. .g . .
P
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: /p / -1 a 2v
Company Name: o t fie t- /t c t,r
Electrician's Name: �,F Wi t L o y
License No.: G Al 6- Elec. email: 6-' At.,c f-. C'
Elec. Phone No: ,° 7) - fg 3 � % request an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Required)
Name: A,,b,, . K t
Address: 'I'l I
Cross Street: -/ -e
Phone No.: q /7- --;L/- �7- 0 Z
Bldg.Permit#: �Jf� email:
Tax Map District: 1000 Section: D `'l 4 Block: 0 �' Lot: D
'BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
/-� 0 five
Square Footage: g"5-0
Circle All That Apply:
Is job ready for inspection?: YES NO ❑Rough In ❑ Final
Do you need a Temp Certificate?: F] YES aNO Issued On
Temp Information: (All information required)
Service Size Ell Ph 3 Ph Size: A # Meters Old Meter#
❑New Service[:]Fire Reconnect[]Flood Reconnect[:]service Reconnect❑Underground❑Overhead
# Underground Laterals D 1 H Frame 0 Pole Work done on Service? 11,Y__DN
Additional Information:
PAYMENT DUE WITH APPLICATION
---------------------------------------------------------------------------------------------
Cl
51�
10,90,
IL VOO
d YES ft
............