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HomeMy WebLinkAbout48352-Z ., TOWN OF SOUTHOLD t . BUILDING DEPARTMENT TOWN CLERK'S OFFICE µam ;" 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#: 48352 Date: 9/30/2022 Permission is hereby granted to: Streeter, Erin 48 Highland Rd Rock Point, NY 11778 To: legalize "as built" window replacements and AC unit to existing single-family dwelling as applied for. Additional certification may be required. At premises located at: 400 Town Creek Ln., Southold SCTM # 473889 Sec/Block/Lot# 64.-1-14.6 Pursuant to application dated 8/15/2022 and approved by the Building Inspector. To expire on 3/31/2024. Fees: AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $400.00 CO-ALTERATION TO DWELLING $50.00 Total: $450.00 Building br ra TOWN OF SOUTHOLD—BUILDING DEPARTMENT w Town Hall Annex 54375 Main Road P. O. Box 1179 Southold NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 htt s://www.southoldt ^Lvn o Date Received APPLICATIONL IIT For Office Use Only M b ( � i, 9 5k" PERMIT NO. [:K-35 � Building Inspector., ', "'022 Applications and forms must be filled out in their entirety. Incomplete TOi44'IBNO Dui.:-. applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date: OWNER(S)OF PROPERTY: Name: SCTM# 1000- & — , Lp r Project Address: Phone#: La t4--> © ( Email: da cl Mailing Address: -/t- CONTACT PERSON: Name: Mailing Address: Phone#: Email: DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: Mailing Address: Phone#: EmaiL DESCRIPTION OF PROPOSED CONSTRUCTION 1:1 New Struct a ❑Addition. ❑Alteraion ❑Repair ❑Demolition Estimated Cost of Project: Other I- J 4D Will the lot be re-graded? ❑Yes []No Will excess fill be removed from premises? ❑Yes El No - Uri 91W 1 PROPERTY INFORMATION Existing use of property: Intended use of property: Zone o use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes P- o IF YES, PROVIDE A COPY. Ed 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): ❑Auth rite Agent Owner Signature of Applicant: Gate: � �� STATE OF NEW YORK) ss�, COUNTY OF 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 h` er knowledge and belief; and that the work will be performed in the manner set forth in the application fil then h. Sworn before me this day da of v'S 202,Z_ Notary Public 1=clu1 S'Imlnrana Notmy Public State end pqew yorf� OROPERTY OWNER AU,TI 10FUZA HON No a �l6 f6P�aP 41arty COMMssidljra Expires 1 If (Where the applicant is not the owner) 1, 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 BUILDING DEPARTMENT- Electrical Inspector M: TOWN OF SOUTHOLD ws °" Town Hall Annex - 54375 Main Road - PO Box 1179 r4Southold, New York 11971-0959 .' Telephone (631) 765-1802 - FAX (631) 765-9502 :. rogerr@southoldtownny.gov - sea nd@southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INF RMATION (Au information Required) Date: 9/14- Li- Company Name: Electrician's Name: License No.: Elec. email: El copy Compliance mm Elec. Address.: .� � _ ate of Elec. Phone N quest an email co o Certificate a -07o JOB SITE INFORMATION (All Information Required) Name: ._ Address: ©® . Cross Street: Phone No.: (0 o Y Bldg.Permit#: 3Sa email: ��-i-- o •� .c' Tax Map District: 1000 Section: Block: Lot: BRIEF D SCRIPTTION OF WORK, INCLUDE SQUARE FOOTAGE Please Print Clearly): CD Square Footage: Circle All That Apply: Is job ready for inspection?: YES [_] NO Rough In 11 Final Do you need a Temp Certificate?: F-1 YES O Issued On Temp Information: (All information required) Service SizeEl1 Ph[]3 Ph Size: A # Meters Old Meter# ❑New Service❑Fire Reconnect[-]Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals 1 R2 H Frame r Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION