HomeMy WebLinkAbout48550-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
4 r 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 #: 48550 Date: 12/1/2022 ww
Permission is hereby granted to:
Moran, .Susanne.�_..�� .......... _— Ae__ __ _ .... ........ ....� .. .....�m_ .... .._.. .�.�
11_1 Autumn Dr _
. pHau au.gNY 11..7.88.............�....._......�... --�...............................___ w.....................�........�___ ..............................�
�.u �. ..�a, ��.e...._
To: Install a new boiler converting oil to propane gas to a single family dwelling as applied
for per manufacturer specifications.
At premises located at:
506...Azalea yRd,,, Mattituck�.�� ........................�. _ _....�......�.�......... --.aa...........................
SCTM #473889
Sec/Block/Lot# 115.-6-8
Pursuant to application dated 10/3/2022 and approved by the Building Inspector.
/1/2024.
To expire on 6/1/2024.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $200.00
CERTIFICATE OF OCCUPANCY $50.00
............................................m...................�
Total: $250.00
Building Inspector
'" rav 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 https://www,sotitlioldtownny.gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. q55 0 Building Inspectorsy R E)) 0 CT 3 2022
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the owner,an BUILDING DEPT.
Owner's Authorization form(Page 2)shall be completed. TOWN OF SOUTHOLD
Date:9/26/2022
OWNER(S)OF PROPERTY: ®®��
Name: SCTM# 1000- I I rJ• ' IP
Project Address:505 Azalea Road, Mattituck, NY 11952
Phone#:631-304-8855 Email:tmoran1277@
Mailing Address: 15prie
CONTACT PERSON: '
Name:N/A
Mailing Address:
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name:N/A
Mailing Address:
Phone#:
Email: �
ti'
CONTRACTOR INFORMATION:
Name:NH Ross Inc.
Mailing Address:120 Middle Country Road, Middle Island, NY 11953
Phone#:631-924-0677 1Email:service@nhross.com
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
E10ther Oil to Propane conversion of Boiler System $14,850.00
Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ❑Yes 9 No
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