HomeMy WebLinkAbout48581-Z t TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
W, + . SOUTHOLD, NY
tie,
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 #: 48581 Date: 12/12/2022., wr-........................._......
Permission is hereby granted to:
Hairston Hayes, Olive
.....� ... ........ �- ....,, ..........m e.
2021 1 st Ave Apt 2E
New York, 009
NY 12
To: Legalize "as built" additions and alterations to an existing three family dwelling as
applied for.
At premises located at:
2850 Peconic Ln, Peconic
SCTM # 473889
Sec/Block/Lot# 74.-3-17
Pursuant to application dated 10/6/2022 and approved by the Building Inspector.
To expire on �6/12/2024.�
Fees:
AS-BUILT FEE $1,285.00
CO-ALTERATION TO DWELLING $50.00
Total: $1,335.00
Building 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 https://www.southoldtownny.gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only P '
a
PERMIT NO„ q8 5 Building Inspectorr,_ y
Ya
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Wherethe Applicant Is not the owner,an
Owner's Authori ation form(Page 2)shall be completed.
Date: ,
OWNER(S)OF PROPERTY:
Name: �.�vt Q SCTM# 1000-
Project Address: a 0 C ) &QC e C 3AJI C
Phone#: L5 3 C� 8'6 Email: O Q
Mailing Address:
CONTACT PERSON:
Name:
01tue Ifir
Mailing Address: ofxv
Phone#: O �.3— Email: c)hu" k
DESIGN PROFESSIONAL INFORMATION:
Name,.
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email;
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other
Will the lot be re-graded? ❑Yes El No Will excess fill be removed from premises? ❑Yes El No
1
PRdotkTY INFORMATION ;
m
Existing use of property: Intended use of property:
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.
kCheck BOX After Reading: The owner/coal etor/design professional is responsible forall drainage and storm grater lssues as provided by
#aEster M of the Town'Codo, APPLICATION IS Hk1fiEBY ADE to the Ouilding Department for the Issuance of a Sullding Pernik pu iri6ant to the quill ing Zone
Ordinance of the Town of Southold,Suffolk,County,Newyork 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 applicablelaws,ordinances,building code,
housing code and regulations and to admit authorized inspectors on premises and in building(s)for necessary inspections.False siatements made herein are
punishable as a Class A`misdemeanor pursuant to Section'210.4S of the New York State Penal Law.
Application Submitted By(print name):�`�t?r ir, ❑!Authorized Agent r wrier
Signature of Applicant- .. ? bate:
STATE OF NEW YORK)
SS:
COUNTY OF S I )
I�
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual si Hing 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 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
tb,
day of , 20
jNff ry Public
TRACEY LY,VYER
LI .,
OF NEWYORK
NO.0 P Cr'J F''J690�J
PROPERTY OWNER AUTHORIZATION QUI_PED IN ,JFF I I<COUNTY
(Where the applicant is not the owner) C0MMsSION E),PIA It`SJUNE30,2
V, 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
YBUILDING DEPARTMENT- Electrical Inspector
i TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
.wSouthold, New York 11971-0959
Telephone (631) 765-1802 - FAX (631) 765-9502
roaerr@southoldtownny.gov - seand southoldto!A . ov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (Au Information Required) Date:
Company Name: Sol OIL
ry
Electrician's Name:
License No.: Elec. email:
Elec. Phone No. q
❑1 request an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Required)
Name: 01vL f 0
Address: 9,�bo kjcowc,
Cross Street:
Phone No.:
Bldg.Permit email
Tax Map District: 1000 Section Block: Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
Square Footage, IZO60
Circle All That Apply:
Is job ready for inspection?: Z110YES ! NO �Rough In Final
Do you need a Temp Certificate?: YESE�lNO Issued On
Temp Information: (All information required)
Service SizeLJ1 Ph[:]3 Ph Size: A # Meters Old Meter#
❑New Servicer-1 Fire Reconnect[:]Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Lateralsi HFrame Pole Work done on Service? "r iv
Additional Information:
PAYMENT DUE WITH APPLICATION