HomeMy WebLinkAbout48880-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
x 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#: 48880 Date: 2/8/2023
Permission is hereby granted to:
Sproat, Thomas
65 Harvard St
Garden Ci , NY 11530
To legalize as-built AC as applied for.
At premises located at:
2055 Anchor Ln Southold
SCTM #473889
Sec/Block/Lot# 79.-4-38
Pursuant to application dated 1/23/2023 and approved by the Building Inspector.
To expire on 8/9/2024.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $400.00
CO-ALTERATION TO DWELLING $50.00
Total: $450.00
i -
Building Inspector
�� 7PTpL
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
9Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 ht!ps:�/www.soitt,holdtownny.gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
V00
PERMIT N0. Building Inspector: JAN 2 023
WILUING DEN;
Applications and forms must be filled out in their entirety.Incomplete T�➢ 0Fq01JTH&r1
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-
✓ TiGG(.L� ✓�dClT
Project Address:
Phone M - Email: ZV 7-"� c? di7` ((�
Mailing Address: k
CONTACT PERSON:
Name:
Mailing Address: �4�7 40re
Phone#: ,. Email�i Ive
DESIGN PROFESSIONAL INFORMATION; .
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
eW Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
Other ASWill the the lot be re-graded? ❑Yes No Will excess fill be removed from premises? ❑Yes 2<0
1
'JPROPERTY INFORMATION
o�
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 ❑No IF YES, PROVIDE A COPY.
❑ Check Box After Reading: The owner/contra
or/design rofess ' `
g St" professional is responsible for all drainage and stone water Issues asp 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 Newyork and other applicable Laws,Ordinances or Regulations,for the construction of buildings,
additions,alterations or,for removal or demorition as herein described.The a "licant agrees
to comply with all a` "
pp g p y p�licable laws ordinances,-building code,
housing code and regulations and to admit authorized inspectors on premises and In building(s)for necessary Inspections.False sta�Yemenjs 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 na �G } 1C�� �S�o Authr►ri ed Agent ❑Owner
Signature of Applicant: �i —� Date: z
STATE OF NEW YORK)
SS:
COUNTY OF
/ r-9 A 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 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 ILNIVE LAMARRE
-State of
y r 14
al so° oinLNassau�Ctae� 10 k
.
Notary Public
a
I ion Expi
r
eApr, 2t2S d
No ry Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
[, 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
IDBI `�6l I UILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
� (JAN 2 3 2073
Hall Annex - 54375 Main Road - PO Box 1179
ttJar W)EPT Southold, New York 11971-0959
WN10IFSOUTHOLD
Telephone (631) 765-1802 - FAX (631) 765-9502
ro err southoldtownn ov - seand s )lutholdtow iny.gov
APPLICATION FOR ELECTRICAL, INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date:.
Company Name:
Electrician's Name:
License No.: Elec. email:
Elec. Phone No: ❑I request an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Required)
Name: � -
Address: , // ✓"
Cross Street:
Phone No.:
Bldg.Permit#: email:
Tax Map District: 1000 Section: Block: Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
AtC- A-5- `4 [—Square Footage:
Circle All That Apply:
Is job ready for inspection?: Rr YES NO F-] Rough In ❑ Final
Do you need a Temp Certificate?: El YES 0 NO Issued On
Temp Information: (All information required)
Service SizeF_11 Ph 03 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# underground Laterals Di 2 H Frame Pole Work done on Service? Y ON
,Additional Information:
PAYMENT DUE WITH APPLICATION