HomeMy WebLinkAbout48958-Z - TOWN OF SOUTHOLD
� BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
a
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 #: 48958 Date: 2/24/2023
Permission is hereby granted to:
Piacente, Keith
4375 Mill Ln
Mattituck N2 ..
To: Legalize "as built" accessory shed (193 sq.ft.) to an existing single family dwelling as
applied for. Must maintain a minimum setback of 25 feet. Additional certification may
be required.
At premises located at:
4375 Mill Ln , Mattituck
SCTM # 473889
Sec/Block/Lot# 107.-4-2.5
Pursuant to application dated 2/24/2023 and approved by the Building Inspector.
To expire on 8/25/2024.
Fees:
AS BUILT-ACCESSORY $354.40
CO-ACCESSORY BUILDING $50.00
ELECTRIC $180.00
Total: $584.40
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 1�ttG :l� w - owtl°ioldQow � r
Date Received
APPLICATION FOR BUILDING PERMIT
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PERMIT N0. Building Inspector•:
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u�•_.., C.•+i rv. +.,.� wait of Project:
. epalr ❑UernUIILIUII �������� �`”
El New Structure ❑Additian ❑Alteration ❑ic $ �
thaer
Will the lot be re- raded
g ? ❑Yes o Will excess fill be removed from premises? ❑Yes ElNo
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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.
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Application Submitted By(pant ❑Authorized Agent uvner
�r Date: _
Signature of Applicant: a
STATE OF NEW YORK)
SS:
COUNTY OF SUj!Fn I I-,- )
i '" k 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
day of ru 0 Z0 3L
Notary Public
PROPERTY OWNER AUTHORIZATION NOTARY PUBLIC,3Tr OF"NEWYO K
NOOIDW630(1,900
(Where the applicant is not the owner) QUALIFIED IN 8UFFOLK COUNTY
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COLI%f S' EON EXPIRES JUNE ,4
I, � �% r �� �� ,.residing at .
�do hereby authorize �'' to apply on
�'^ 1__IJ n..•1 J:.__n........1.........4 C..� I d bpd fS Yeln
my oehr'Ir tt ,fi:h Town�7f 5 ut'-olu DuMing Department ll o approval a$ e:scr i ham.,reln.
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"Owner's Signature Date
ner s
Ow Name
2
BUILDING DEPARTMENT Electrical Inspector �i r
TO"IM'U"N OF SOUTHOLD
Town Hall Annear _ ,54375 Main lead.- PO Boy 1 ���
Southold, New York 11971-0959
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Telephone Tele 631) 755-1802 - FAX (531) '705-9502 �
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APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All information Required) Date:
Company Name: si
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: .
M
w
Cross Street: r °
Phone No.:
Bldg.Permit .. email: ` f ,
Tax Map District: 1000nction:
Block: : ? Lot.
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE(Please Print Clearly):
( Iq � � Square Footagd:
Circle All That Apply:
Is job ready for inspection?: 11
YES NO Rough In Final
Do you need a Temp Certificate?: El YES ❑ NO Issued On
Temp Information: (All information required)
Service Size1-11Ph E]3 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground[]Overhead
# Underground LateralsDI E2 D H Frame Pole Work done on Service? Y N
Additional Information:,
PAYMENT DUE WITH APPLICATION
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