HomeMy WebLinkAbout48961-Z TOWN OF SOUTHOLD
�r BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
k° 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#: 48961 Date: 2/24/2023
Permission is hereby granted to:
Chapman, Russell
c/o Cobblestone-Capital Adv
500 Linden Oaks Ste 210
Rochester, NY 14625
To: install generator as applied for.
At premises located at
790 Vanston Rd, Cutcho ue
SCTM #473889
Sec/Block/Lot# 104.-12-10.3
Pursuant to application dated 2/17/2023 and approved by the Building Inspector.
To expire on 8/25/2024.
Fees:
ACCESSORY $100.00
ELECTRIC $85.00
CERTIFICATE OF OCCUPANCY $50.00
Total: $235.00
t1inspector
WON—
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
i Telephone(631) 765-1802 Fax(631) 765-9502 htlj)s://NV'ww.soutliomdtown,tiv.ggv
Date Received
APPLICA 111011M 11,,,,DING P MIT
For Office Use Only qm�
La llJr I
PERMIT NO. Building Inspettcr:
FEB 179,02',1
Applications and forms must be filled out in their entirety.Incomplete (3U11 DING-i IX-P
applications will not be accepted. Where the Applicant is not the owner,an "O NOFSM"'HIM.'i:l
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: -it 6 1 SCTM#1000- 0'4 1 -2—
Project
..Project Address: 710 v4,
Phone#: 5-SS-- -7`t - a-o Email: --S3 .. i . g.v
Mailing Address: -7 V ^" .A4 I Ll 315'
CONTACT PERSON:
Name:
Mailing Address:
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address::
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address: G - lt2
Phone#: pq Email: co�
. . A
DESCRIPTION OF PROPOSED CONSTRUCTION
❑Ncvv au Uct-U c u a4uiaw.i -- - 9 w.. omnlit..... F_ 'mated Cost of Proiect:
.....c+. .•+.. f-lna.�'+i., lul�ltor�+inn [,IRnn�ir nrlmm�litinn 1-Stl
L6ther f -- w -
Will the lot be re-graded? ❑Yes PKI01, Will excess fill be removed from premises? ❑Yes 9f46-
PROPERTY INFORMATION
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 ZNo IF YES, PROVIDE A COPY.
[B/Check RDx',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 15 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 buUding(s)for necessary Inspections.False statements made herein are
punishable as a Gass A misdemeanor pursuant to Section 210AS of the New York State Penal Law.
Application Submitted By(print name): 1`� /�S �c/L• M.-Uthorized Agent ❑Owner
Signature of Applicant: Date:
STATE OF NEW YORK)
SS:
COUNTY OF SUVFOA— )
06-C"� being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the Gey r% r—
(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
tx� day of 20 as
of r Public
EVE L.GATZ-SCHWA-MBORN
`:OTAR Y PUBLIC.STATE OF NEW YORK
T �" T ORI I III Registration No.OIGA6274028
.M ........... W Qualified in Suffolk County
(Where the applicant is not the o r) mission(Expires Dec.24,20g��-
Com
� M
residing a
a—kru'o-�il lip. i1r, Z do hereby authorize 1 c(-� to apply on
e„y al, rhe T n of Sou o Ruilding Department for approval as des ibe d rein,
Owners S40ature Date
Print OwnegAame
2
a; BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
Town Hall Annex- 54375 Main Road - PO Box 1179
u
Southold, New York 11971-0959
Telephone (631) 765-1802 - FAX (631) 765-9502
ro err sdutholdtownn o seared southoldtownn . o
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date:
Company Name: „s
Electrician's Name: go
License No.: /vx- 45—of]L Elec. email:
Elec. Phone No: q--7 I'll 1 ❑1 request an email copy of Certificate of Compliance
Elec. Address., J30X 5-1,°4 A.- el-3�
JOB SITE INFORMATION (All Information Required)
Name: G
Address: 71v Z
Cross Street:
Phone No.: S'195'- -7 Ll
Bldg.Permit#: email: vCke' ,—w-, 3
Tax Ma District: 1000 Section: Block: Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
I Square Footage:.
Circle All ThAt Apply:
Is job ready for inspection?: LLj YES NO Rough In El Final
Do you need a Temp Certificate?: YES�O Issued On
Temp Information: (All information required)
Service Size F-11 Ph[]3 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect[]Flood Reconnect❑Service Reconnect❑Underground E]Overhead
#Underground Laterals 1 M2 H Frame Pole Work done on Service? Y N
Additional Information:
PAYMENT DIME WITH APPLICATION
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