HomeMy WebLinkAbout49019-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
"o � 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#: 49019 Date: 3/13/2023
Permission is hereby granted to:
Dorman Mary
306 W 19th St Ste 902
New York, NY 10011
To: install generator as applied for.
At premises located at:
300 Cedar Birch Rd, Orient
SCTM # 473889
Sec/Block/Lot# 15.-8-25
Pursuant to application dated 3/6/2023 and approved by the Building Inspector,.
To expire on 9/11/2024.
Fees:
ACCESSORY $100.00
ELECTRIC $85.00
CERTIFICATE OF OCCUPANCY $50.00
Total: $235.00
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 htC s l/°www.south ldtown o
44,
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMITNO. Building Inspector,
Applications and forms must be filled out in their entirety.Incomplete I!,,.tbiNG p)E-1�P+
applications will not be accepted. Where the Applicant is not the owner,an GWN OFS0011-40k-[l
Owners Authorization form(Page 2)shall be completed.
Date:2/24/2023
OWNER(S)OF PROPERTY:
Name:Mary D. Dorman SCTM#1000-15-08-25
Project Address:300 Cedar Birch Lane, Orient, NY 11957
Phone#:917-805-6139 Email:maryddorman@gmail.com
Mailing Address:
CONTACT PERSON:
Name: See above
Mailing Address:
Phone#: Eaail:
DESIGN PROFESSIONAL INFORMATION:
Name:see above
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:Peconic Power Systems
Mailing Address:POBox 512, Cutcogue, NY 11935
Phone#:631-734-5026 Email:peconicpowersys@gmail.com
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other generator installation $ !0,500
Will the lot be re-graded? ❑Yes WNo Will excess fill be removed from premises? ❑Yes WNo
1
PROPERTY INFORMATION
Existing use of property:reSldentlal Intended use of property:no Change
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes ltw o IF YES, PROVIDE A COPY.
ig Check Box 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 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,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 building(s)for necessary inspections.False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 210AS of the New York State Penal Law.
Application Submitted By Tint name Dorman ❑Authorized Agent IROWner
Signature of Applicant: Date: W-73
STATE OF NEW YORK)
SS:
COUNTY OF Suffolk
Mary D. Dorman being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the Owner
(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 thkrewith
Sworn before me this
I / day of Q 20 �3
c
DIANAFRANIQ:
NOTARY PUBLIC,STATE OF NEW YORK
Registration No.05FA6288M
PROPERTY OWNER AUTHORIZATION Clualft in Suffolk County
(Where the applicant is not the owner) my Wwriber0%M=
I, 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
BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
o- Town Hall Annex- 54375 Main Road - PO Box 1179
P Southold, New York 11971-0959
y,, Telephone (631) 765-1802 - FAX (631) 765-9502
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ro err souths ldtow n . ov seand southoldtownny ov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: 31.3
Company Name: Oc
Electrician's Name: fo
License No.: AA s Sb �, Elec. email:
Elec. Phone No: I }q- 1 q I ❑I request an email copy of bertifkate of Compliance
Elec. Address.: - ) 3ax b �
JOB SITE INFORMATION (All Information Required)
Name:
Address: 3 co 0n- AA) I10 -7
Cross Street:
Phone No.: r 7 - q - 6 t
Bldg.Permit#: O email:
Tax flap District: 1000 Section: Block: Lo : `"
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
Square Foota e:
Circle All That Apply:.
Is job ready for inspection?: YES O LJ Rough In Final
Do you need a Temp Certificate?: YES R-NO Issued On
Temp Information: (All information required)
Service Size 1 Ph F]3 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead
Underground Laterals 1 2 H Frame Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION
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