HomeMy WebLinkAbout49090-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
f 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#: 49090 Date: 4/4/2023
Permission is hereby granted to:
400 Hill Rd LLC
32-15 35th St#D9
Astoria, NY 11106
To: legalize "as built" HVAC system as applied for.
At premises located at:
400 Hill Rd, Southold
SCTM #473889
Sec/Block/Lot# 70.4-36
Pursuant to application dated 3/9/2023 and approved by the Building Inspector.
To expire on 10/3/2024.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $400.00
CO-ALTERATION TO DWELLING $50.00
Total: $450.00
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
01 .4
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone(631) 765-1802 Fax(631) 765-9502 h psnHwww.sou1 oldto nn . 'oar,
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Date Received
BUILDINGAPPLICATION FOR
For Office Use Only
y
PERMIT NO. Building Inspectors m' ;
Applications and forms must be filled out in their entirety.Incomplete d ,IR
applications will not be accepted. Where the Applicant is not the owner,an 0FS0 i' 1()i'd,;
Owner's Authorization form(Page 2)shall be completed.
Date: 'J—Cf` 2-5
OWNER(S)OF PROPERTY: -
Name: '-KBD ( SCTM#1000- 7 D -
Project Address: Biu -v fd
Phone#: �(�S � �� Email �/ gS_��yt'vkVt✓e Q iMC - Qq(VI
Mailing Address:
CONTACT PERSON.
Name: � .. OOY`c_
9 -7
Mailing Address: 51020 8C10
Y� �o[.�d �{�'G1U
10 1
Phone#: -7 5- �J f7 5
(P �' Email- C.1�1�1C�Y� C ti10c�1 .�:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:.
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email
DESCRIPTION OF PROPOSED CONSTRUCTION
Structure ❑Addition ❑A
OthaIteration ❑Re air ❑Demolition Estimated Cost of Project:
r
vv
ziia
Will the lot be re-graded? ❑Yes ao Will excess fill be removed from premises? ❑Yes El No
1
PROPERTY INFORMATION
Existing use of property: Pco U se_ Intended use of property: C U -�_,v0Cj CfZO-kL'4/
Zone or use district in which premises is situated:. Are there any covenawor
d restrictions with respect to
n this property? ❑Yes IF YES, PROVIDE A COPY.
❑ 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(print-name),:, [?�-P uthori ed Agent ❑Owner
Signature of Applicant" .. -- Date:
-------------
STATE OF NEW YORK)
SS:
COUNTY OF SU 1 IC )
lak)c iq C, M DnV-� 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 ljiuc .2o!-3— is b
Notary Public
KYLEE S DEFRESE
NOTARY PUBLIC-STATE OF NEW YO
PROIPERTY OWNERATI No.01DE6420156
(Where the applicant is not the owner) Qualified in Suffolk County
My Commission Expires 0 -02-202
I, rir.eCC, residing at
do hereby authorize ®Y-1 " C. 1111111694hr to apply on
my behalf to the Town of Southold Building Department for approval as described herein,.
Orws Signature Date
ell
x
Print Owner's Name
2
BUILDING DEPARTMENT- Elect fz'a nsp ter'
`� " TOWN OF SOUT O
f7 l
Town Hall Annex - 54375 Main Road - P%gov,
w Southold, New York 11971-0959
Telephone (631) 765-1802 - FAX (631) 765-9502
ro err southoldtownnciov - sea ndsoutholdtt . ov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required)
Date:
Company Name: '
Electrician's Name:
License No.: Elec. email:
Elec. Phone No: ❑1 request an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Requir
Name: ) I`/r � It
Address: 'S, ,
11
Cross Street:
Phone No.:
BIdg.Permit #: email:
Tax Map District:. 1000 Section: Block: Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE. (Please Print Clearly):
-A 6V G6, I T-)
Square Footage:
Circle All That Apply:
Is job ready for inspection?: YES NO []Rough In Final
Do you need a Temp Certificate?: El YES 'NO Issued On
Temp Information: (All information required)
Service Size 1:11 Ph[:]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! I ly N
Additional Information.,
PAYMENT DUE WITH APPLICATION