HomeMy WebLinkAbout49137-Z " IFC "
TOWN OF SOUTHOLD
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BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
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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 #: 49137 Date: 4/18/2023
Permission is hereby granted to:
McKa , Scott
150 Blossom Ln
Southold NY 11971
To: install HVAC unit in existing single-family dwelling as applied for.
At premises located at:
150 Blossom Ln, Southold
SCTM #473889
Sec/Block/Lot# 69.-3-10.3
Pursuant to application dated 3/20/2023 and approved by the Building Inspector..
To expire on 10/17/2024.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00
CO-ALTERATION TO DWELLING $50.00
Total: $250.00
Buil ing nspector
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 It1www,sot�il':aaldi,ownn
Date Received
APPLIcAmON FOR BUILDINGPERMIT
For Office Use Only
PERMIT NO. Building Inspector. 2023
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Applications and forms must be filled out in their entirety.IncompleteW0 �01 "�
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date:March 13, 2023
OWNERS)OF PROPERTY:
Name:Maryanne, Kristen and Alex Greeley scTM#1000- b q 3---
Project Address:150 Blossom Lane Southold, N.Y. 11971
Phone#:646-824-5750 Email:maryanne.greeley@gmail.com
Mailing Address:150 Blossom Lane Southold, N.Y. 11971
CONTACT PERSON:
Name:Maryanne Greeley
Mailing Address:150 Blossom Lane Southold, N.Y. 11971
Phone#:646-824-5750 Email:maryanne.greeley@gmail.com
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:Kolb Heating & Cooling
Mailing Address:11500 Old Sound Ave, P.O. Box 106 Mattituck , New York 11952
Phone#:631-298-5527 1 Email:gregory@ kolbmechanic.com
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
ECItherductless HVAC installation ,4100
Will the lot be re-graded? ❑Yes RNo Will excess fill be removed from premises? ❑Yes iiNo
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PROPERTY INFORMATION
Existing use of property:residential Intended use of property:reSidential
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
AC this property? ❑Yes ❑No IF YES, PROVIDE A COPY.
R Check Box After Reading.: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by
Chapter Z36 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.
Maryanne Greeley
Application Submitted By(print name): ❑Authorized Agent I@Owner
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Signature of Applicant: Date: IOW"CL 2-3
STATE OF NEW YORK)
SS:
COUNTY OF 1,6
�� being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)dove 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---3--------., 20 Z
Notary Pub "
SES Gan
Notary PUblic Sm of Now Yofk
U' R ( w
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-Nii 2021
(Where the applicant is not the fmm
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
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