HomeMy WebLinkAbout49507-Z TOWN OF SOUTHOLD
PFFD
BUILDING DEPARTMENT
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 #: 49507 Date: 7/24/2023
Permission is hereby granted to:
Hammel Stephen
16 Voorhis Dr
Old Bethpage,, NY 11804
To: legalize "as built" AC unit as applied for.
At premises located at:
12340 Soundview Ave, Southold
SCTM # 473889
Sec/Block/Lot# 54.-7-7
Pursuant to application dated 6/15/2023 and approved by the Building Inspector.
To expire on 1/22/2025.
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
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
,•`� Telephone(631) 765-1802 Fax(631) 765-9502 littl2s://www.southoldtowntiy,�ov
Date Received
BUILDINGAPPLICATION FOR
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For Office Use Only
�ff�PERMIT NO. Building Inspector. JUN
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an ... :,.
Owner's Authorization form(Page 2)shall be completed.
Date: (y l
OWNER(S)OF PROPERTY:
Name: }n SCTM#1000- 54
--7 —�
Project Addres :
Phone#: �� (� �� Email:SGcJJ "". ✓ C?1�
/ �C /3a
Mailing Address:
CONTACT PERSON:
Name: C.Z YL2 GZ/J y>�
Mailing Address:
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
r ,
Mailing Address: /
Phone#: 3 D /2 Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
New Strocture ❑Addition
❑Alter tion ❑Repair ❑Demolltlorl� Estimated Cost of Project:
Other c = 4 X
Will the lot be re-graded? ❑Yes'u�'No Will excess fill be removed from premises? ❑Yes No
1
PROPERTY INFORMATION
Existing use of property, - ` Intended use of property:
Zone or use district in which pr�mis is situated Are this property?ern ?cT 6' ❑Yesnts and
dIF E ion ith respe 0
C� p p y S, PROVIDE A COPY.
("heck 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 Gass A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
Application Submitted By(print name : 9y M 1boV, �Y/Authorized
Agent ❑Owner
Signature of Applicant: Date: (D S,�>v C 2-O7.3
CONNIE D.BUNCH
STATE OF NEW YORK) Notary Public,State of New York
No. 01 BU6185050
� � Qualified in Suffolk County
COUNTY OF
�) Commission Expires April 14,20a I�/
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
1)day of �� Zti M�
Notary Public
Illi I)IIICIIIIR OWNER I II�"IIU� i' � " I IO_
(Where the applicant is not the owner)
a
I, residing at, C ,
i'"
& do hereby authorize o apply on
r
my behalf to the Town of Southold Building Department forr approval as described herein,
r
O ner's Signature Date
Print Owner's Name
2
BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
Town Hall Annex- 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
Telephone 1
ro err outhcidto nn765ov - seandsoutho town
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APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date:
Company Name:
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 Re uired)
Name: 7
Address: 2`3 4-.1
Cross Street:
Phone No.: . g
Bldg.Permit#: LM50Q email
Tax Map District: 1000 Section: ��� Block: Lo : 7
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
Square Footage:
Circle All That Apply:
Is job ready for inspection?: El YES F-] NO E]Rough In 0, Final
Do you need a Temp Certificate?: FI YES[ NO Issued On
Temp Information: (All information required)
Service Size Ill Ph F]3 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead '.
# Underground Laterals 1 11 H Frame Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION