HomeMy WebLinkAbout49827-Z TOWN OF SOUTHOLD
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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#: 49827 Date: 10/4/2023
Permission is hereby granted to:
Hall, Thomas
2985 Highland Rd
Cutcho ue NY 11935
To: Legalize as-installed HVAC at existing single family dwelling as applied for.
Additional certification may be required.
At premises located at:
2985 Highland Rd Cutcho ue
SCTM #473889
Sec/Block/Lot# 102.-8-14
Pursuant to application dated 9/20/2023 and approved by the Building Inspector.
To expire on 4/4/2025.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $400.00
CO-RESIDENTIAL $50.00
Total: $450.00
Building Inspector
�sro,r� 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 https://www.southoldtown.ny.gov
0
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. Building Inspector.
ector.
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Date: ,
OINNERS�OF Pt—
Name: �— p f/ SCTM # 1000-
Project Address: g o e"co fC '
Phone#: 7 Email: / Z
Mailing Address: — ?" �"� l ". �
CONTACTPERSON:
Name:
Mailing Address:..
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION;
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structur []Addition ❑Alteration ❑Repai Demoliti n Estimated Cect:.
❑Other G °d✓ L �° s -�'
Will the lot be re-graded? ❑Yesl?No Will excess fill be removed from premises? ❑Yes o
1
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 ❑No 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 Lacers,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): l Cl a-X k1 4-5 �-f/ ❑Authorized Agent ner
Signature of Applicant: Date:
STATE OF NEW YORK) CONNIE D.BUNCH
SS: Notary Public,State of New York
No,41 BU6185050
COUNTY OF ) Qualified in Suffolk County
CornrniSSion Expires April 14,2C)Q�
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 20
c, a01
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
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
Zza";�
�, off qoBUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
a * 4 Telephone (631) 765-1802 - FAX (631) 765-9502
rogerr@southoldtownny.gov - seand @southoldtownn ov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: fZ1 i 2 '
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 Required)
Name:
Address: lYIIVF
Cross Street:
Phone No.: 6 -S
Bld
g.Permit email:
Tax Map District:
1000 Section: Block; Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly);
Square Footage:.
Circle All That Apply:
Is job ready for inspection?: YES [] NO Rough In Final
Do you need a Temp Certificate?: YES �'NO Issued On
Temp Information: (All information required)
Service SizeF]1 Ph 3 Ph Size: A # Meters Old Meter#
❑New service[—]Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals 1 2 0 H Frame Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION