HomeMy WebLinkAbout49939-Z xm TOWN OF SOUTHOLD
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 #: 49939 Date: 10/24/2023
Permission is hereby granted to:
Vassilakos Gregory
189 Bay 31st St
Brooklyn, NY 11214
To: legalize "as built" AC as applied for.
At premises located at:
14370 Soundview Ave Southold
SCTM # 473889
Sec/Block/Lot# 50.-6-1
Pursuant to application dated 10/12/2023 and approved by the Building Inspector.
To expire on 4/24/2025.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $500.00
ELECTRIC $200.00
CERTIFICATE OF OCCUPANCY $100.00
Total: $800.00
Building Inspector
coax ' 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 l�tlla � v cll;[ a�1lt ��m .� o :.
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO, Building Inspector
0(,.�. _..
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Applications and forms mustb"e filled out, 11
thelrenti�ety Incorriplete
applications will not be accepted,. Where the Applicant is,not,the owner,,an
Owner's Authorization form(Page 2)shall be,complete"d. ;
Date:10/3/23
a .
OWNER(S) OF PROPERTY:
Name:Kristen Musial A�M# 00- 50 — (, — )
Project Address:14370 Soundview Ave Southold NY 11971
Phone#:9172994753 =maiikkristen.musiall7@gmail.com
Mailing Address:189 Bay 31 st Brooklyn NY 11214
CONTACT PERSON:
Name:Kristen Musial
Mailing Address:189 Bay 31 st Brooklyn NY 11214
Phone#:9172994753 Email:Kristen.musial17@gmail.com
DESIGN PROFESSIONAL INFORMATO
N
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION: °
Name:
Mailing Address;
Phone#; Email:.
DESCRIPTION OF PROPOSED CONSTRUCTION
LJ New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
F±1 Other existing AC unit $
Will the lot be re-graded? ❑Yes L6No Will excess fill be removed from premises? ❑Yes 5&No
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PROPERTY INFORMATION'
Existing use of property:Single fam home Intended use of property:Single fam home ome
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.
19 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 HEREBTIVIADE to the-Building oepartment 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,forthe 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): I<Y)'S+C n K u5('a ll ❑Authorized Agent IXOwner
Signature of Applicant:--rkL1-t, Date:
STATE OF NEW YORK)
SS:
COUNTY OF )
Kristen MusialM, _ being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the U. 0 '
(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 J10 er , 20
Notary Pubic
VOULA VIGLIS
N TARY PUBLIC,STATE OF NEW YORK
Registration No.02VI6295623 PROPERTY OWNER AUTHORIZATION
Qualified in Kings County
ommission Expires January 6,2026 (Where the applicant is not the owner)
----------------
I,p residing at
do hereby authorize to apply on
my behalf Lu Lhe Town of Southold Building Department for approval as described herein.
Owner's Signature Date
Print Owner's Name
2
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BUILDING DEPARTMENT- Electrical Inspector
1,4
TOWN OF SOUTHOLD
town Flall Annex - 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
�rfvk 'Telephone (631) 765-1802 - FAX (631) 765-9502
v 116
" ro err southoldtown . ov - seand@southoldtownny.gov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATI NI Information Required) Date;
Company Name: otc �� �� - U
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 Required)
Name: Kristen Musial
Address: 14370 Sou ndview Ave Southold NY 11971
Cross Street:
Phone No.: 9172994753 IA
Bldg.Permit #: email: Kristen.musial17@gmail.com
Tax Map District: 1000 Section: Block: Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
Pr_Tm,A -For exi�tirg A/c uh,'k {ha+ ,was �resev�t
poor -Fv p,�rC�nc�s r ►�o tQS� � Square Footage: " p
Circle All That Apply:
Is job ready for inspection?: Z YES [] NO E]Rough In ElFinal
Do you need a Temp Certificate?: YES R NO Issued On
Temp Information: (All information required)
Service Size Ell Ph F]3 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals 1 1712 H Frame Pole Work done on Service? El Y N
Additional Information:
PAYMENT DUE WITH APPLICATION
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