HomeMy WebLinkAbout50046-Z TOWN OF SOUTHOLD
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BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
60 C
SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLAN'S AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 50046 Date: 11/20/2023
Permission is hereby granted to:
Melly BJ Irry Trt
2555 Youngs Ave 14A
Southold NY 11971
To: construct alterations to existing single-family dwelling as applied for.
At premises located at:
2555 Youngs Ave Unit 14A Southold
SCTM # 473889
Sec/Block/Lot# 63.2-1-43
Pursuant to application dated 11/3/2023 and approved by the Building Inspector,
To expire on 5/21/2025.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $250.00
CO-ALTERATION TO DWELLING $100.00
Total: $350.00
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
Date Received
APPLICATIONF::0R BUILDING PERMIT
For Office Use Only
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PERMIT N0. Building5664_ Ices
ector't
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: f J 2a
OWNER(S)OF PROPERTY:
Name: SCTM# 1000 3; 2. .
Project Address: ZS 5Yb v i k i AVC 8I/1 L-0/'V (IoV 7 4 J O 17JV t�q
Phone#: S,6 — Fr�Z
Email: Sf-C
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Mailing Address: 1,) 1-/e. igcq�-/ 33` 813
CONTACT PERSON:
Name: AN WCSL�
Mailing Address: PO 130( 6Sq S/. 1-L4 -T 5L l 'JO'
Phone#:(6 51) 3 -77 r 2-606 Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name: /11/t 12-1-/AJ C LAW-eL A/ C G C . 1�I le-1 37-9
Mailing Address: 99 C0 uliVk f WOOD D2 S44 N 63
Phone#: G31 160-1 -sJ23� Email: /11 �-Cif//I&C t- ?6
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Add itionlxAlteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $ J16 (V . "0
Will the lot be re-;graded? ❑Yes o Will excess fill be removed from premises? ❑Yes/N�o
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Ago 11,11(CA y-±r1J -41y
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PROPERTY INFORMATION
Existing use of property: SvAgtjA Lyl plug' Intended use of property: s vM M.--C MU!4E-
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 Reed!U"IR: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by
Chapter 236 of the Town Code. APPUCATION 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 210.45 of the New York State Penal Law.
Application Submitted By(print name): DU" f��� Authorized Agent ❑Owner
Signature of Applicant: Date: /I /3/z
STATE OF NEW YORK)
SS:
COUNTY O WeSr
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the t7`'
(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
I
day of 202--3
Notary 13661ke,
ROBERTA MAZZAFERRO
NOTARY PUBLIC-STATE OF NEW YORII
NO. 01 MA6207376
PROPER C kIIIImf C w �� QUALIFIED IN SUFFOLK COUNTY
Where the applicant is not the owner)
( coMMlssloN EXPIRES JUNE 15,20--,;-&
I, JhL, �� � residing at 255-5 Vovwt,s Ave OVlt'01"" IT/4
'c U) fflbo I P do hereby authorize �' '°" Wes ilviz— to apply on
my alf o t e Tow Sout aid' Buildin Department for approval as described er in.
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Owner's Signature to
Prin Owner's Name
i
2
apt BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1802 - FAX (631) 765-9502
ro err so utholdtownn ov — seand southoldtownn ov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All information Required) Date: 1113Z2-3�
Company Name: 14W j"Nc
Electrician's Name: N,11-t i.i H�--r
License No.: 5 q Elec. email: � �,✓2,,�rx IG N Ccin Au(-If 60r
Elec. Phone No: 631 1 request an email copy of Certificate of Compliance
Elec. Address.: I ,1 1A, Sd
JOB SITE INFORMATION (All Information Required)
Name: I 5 L � Ll�
Address: Z5n,5 N(is LTC �U r,r,a L
Cross Street:
Phone No.: L3L 3'IT 2606
Bldg.Permit#: C)q, email: I I ( Pr�L • Cn��l
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
y p NO Issued On
Do you need a Tem Certificate?-. YES
Temp Information: (All information required)
❑
Service SizeEll Ph 3 Ph Size: A # Meters Old Meter#
❑New service[:]Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals 0 1 FJ2 H Frame Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION
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