HomeMy WebLinkAbout50333-Z - TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
VI 11� '" 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#: 50333 Date: 2/12/2024
Permission is hereby granted to:
Graves, Jason
550 Fasbender Ave
Peconic, NY 11958
To: legalize "as built" hot tub as applied for.
At premises located at:
555 Fasbender Ave, Peconic
SCTM # 473889
Sec/Block/Lot# 67.-6-4.1
Pursuant to application dated 1/11/2024 and approved by the Building Inspector.
To expire on 8/13/2025.
Fees:
AS BUILT- SWIMMING POOL $600.00
CO- SWIMMING POOL $100.00
Total: $700.00
Building Inspector
in
^ � 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 littps://www.southoldtowliliv.go�
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only 8
PERMIT NO. Building Inspector- A
Applications and forms must be filled out in their entirety.Incomplete "1 •.,
applications willnot be accepted,. Where the Applicant is not"the owner,an,
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: MQ+ AsorJ SCTM#1000-
Project Address: S S �.. I^
Phone#: SSC S Email: u"VJrj�j�
Mailing Address;
Ok 0?� J'sVXV)*" C*J
CONTACT PERSON:
Name., +, Il
Mailing Address: ' e 1i9 w s
Phone#: ,5Vo: . &-q— SGG Email:,
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address::
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New tru re ❑Addition ❑Alteration a ail•' []Die litio Estimated Cost of Project:
p i $
Will the lot be re-graded? El Yes ❑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 premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes El 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 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 230AS of the New York State Penal Law.
Application Submitted By(print name):, � �f Ault riled 4gent 2
Signature of Applicant: - Date: ii 0
CONNIE®.BUNCH
STATE OF NEW YORK) Notary Public,State of New York
SS: No.01 BU6185050
) Qualified In Suffolk County
Commission Expires April 14,
COUNTY OF �
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
t C1
A)day of�1� U 20" x
Notary Public
AUTHORIZATIONPROPERTY OWNER
(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.
Owners Signature Date
Print Owner's Name
2
�gl`Wjt BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
Town Hall Annex- 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
ip
Telephone (631) 765-1802 - FAX (631) 765-9502
„,.
lamesh@southoldtownny.gov - seand southoldtownn . ov
APPLICATION FOR ELECTRICAL. INSPECTION
ELECTRICIAN INFORMATi ION (AII information Required) Date:
Company Name: CG31)+� C wle LL
Electrician's Name; YL 0
License No.: -I- Q-IS tA FElec. email: kA9 e Ntil ['a^-
Elec. Phone No: ❑I request an email copy bf Certificate of Compliance
Elec. Address.: -+ C ry
JOB SITE INFORMATION (All Information Required)
Name: (4 r
Address: C,
Cross Street:
Phone No.:
Bldg.Permit#: email:
Tax Map District: 1000 Section: Block: Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly).
Wt!;T 5 �[+
Square Footage:
Circle All That Apply:
Is job ready for inspection?: YES NO [:]Rough In Final
Do you need a Temp Certificate?: YES F-] NO Issued On
"Temp Information: (All information required)
Service Size F-11 Ph F]3 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect[]Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals 1 2 H Frame Pole Work done on Service? Y DN
Additional Information:
PAYMENT DUE WITH APPLICATION
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