HomeMy WebLinkAbout50334-Z � t TOWN OF SOUTHOLD
a ' 6 BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
ral'
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 #: 50334 Date: 2/13/2024
Permission is hereby granted to:
Dickinson Fam 2015 Irr Tst
... ................._.____ _
60 Koke Dr
..... --------------—----- ............
Southold, NY 1.. . , mmm.... __ .... .. n.,...
__.
1971
To: Legalize an "as built" HVAC system to an existing single-family dwelling as applied for.
At premises located at:
60 Koke Dr„ Southold
SCTM # 473889
Sec/Block/Lot# 78.-6-14
Pursuant to application dated 1/17/2024 and approved by the Building Inspector.
To expire on ___ 8/1.4/20.2.5.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $500.00
CO - RESIDENTIAL $100.00
ELECTRIC $200.00
Total: $800.00
.......... �.
Building Inspector
rc
TOWN OF SOLITHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 litt s:�/NvNv� ,sogilioldtowru v° iLoi^
Date Received
APPLICATION FOR BUILDING PERMIT
4 P
For Office Use Only
PERMIT NO. Bu Inspector:,- ;,,,
Applications and forms must be filled out in their entirety.incomplete �
appUcatio=wW not be accepted. Where the Appileantis not the owner,an
ow#wes A diaorfiation fmn JP W 2)shafi W Y♦Dp1ewd.
Date: December 22, 2023
OWNER(S)OF PROPE11TY:
Name: Dickinson Fam 2015 Irr78-6-14
SCTM#1000-
Project Address:60 Koke Drive Southold NY 11971
Phone#: Email:
Mailing Address:
CONTACT PERSON:
Name:John KOwal
Mailing Address: 101 W 12th St #4V, NYC NY 10011
Phone #:917-371 -0049 Email:JohnKowal@mac.com
DESK!PROFESSIONAL INFORMATION
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR I114FORIVIA710ft.
Name:
Mailing Address:
Phone#: Email:
MCRIfMON OF PROPOSED CONSTRDCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
[W10ther Installation of central air conditioning $ 12.000.00
7w-illt he lot be re-graded? ❑Yes *No Will excess fill be removed from premises? ❑Yes No
1
PROPERTY MFORMATM
Existing use of property:residential Intended use of property: residential
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
140 this property? ❑Yes *-No IF YES, PROVIDE A COPY.
Check Box After Reading: The nr/d gnprafesslonalLsmsponsmbeeforalldrainapand awater Issues aproWedby
Chaoer 228 of ti�a Terson code. APPL[CAT UM IS HERMY M DE to the Braldlq Departnent for tate issuance of a t3uilding Permit pursuant to the Miding Zone
'dwinean of the Torun of Std,Suffolk county,New York and®Barr aFplieabte Lases,ordinances or Regulations,for the consbuction of buildings,
addlam, tans or for removal or deraol€tianas haste described.The applimat agrees to comptV w th of applicable laws,ordinances,bUMng rale,
housing code and mptatlons and to admit audwriaed hupectars on premise and In bialldWs)for accessary Inspectlons.False statements merle herein are
ponishable as a Class A misderneanor pursuent tia Sectlon 210.45 of the New York State Pe al Lasa.
Application Submitted By(print name):John Koval RAuthorized Agent ❑Owner
Signature of Applicant: . Date: December 22, 2023
STATE OF NEW YORK)
SS:
COUNTY OF
John Kowal being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the contract vendee/agent
(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.
IVEY 1,lTR1' FrDYSON
Sworn before me this NOTARY PUBLIC STATE OF NEW YORK
Registration No 02DY6442790
day ofd 20 Qualified in New York County
_. , .
orrmm 46 WyP'u� i
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
I, OV - LAS s : Gt7c�`�(/ �— residing at 60 1&J k6E 5 'r SO�lW N`
do hereby authorize John Kowal to apply on
my behalf to the Town of Southold Building Department for approval as described herein,.
4 Z4
Owner's Signature Date
Print Owner's Name
2
BUILDING DEPARTMENT-Electrical Inspector
TOWN OFSOUTHOLD
4 Town Hall Annex - 54375 Main Road - PO Box 1179
VV Southold, New York 11971-0959
Telephone (631) 765-1802 - FAX (631) 765-9502
smashYoutholdto+Ann .c oar wand southoldtownn ov
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 Required)
Name: Dickerson Fam Irr 2015
Address: 60 Doke Drive Southold NY 11971
Cross Street: Main Bayview
Phone No.: 917-371 -0049
Bldg.Permit#: 5b b3 email: Johnl oWal9mac.com
Tax Mae District: 1000 Section. 76, Block: 6 Lot: 14
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
installation of central air conditioning
Square Footage:
Circle All That Apply:
Is job ready for inspection?: l YES O NO [—]Rough In Final
Do you need a Temp Certificate'?: El YES 0 NO Issued On
Temp Information: (All information required)
Service Size1 Ph F]3 Ph Size: A # Meters Old Meter#
New Service Fire Reconnect Flood Reconnect Service Reconnect[]Underground❑Overhead
Underground Laterals 1 H Frame Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION