HomeMy WebLinkAbout50502-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
i TOWN CLERK'S OFFICE
t 0 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#: 50502 Date: 4/2/2024
Permission is hereby granted to:
Millard, Amo
435 E 57th St A t 4C
New York NY 10022
To: legalize "as built" generator as applied for.
At premises located at:
495 Maple Ln, Orient
SCTM # 473889
Sec/Block/Lot# 17.-2-3.1
Pursuant to application dated 2/22/2024 and approved by the Building Inspector.
To expire on 10/2/2025.
Fees:
AS BUILT-ACCESSORY $250.00
ELECTRIC $200.00
CERTIFICATE OF OCCUPANCY $100.00
Total: $550.00
-A-
Building Inspector
TOWN OF SOUTHO.LD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. 0. ]fox 1179 Southold, NY 11971-0959
Telephone(631)765-1802 Fax (631) 765-9502
Date Received
- E C E g W E
rar Office Use Only ��
PERMIT NO_ �"''� Building Inspector. ✓
Applications and forms must be filled out In their entirety.Incomplete
applications will not be accepted. where the Applicant is not the owner,an �wr #p°� ref
Owner's Authorization form(Page 21 shall he completed.
Date;
OWNER(S)OF PROPERTY:
Name: f� • 04 KA6,14 A TS—CT M
#1000-
Project Address: 01It V
Phone#: 2�Z ' '30% — " 9 I Email:
Mailing Address. . V lD 1 0V "A d.
CONTACT PERSON:
Name: 0 , ,
Mailing Address:
Phone#: Email-
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address: oc
Phone#: Email': (k L Th
CONTRACTOR!INFORMATION:
Name: T' 1
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure DAddition DAlteration Repair Ell em ition Estimated Cost of Project:
00
then ,
Will the lot be re-graded? IOYes to Will excess fill be removed from premises? ❑Yes AND
l
PROPER'"INFORMATION
Existing use of property , Intended use of property: S) t-
1
Zone or use district in which pre ses is situated: Are there any covens is and restrictions xvith respect to
Ll 0
this property? EJYesA10 IF YES, PROVIDE A COPY.
The owner/contractor/design professional is responsible for all drainage and storm water issues as provided!by
chapter 136 of the Town Code. ,APPUCA N 15 HEII SY MP413 to the f uil(Un b for 'lse Issuance and a u ldi g Porrnit pssmuz mt to We s at"na Zone
Ordinance of thew Tbsfiln of Scs6thold,Suffolk,rounty,New York and other applicable laws,ordinances or Regulations,for tlwe constriction of buildings,
addillons,afterations or far removal ov demolition as hersaln dcesrAbcJ.The applicant agrees to comply wills ail applicable laws,ordlaauces,building code,
housing code and regulations and to admit authorized inspectors on premises and in building(s)for necessary inspections.False statements shade herein are
punishable as a Mass A misdemeanor pursuant to Suction 2 AS,of the New York Mate(renal Law.
17
Applicatibn Submitted 13y Print narne): �✓ � �ee'� � sY ❑Authorized Agent Xowner
Signature of Applicarflt � �;; ;, Date: 2
STATE OF NEW Yt RK)
COUNTY OF h{
AM Or W UardA It'd rell-being duly sworn, deposes and says that(s)he is the applicant
(Name of iri ivi'dual signing contract)above named,
( i �? z�_
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
01) day of�� ,2
3 Publi x i !nA �'q
%Btat"ublc,
rp g i `w �.
ilt4lilSy�it ' iw ,yu
w„ f d
cor 4 "gyp '�I ilik
(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
m
2
� 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 southoldtov nn . ov -seand sout,holdtownn , ov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date-,
Company Name.-
Name:
License No.: email:
Address:
Phone No.:
JOB SITE INFORMATION (All Information Required)
Name: A)% ko��'awi
Address: ` C_ 6_4 11�57
Cross Street: VAC,
Phone No.: -LN , 0 3I1
email: a V1,u-( ' v° wd
B1dg.Permit#: O�I� �� �, x
Tax Map District: 10 0 Section: _1 a Block: Z Lot:
BRIEF DESCRIPTION OF WORK(Please Print Clearly)
dt e�
Circle All That Apply:
Is job ready for inspection?: AYES NO Rough In final
Do you need a Temp Certificate?: YES 'O Issued On
Temp Information: (AII information required)
Service Size 1 Ph 3 Ph Size: A #Meters Old Meter#
New Service- Fire Reconnect- Flood Reconnect-Service Reconnected-Underground -Overhead
# Underground Laterals 1 2 H Frame Pole Work done on Service? Y N
Additional Information,
PAYMENT DICE"I I,TH�APPL�ICAT�IQN
Request for Inspection FornI
' SURVEY OF PROPERTY
AT ORIENT
TOWN OF SOUTHOL.D
SUFFOLK COUNTY, N.Y.
1000-17-�2-�?1
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