HomeMy WebLinkAbout50528-Z -. TOWN OF SOUTHOLD
" BUILDING DEPARTMENT
VIPTOWN CLERK'S OFFICE
F 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#: 50528 Date: 4/9/2024
Permission is hereby granted to:.
5350 CR 48 LLC
c/o Gary Doroski
PO BOX 781
Cutcho ue, NY 11935
To install EV charger as applied for. Vehicle protection must be installed.
At premises located at:
5350 CR 48, Mattituck
SCTM # 473889
Sec/Block/Lot# 140.-2-15
Pursuant to application dated 3/1/2024 and approved by the Building Inspector.
To expire on 10/9/2025.
Fees:
ELECTRIC $100.00
ACCESSORY $125.00
CERTIFICATE OF OCCUPANCY $100.00
Total: $325.00
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
ge
Telephone (631) 765-1802 Fax(631) 765-9502 h"s-//www.southoldtomM. ov
Date Received
APPLICATION FOR BUILDING PERMIT
E C E Q V E
For Office Use Only
M�k
PERMIT N0. Building Inspectors i MAR L)
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant k not the owner,an .W
Owner's Authorl ation form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name:Gary Doroski SUM#1000- �rj
Project Address:5170 Route 48 Mattituck NY 11952
Phone#:631-298-4588 Email:
Mailing Address:PO Box 781 Cutchogue NY 11935
CONTACT PERSON:
Name:Benjamin Doroski
Mailing Address:PO Box 1698 Mattituck NY 11952
Phone#:631-298-4588 Email:CLOS5170@gmail.com
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Erf4ail:
CONTRACTOR INIFI TION:
Name:CLOS, Inc
Mailing Address:PO Box 1698 Mattituck NY 11952
Phone#:631-298-4588 Email:CLOS5170@gmail.com
DESCRIP11ON OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
00therEV Charger 1600
Will the lot be re-graded? ❑Yes ]No Will excess fill be removed from premises? ❑Yes 6c7 No
1
PROP'ERIY INFORMATION
Existing use of property:Commerical Intended use of property:Commercial .
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 Reading-. 'The ownericantiractor/destp profealonal is responstl a for all dralrap and slum slumwater Issuesas provkled by
chapter 2M of the Town d'*,APPLICATION IS itN:RESY MADE to the Building Department for the Issuance of a iialMdinq f POWMIt pursuant to the Smildt"ll Zrxne
Ordinance of the Town of Southold,folk,l raarrtY,Now York and anther Vpllcahle laws,ordinances orRept;ulathani6 frrr thasranstrrrction of builadin
addtleana,afterations at for rerruont or,demon as heraln described.'The applicant sgr s,to comply width ail appitcabie laws,rtrdhaarauesa,4ull41 O*,
hauwsimd code and-mpbdatwns and to admit authortted Inspectors an prenikes and In haul kiln; sl for netemry Inspection&False sUftmonts Me&hweini am
pu nhha ale as a Ow Aw mIsd emeanor pursuant to Section210.45 of the Now'York State Penal Law.
Application Submitted By(print mgtitil .Benjamin Doroski NAuthorized Agent ❑Owner
Signature of Applicant: Date:
._. CONNIE D.13UNCH
Notary Public,Skate of New York.
STATE OF NEW YORK) Qualified
�B6 Suffolk County
COUNTY OF
SS: !Ca rrrifnlaalon EtfplrORApril 14, �.
)
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
I—6 day of �a-C 1 ,20,a 7 `-�v i `��
Notary Public
PROPERTY ' NER AUTHORIZATION
(Where the applicant is not the owner)
l residing at
do hereby authorize to apply on
rriV behalf to the Town of Southold Buildin Department for approval as described herein,
Owner's Signature Date
Print Owner's Name
2
Lf BUILDING DEPARTMENT- Electrical Inspector
" TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
a Southold, New York 11971-0959
Telephone (631) 765-1802 - FAX (631) 765-9502
amesh southoldtownn .gov - seand.@southoldtownny,.gov
Y M of
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION t�lnformation Required) Date: :2
Company Name: lit 1/.
Electrician's Name: l,4
License No.: -3$b'73 NkE- Elec. email: C S 5V� ®C%-,(4;
Elec. Phone No: &yj c� S t1r9$ ❑I request an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Required)
Name: f. .: � � C 8LLC .
Address: LnV e L f < v. k LtA c c ✓. k eJ9--k
Cross Street: 12 0 P f JA,4 f-(f 7-6t C U
Phone No.: 6 ` ( C9 9 9 q5�&-
Bldg.Permit #: 5v50?9- email:
Tax Map District: 1000 Section: Block: c�;Z Lot: 75
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
�-� C�t � :
Square Footage:
Circle All That Apply:
Is job ready for inspection?: YES F� NO 0 Rough In Final
Do you need a Temp Certificate?: 1:1 YESZNO Issued On
Temp Information: (All information required)
Service Size01 PhF�3 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals 1 FJ2 H Frame Pole Work done on Service? Y N
Additional Information:
PAYMENT DIME WITH APPLICATION
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