HomeMy WebLinkAbout50654-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
f TOWN CLERK'S OFFICE
� r 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 #: 50654 Date: 5/10/2024
Permission is hereby granted to:
Tully, Carolyn
PO BOX 49
...._. ........ ............�.....
East Marion,.NY 11939
To: Legalize an "as built" hvac system and "as built" outdoor shower additions to an
existing single-family dwelling as applied for.
At premises located at:
rd Rd, East Marion
2255 Old.Orcha..._...... ... .... ............ . ......_. ................._ ............. ... ...... ....
3889
T........ 4 .... ........ _....._ _._..... . ._....
Sec/Block/Lot# 37.-3-2.1
Pursuant to application dated 3/28/2024 and approved by the Building Inspector.
To exire on 1 p' /2025.
. .
..1./.9................... .........
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $500.00
CO-ADDITION TO DWELLING $100.00
ELECTRIC $200.00
....................
Total: $800.00
�._.............._ry.ry .. ......_.v _..._.._... ..._..._.....
.
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959
0 9 Telephone (631) 765-1802 Fax (631) 765- 52 L //iqp5; w\Mw.sqqthld oto\yipy g
gv
;01 -
Date Received
APPLICATION FOR BUILDING PERMIT
V"
For Office Use Only
PERMIT NO. Lf Building lnspectoro-...... O `)(19
'J -1........ kIAR' 21� J(A
A ir0ty'.,Incomp
pplitatiphs'and forms must be out In the!reht
ls'ndt
applications wi not be accepted: e tho'A e owner,an
'PP Icant
6404's'"Atit"h'b' diza f/ion farm{Page 24"i'lla fit,bo/cd'i nP(0ed/'."
Date:
,OWNERS)OF PROPERTY:1
Name: SCTM`#1600- 39 2. 1
-i"n 11 e, M- b/rhi)" —
Project Address: 4�2 rr LIV 41a Lall YL-c—, ftkxlc/ji
Phone#:, Email:
Mailing Address: ?lot go)( 104- MkIrt6n,
CONTACT PERSON:
Name: I rhd IkJ�f
Mailing Address: E� /P 4
L
Phone#: 5-3q Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#:
CONTRACTOR INFORMATION:
Name:
Mailing Address;
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
[JNPwStructure D- Addition [--]Alteration E]Repair ElDemolition Estimated Cost of Project:
VOther—jtL (b(A-141[k $
Will the lot be re-graded? E]Yes D No Will excess fill be removed from premises? DYes El No
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 []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,fhe,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,Counter,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 bulldin$js)for necessary Inspections.False statements made herein are
punishable'as a class'Armisdemeanor pursuant to Section 21o.45 of the New York State;Penal Law.
Application Submitted By(print name): f�1'�/Le // � ❑Authorized Agent �ner
Signature of Applicant: Date: as a p
CONNIE D.BUNCH
Notary Public,State of New York
STATE OF NEW YORK) No.01BU6185050
Qualified In Suffolk County
COUNTY OF- ) Commission Expires April 14,2 T-�QL`I
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
,� p ��^^ a
D � dayGUI,ff of Cl I:_......--.. __._ A 20 c)
Notary Public
PROPERTY OWNER AUTHORIZATION
(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
2
BUILDING DEPARTMENT- Electrical Inspector
, TOWN OF SOUTHOLD
F'`
Town Hall Annex - 54375 Main Road - PO Box 1179
' Southold, New York 11971-0959
Telephone (631) 765-1802 - FAX (631) 765-9502
°amesh southoldtown ny.gov - seand southoldtownn . ov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: - -2
Company Name: '
Electrician's Name:
License No.: Elec. email:
Elec. Phone No: ❑1 request an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Required)
Name: { 2 1 �r�� l
Address:
Cross Street:
Phone No.: 7, � - ...
Bldg.Permit #: 5 email:
Tax Map District: 1000 Section. 9 Block: Lot: f
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
Le aj I - `e U. Square Footage:
Circle AII That Apply:
Is job ready for inspection?: El YES F NO E]Rough In Final
Do you need a Temp Certificate?: YES r-] NO Issued On
Temp Information: (All information required)
Service Size Ell Ph[]3 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals 0 1 2 H Frame D Pole Work done on Service? Y nN
Additional Information:
PAYMENT DUE WITH APPLICATION
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