HomeMy WebLinkAbout50869-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
u TOWN CLERK'S OFFICE
SOUTHOLD, NY
r
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#: 50869 Date: 6/26/2024
Permission is hereby granted to:
Anthony, Robert
444 E 82nd St Apt 21 F
New York, NY 100285909
To: legalize "as built" EV charger as applied for.
At premises located at:
Equestrian Ave, Fishers Island
SCTM #473889
Sec/Block/Lot# 9.-9-26.1
Pursuant to application dated 5/3/2024 and approved by the Building Inspector.
To expire on 12/26/2025.
Fees:
AS BUILT-ACCESSORY $250.00
ELECTRIC $200.00
CERTIFICATE OF OCCUPANCY $100.00
Total: $550.00
4
Building Inspector
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 h tt s:/1www. utho dtow na o
Date Received ,
APPLICATION FOR BUILDING PERMIT
� I
For 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
-
Owners Authorization form JPage 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: r ir SCTM#1000-
q ;�(p
Project Address: CdS }ti-iccc� r u -end 06 9 F d
Phone#: �_7 � `�C Email P0.V� .e, i 0
Mailing Address: Z&0 ` -- 6-ba i,19 q4Z TILel.69,10109390
CONTACT PERSON;
Name: L
Mailing Address„ 1.
r10
Phone#: �03��-? 7G�� Email:
DESIGN PROFESSIONAL INFORMATION:
Name: '
Mailing Address: h Lt l% 6 6 2E.0
Phone#: 6 3I'`?.5-r-?q/ Email:
CONTRACTOR INFORMATION:
Name: VL
Mailing Address: I
Phone#: (�'3���� 7 Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
p ted Cost of Project:
❑New Structure ❑Addition ❑Alteration ❑Re air ❑Demolition Estimated
❑Other
Will the lot be re-graded? ❑Yes Will excess fill be removed from premises? ❑YeslQ
1
PROPERTY INFORMATION
Existing use of property: , Intended use of property: 0
11,47'S.(&LUL L�--1 Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes ry IF YES, PROVIDE A COPY.
e k Box After Reading: The [owner/contractor/design professional Is responsible for all drainage and storm water issues as provided by
ptpr 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 210As of the New York State Penal law.
Application Submitted By(print name): Aacd A, ve9q CfAuthorized Agent ❑Owner
Signature of Applicant: , Date:
STATE OF NEW YORK)
Atu
:
COUNTY OF I IC )
,�,PU being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named, /�
(S)he is the � � Kt! GL Con Z�e�G' oY
(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 � �„r1404,10
,.. ,
day of JASOI I Wdt'd "Public
Qi i'iipA:�in Su,triCc crr2rarRly/ "" +�,
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�t u,y i'aulallc �t�te of Neriv Ybrk,, +
i+(0 01t,)'63504i4 =M
cs Nora nbpi 07,2024 � sw 1�
PROPERTY OWNER AI�T'I�C� ( Acid-I� ; C) .a.
F� .
(Where the applicant is not the owner)
��ar,mrw�wb
I, residing at
do hereby authorizer to apply on
my behalf' o the Town of Southold Building Department for approval as described herein.
µ�
� -
Cfwner's Signature Date
Cj�n
Print Owner's Name
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
µ iam,esh@southoldtownny.gov— seand@southoldtownny.gov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: 4/30/2024
Company Name: BD Remodeling and Restoration
Electrician's Name: Patrick Choquette
License No.: ME-64662 Elec. email:pat@bdrrusa.com
Elec. Phone No: 631-788-7919 [DI request an email copy of Certificate of Compliance
Elec. Address.: 1420 The Gloaming 447 Fishers Island NY 06390
JOB SITE INFORMATION (All Information Required)
Name: Robert W. Anthony
Address: 3913 Equestfllan Ave
Cross Street: East Main Rd
Phone No.: 631-788-7919
Bldg.Permit#: email:pat@bdrrusa.com
Tax Mae District: 1000 Section:9 Block: 9 Lot:26.1
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
Install wiring for owner supplied EV Car Charger on exterior of garage/shed
Square Footage:
Circle All That Apply.
Is job ready for inspection?: YES❑ NO [ Rough In 1:1 Final
Do you need a Temp Certificate?: 11 YES NO Issued On
Temp Information: (All information required)
Service Size1 Ph❑3 Ph Size: 200 A # Meters 1 Old Meter#
❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead
#Underground Laterals Z 1 n2 H Frame Pole Work done on Service? Y ✓N
Additional Information:
PAYMENT DUE WITH APPLICATION
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