HomeMy WebLinkAbout50885-Z "-
"41 TOWN OF SOUTHOLD
41�` � BUILDING DEPARTMENT
TOWN CLERKS OFFICE
r07
�w 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 #: 50885 Date: 6/27/2024
Permission is hereby granted to:
Rivelli Mario
1435 Hobart Rd
Southold, NY 11971
To: legalize "as built" mini-split unit and alterations to existing accessory garage as applied
for. Additional certification may be required.
At premises located at:
1435 Hobart Rd Southold
SCTM # 473889
Sec/Block/Lot# 64.-2-11
Pursuant to application dated 4/16/2024 and approved by the Building Inspector.
To expire on 12/27/2025.
Fees:
AS BUILT-ACCESSORY $250.00
ELECTRIC $200.00
CERTIFICATE OF OCCUPANCY $100.00
Total: $550.00
Building nspector
e
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959
. x" Telephone (631) 765-1802 Fax (631) 765-9502 htt � ww.soutlEdtovn o ,
Date Received
APPLICATION FOR BUILDING PERMIT rv..
o Y
For Office Use Only
6 Building Inspector:
PERMIT NO. i'i 2024
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 f6rm'(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: SCTM# 1000-
Project Address: 1
Phone#: Email:
Mailing Address: -#GJ ,v
CONTACT PERSON:
Name:
Mailing Address:
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:.
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $__ 3 N
Will the lot be re-graded? ❑Yes ONO Will excess fill be removed from premises? ❑Yes ❑No
1
x t
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 the Town Code. APPIICATION 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 210.45 of the New York State Penal Law.
Application Submitted By(print name): ri )��Ll-� ❑Authorized Agent ❑Owner
Signature of Applicant: 7 P4
STATE OF NEW YORK) CONNIE D.BUNCH
Notary Public,State of New York
SS: No.01 BU6185050
COUNTY OF Qualified in Suffolk County
Commission Expires April 14,2
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
� ..
day of l , 20
Notary Public
OWNERPROPERTY 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
y�7
r fl" i ILDING DEPARTMENT- Electrical Inspector
1
.; P r& 5 2024 T01MN OF SOUTHOLD
cm
r 4 Town Hall Annex - 54375 Main Road - PO Box 1179
� w 7.111:711 a ° Southold, New York 11971-0959
" Telephone (631) 765-1802 - FAX (631) 765-9502
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APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: 2�fP h l
Company Name: ( Z "`1- -
Electrician's Name:
License No.: - Elec. email: �G2 Pic, r
Elec. Phone No: request an email copy of Certificate of Compliance
Elec. Address.: `�
JOB SITE INFORMATION (All Information Required)
Name: A P-1 Z) 41 0
Address: / 3
Cross Street:
Phone No.: l ° g
Bldg.Permit #: email: MN ,vF-z i- (!4 L—Co
Tax Map District:. 1000 Section: (,, Block: W-2- Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAG
E (Please Print Clearly):
Square Footage:
Circle All That Apply:
Is job ready for inspection?: 12ZYES NO Rough In 215inal
Do you need a Temp Certificate?: M YES [�O Issued On
Temp Information: (All information required)
Service Size 1 Ph 3 Ph Size: A # Meters Old Meter#
❑New Service[]Fire Reconnect[—]Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals 1 2 H Frame F1 Pole Work done on Service? Y F1N
Additional Information:
PAYMENT DUE WITH APPLICATION
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Side Elevation As Built Front Elevation As Built Side Elevation As Built Back Elevation As Built
Scale:IIr-1-0• - Sate:118•=1'>0• Scale:W-I*W Scale:14r=Y-B'
314• 2x8'CobrBean
Dmbte rubber
rmfng membrane 2'x B'Refers
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POWER SOURCE 208-23OV� 60Hz 1p
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�FRIGERANT R41�pA�'68oz�
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bsIGN Mi -550 PSIG
PRESSURE Lo 0 f SIG
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CONFORMS TO'
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CERTIFIED TO
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