HomeMy WebLinkAbout50971-Z TOWN OF SOUTHOLD
�t BUILDING DEPARTMENT
P
TOWN CLERK'S OFFICE
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#: 50971 Date: 7/22/2024
Permission is hereby granted to:
Ram Bam Nominee Trt
912 Great Peconic Bay Blvd
Laurel NY 11948
To legalize "as built" mini split unit and window replacements to existing accessory
apartment in accessory garage as applied for.
At premises located at:
912 Great Peconic Bay Blvd, Laurel
SCTM # 473889
Sec/Block/Lot# 145.-2-9
Pursuant to application dated 5/28/2024 and approved by the Building Inspector.
To expire on 1/21/2026.
Fees:
AS BUILT-ACCESSORY $250.00
CERTIFICATE OF OCCUPANCY $100.00
ELECTRIC $200.00
Total: $550.00
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
' Telephone (631) 765-1802 Fax (631) 765-9502 https://www.so,utlloldto �� .g
Date Received
APPLICATION FOR BUILDING PERMIT ed
For Office Use Only s s0 %J
PERMIT NO. 5�q7l_ Building inspectort
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed. "
Date: 2-07-:5 Z
OWNER(S)OF PROPERTY:
Name: ll�� � ' � SCTM# 1000-
Project Address: lZ ♦c(q),ne 1 LI�Q
Phone#: 7� _ r75-- 9 2-11 Email: �P f7f �1 �I! Z C� Maj uk"
Mailing Address: ro F,w 1 of , L..igVJKi L fvtY 1' V$
CONTACT PERSON:
Name. 6 ` 4 f � �z„ ,
Mailing Address: 1&,
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:
NOther 1 ia)OW 3 $ •b
Will the lot be re-graded? ❑Yes PNo Will excess fill be removed from premises? ❑Yes ❑No
1
PROPERTY INFORMATION
Existing use of property: �4 �c � �` Intended use of property: 1-2 )vy),q
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes f2No IF YES, PROVIDE A COPY.
C'heclk 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. 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 Gass A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
Application Submitted By(print name): CH,4 � ��/? ❑Authorized Agent EfOwner
Signature of Applicant: i Date:
STATE OF NEW YORK)
SS:
COUNTY OF f )!�UiK-21 S(j v"Al 5)
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual sig ing contract)above named,
(S)he is the '?WF?0�h A �)In)i V
( �ntract`r,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
� nrrrawarr'
that the work will be performed in the manner set fog t tion file therewith.
Sworn before me this
w'Of tl
day of ,20 "
Notary Public
PROPERTY T RIB TI
(Where the applicant is not the owner)
residing at 7 fl`v,J
Avi.VzL � 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
r* TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
s Southold, New York 11971-0959
�pF Telephone (631) 765-1802 - FAX (631) 765-9502
v
iamesh@,southoldtownny.gov - seand@southoIdtownny.gov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (Ali information Required) Date:
Company Name:
Electrician's Name:
License No.: Elec. email:
Elec. Phone No: ❑I request an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Required)
Name: i Hwo zo ti °
Address: i.-atAv zh.c
Cross Street:
Phone No.:
Bldg.Permit#: S0q1L email i3 �i`r d r rh
Tax Map District: 1000 Section: f q Block: Z Lot: ..
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
MUD e W)✓v6JOWC,
Square Footage:
Circle All That Apply:
Is job ready for inspection?: LJ YES NO Rough In Final
Do you need a Temp Certificate?: YES NO issued On
Temp Information: (All information required)
Service Size 1:11 Ph[:]3 Ph Size: A # Meters Old Meter#
❑New service[:]Fire Reconnect[:]Flood Reconnect❑Service Reconnect❑Underground❑Overhead
#Underground Laterals 1 2 D H Frame 0 Pole Work done on Service? Y j, IN
Additional Information:
PAYMENT DUE WITH APPLICATION